Is Period Pain a Sign of a More Serious Problem?

Ann Peters, M.D., MS, is a board certified gynecologist and surgeon with The Gynecology Center at Mercy. Dr. Peters is specially trained in the care of gynecologic diagnoses, focusing on the evaluation and treatment of a wide range conditions including endometriosis, chronic pelvic pain, post-menopausal or uterine bleeding, and fibroids. She responded to questions from Health Digest concerning how women can tell if their period pain is normal or reflects a more serious problem.

How can you tell if your period pain is something more serious?

There are many signs that can sometimes indicate when a period is more serious. Generally speaking, when women experience persistent pain with their cycle that is not controlled with ibuprofen and continue to have cramping pain, this could indicate a more serious problem. If women have to use heating pads on a consistent basis or have to miss work or school this is also an indication that their cycles are more severe than what would be considered normal. Naturally pain can be very subjective, but if women cannot perform their usual daily activities when they are on their cycle or are limited because of too much pain, they should contact their gynecologist.

There are different gynecologic problems that could indicate a problem when women experience severe menstrual pains. This includes a possible diagnoses of endometriosis, fibroids or adenomyosis. These are the three most common causes of severe menstrual pain.

What other signs could there be?

It depends on what is causing the pain. For example patients with endometriosis will often have other symptoms such as chronic fatigue, intestinal symptoms like diarrhea, constipation, or painful bowel movements that may have been labeled as IBS. Sometimes they also experience urinary frequency and pain with sex. Heavy bleeding may also be a symptom. This symptom can also overlap with adenomyosis and fibroids diagnoses. Fibroids will more commonly present with heavy bleeding and clotting as well as symptoms such as pressure, heaviness, constipation or urinary frequency because the increased size of the uterus will press on the surrounding organs in the pelvis. Adenomyosis will present following pregnancy and often is associated with severe cramping, heavy clotting and bleeding. Women sometimes feel as if they were in labor and often have lower back pain.

What complications can these signs lead to?

Endometriosis is the most significant condition because it can lead to infertility if left untreated. It can do so due to inflammatory changes or it can sometimes physically damage the ovaries and the fallopian tubes. It is one of the leading causes of unexplained infertility in women with painful periods. Endometriosis can also lead to significant scar tissue formation between the uterus, ovaries and surrounding structures such as the bladder and the intestines. Fibroids and adenomyosis can lead to anemia and other complications because of heavy blood loss. Some women may even require iron infusions or blood transfusions to manage their symptoms.

Can pain medications help? Why or why not?

Pain medications such as ibuprofen and Tylenol can be helpful in terms of managing the symptoms. However a lot of gynecologic diseases can often progress and at some point women often feel that over-the-counter medications are no longer effective. At this point either surgical intervention or hormonal medication intervention with birth control options is considered for the management of the gynecologic condition that cause pain.

What treatment options are there?

Treatment depends in part on what disease and the severity of it is causing the symptoms. Severe cases of endometriosis generally require surgical intervention. Less severe cases can often successfully be managed with birth control options.

Fibroids and associated bleeding can also be managed with hormonal birth control options, but when patients are experiencing more significant symptoms such as the previously mentioned bulk symptoms, it often requires surgical intervention to either remove fibroids or the uterus if women are done with fertility. All treatments are generally geared towards maximizing women's quality of life and this may mean something different for each woman.

Dr. Ann Peters specializes in laparoscopic surgery for the treatment of endometriosis and uterine fibroids, and is actively involved in clinical research and training in gynecologic surgery. Her research accomplishments include publications in several major GYN journals, including the American Journal of Obstetrics and Gynecology and the Journal of Minimally Invasive Gynecology.