Endometriosis and Period Pain

What is period pain?

Period pain, also called dysmenorrhoea, is cramping or pelvic pain that happens before or during a period. Mild cramps can be common, but pain that stops you from going about life as usual (eg work, school, social activities or sleep) should be discussed with a doctor. Period pain can be ‘primary’, meaning it occurs without another diagnosed pelvic condition, or ‘secondary’, meaning it is linked to another cause such as endometriosis, adenomyosis, fibroids, pelvic inflammatory disease or other pelvic conditions.

What is endometriosis?

Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows outside of it, most commonly in the pelvis. These lesions can contribute to inflammation, scarring, adhesions and pain. Symptoms vary widely, and the amount of pain does not always match the stage or visible extent of disease. Endometriosis can affect periods, pelvic pain, bowel and bladder symptoms, sex, fertility, energy, mood and quality of life. Some people have severe symptoms, while others may have few or no symptoms.

Key statistics

• Around 1 in 7 Australian women born in 1973–78 had been diagnosed with endometriosis by age 44–49.
• Endometriosis affects an estimated 10% of reproductive-age women and girls worldwide, around 190 million people.
• Australian research has reported an average delay of around 7 to 12 years between first symptoms and diagnosis.
• Endometriosis-related pain can have a major impact on daily life, work, study, relationships, mental health and fertility.

What symptoms should I look out for?

Symptoms can be different for everyone and may change over time. Common symptoms include:

• Severe period pain or cramps, especially pain that disrupts normal activities.
• Pelvic, lower abdominal, lower back or leg pain before, during or after a period.
• Pain during or after sex.
• Pain with bowel motions or urination, especially around your period.
• Heavy bleeding, irregular bleeding, bloating, nausea or fatigue.
• Difficulty becoming pregnant.

You should seek medical advice if period pain is severe, getting worse, not helped by usual pain relief, associated with fainting or vomiting, or affecting your ability to function.

How is endometriosis diagnosed?

Start with your GP. They will usually ask about your symptoms, menstrual cycle, pain pattern, medications, sexual health, bowel and bladder symptoms, fertility goals and family history. A pelvic examination may be offered where appropriate, but a normal examination does not rule out endometriosis.

Ultrasound or MRI may help detect ovarian endometriomas or deep endometriosis, but imaging can miss superficial disease. Laparoscopy with biopsy has traditionally been used to confirm endometriosis, but current guidance recognises that diagnosis and early management may begin based on symptoms, examination and imaging, with referral if symptoms are severe, persistent or not responding to initial care.

Information to share with your GP

• When your pain happens in your cycle, how severe it is, and how long it lasts.
• How symptoms affect school, work, exercise, sex, sleep, mood and daily activities.
• All medicines, supplements and therapies you use, including how often and whether they help.
• Bowel, bladder, bloating, fatigue, bleeding or fertility concerns.
• Past scans, surgery, family history of endometriosis, and your treatment goals.

What can help manage period pain?

• Track symptoms: Use a period and pain diary to record bleeding, pain location and severity, bowel or bladder symptoms, fatigue, sleep, triggers, medication use and what helps.
• Heat and comfort measures: Heat packs, warm baths, gentle stretching and rest may help reduce cramps and muscle tension.
• Movement and pacing: Low-impact activity such as walking, stretching, yoga or swimming may support general wellbeing. On flare days, pacing and gentle movement may be more realistic than pushing through pain.
• Anti-inflammatory pain relief: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help some people when taken early in the pain cycle, but they are not suitable for everyone. Ask a doctor or pharmacist if you have asthma, stomach ulcers, kidney disease, are on blood thinners, are pregnant, or have other medical conditions.
• Sleep, stress and mental health: Chronic pain can affect sleep, mood and anxiety. Relaxation, mindfulness, counselling, psychology support or pain-management strategies can be useful parts of a wider plan.

What treatment options are available?

There is no single ‘best’ treatment for everyone. Management is usually personalised and may combine medical, surgical and allied health approaches.

• Medicines for pain: Paracetamol and/or NSAIDs may be used for symptom relief, although endometriosis pain often needs a broader plan if symptoms continue.
• Hormonal treatments: Options such as the combined oral contraceptive pill, progestogen tablets, injections, implants or hormonal IUD may reduce or suppress periods and help reduce endometriosis-associated pain. Specialist medicines that suppress ovarian hormone activity may be considered for some people under specialist care.
• Surgery: Laparoscopic surgery may be used to diagnose and remove endometriosis lesions, particularly when symptoms are severe, imaging suggests more complex disease, fertility is affected, or other treatments have not helped. Surgery can improve symptoms for many people but is not always a cure, and symptoms can recur.
• Allied health support: Pelvic floor physiotherapy, psychology, dietitian support, sexual health care and pain specialists may help manage pain, pelvic floor dysfunction, fatigue, bowel symptoms, mental health and quality of life.

Written by Teledocs

Teledocs Clinic is an Australian alternative healthcare clinic providing telehealth consultations with AHPRA-registered practitioners.

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