Endometriosis, painful periods, hysterectomy and other possible treatments
/Read my friend’s heart breaking story of a lifetime of misunderstood and crippling endometriosis pain and how she finally got relief at 41 with a hysterectomy. This blog talks about painful periods, their possible causes and the treatment options available.
“I've always had incredibly painful periods, right from my very first one. I remember always feeling dizzy and faint as well as being in so much pain across my back and abdomen. It was like I had hot pokers attacking me from the insides - the pain was unreal!
“It was like I had hot pokers attacking me from the insides - the pain was unreal! I also remember the doctors never really took my pain seriously.”
I also remember the doctors never really took my pain seriously. But even with strong pain killers I would feel like I'd been run over by a truck. I'd be in so much pain, and feel so dizzy and tired, that I could hardly function. For a while, I took the contraceptive pill and that helped, but after a few years I started to get migraines from the pill as well.
“Things improved briefly when I had my children, but after I’d finished all my pregnancies and stopped breastfeeding, the pain escalated.”
Things improved briefly when I had my children, but after I'd finished all my pregnancies and stopped breastfeeding, the pain escalated. My periods were so ridiculously heavy that I basically had to stay house-bound for day 1 and 2 of my periods - not even a maxi pad could absorb it fast enough and I was always embarrassed that blood might seep through to my clothing when out in public!
I sought treatment from a gynaecologist at this stage, but the only solution offered was to get the Mirena IUD. I was desperate and tried it, but even though the Mirena only has a low-dose of synthetic hormones, I was one of the small percentage of patients who reacted badly with headaches and weight gain. So I had it removed, and went back to treating myself with strong pain killers.
I got a second opinion from a gynaecologist who specialised in Endometriosis. After some tests, the doctor confirmed I did indeed have a pretty bad case of Endo - I'd probably always had it! Given I hadn't tolerated the Mirena, and I'd finished having children, she suggested having a hysterectomy. I had just the uterus out, leaving the ovaries in so that I didn't go straight into menopause. The surgery has been a huge success. Since recovering from that, I have never felt so good! Pain-free, and also my energy levels are amazing! (No more iron deficiency I guess?)
“I have never felt so good! Pain-free, and also my energy levels are amazing! It’s been life changing for me!”
Looking back, I feel like I wasted a lot of my life, as basically a week out of every month I was incapable of doing anything at all thanks to the pain, dizziness and lethargy. Obviously, a hysterectomy isn't a viable option for all women suffering from endometriosis, but if you've finished having kids and you're a decade or so away from menopause like I was, then I reckon it's worth considering. It's been life changing for me!"
Thankfully a generation on, we have learnt a lot about Endometriosis and GPs, gynaecologists and Women’s Health Physiotherapists can recognise the signs much earlier and direct you to the right treatments for relief. Read below for more information.
What is a normal level of period pain?
Period pain is only there for the first day or two
It goes away with the contraceptive pill or period pain medications
If you have not had a baby yet you would expect period pain (1).
“Endometriosis lesions in your pelvis can cause pain leading up to your period and last the whole length of your period. ”
If your period pain doesn’t sound normal, what could be the cause?
Endometriosis lesions in your pelvis can cause pain leading up to your period and last the whole length of your period. The week after your period should present the least pain (1).
Prostaglandin chemicals are produced in the uterus during your period. Prostaglandin makes the uterus muscles contract which can be painful. The same chemicals are released for uterus contractions during childbirth! Prostaglandin can also give you nausea, fever, diarrhoea or feel faint (1).
Pain from adenomyosis (endometrial layer of uterus breaks through to the muscle layer in the wall of your uterus). This period pain usually develops later in life, in the 30-40s of after having a baby. Periods are heavy as well as painful. A gynaecologist can do an physical exam, ultrasound and order an MRI to confirm the diagnosis (1).
Heavy menstrual bleeding with clots can be another cause of pain (1).
A narrow cervix can block the flow of blood which can be painful because the uterus has to contract more strongly to get the blood out. It is more common in those that have passed menopause or had surgery to their cervix (1).
“Prostaglandin chemicals are produced in the uterus during your period. Prostaglandin makes the uterus muscles contract which can be painful. The same chemicals are released for uterus contractions during childbirth!”
Treatments
There are many options and it is best to discuss these with your GP or gynaecologist so as to ascertain the most likely cause of your pain and thus the best treatment. The best thing is to avoid periods with these potential options:
Anti-prostaglandin medication (eg ibubrufen, naproxen) can help if it is just the prostaglandin release causing the pain and good as the first thing to try (1).
The contraceptive pill can be very helpful for several causes of period pain as you can stop the periods from occurring or minimise the heaviness of them (1).
Mirenas are inserted into the uterus to release localised hormones and are a more effective way of managing period pain than the pill and usually make them lighter or non existant. It can also help pain from endometriosis that is located behind the uterus near the bowel (1).
There are other medication options to stop periods and help pain so ask your GP or gynaecologist about these.
If these treatments don’t help, you may have endometriosis so talk to a gynaecologist experienced in laparoscopy, surgery to remove the endometriosis (1). See the previous blog Endometriosis: signs, symptoms and treatment options and Endometriosis and painful sex for more information about this.
Hysterectomy is an operation to remove the uterus. It treats uterus and period pain very well as well as women with adenomyosis or fibroids. However, it does not treat pain from endometriosis elsewhere, but this can often be removed during the hysterectomy too. This is obviously not an option for young women or women who have not finished having children yet. Many women find this to be a great relief after having had period pain for their whole life. (1)
Summary
There are several causes for painful periods.
Depending on the cause there are several treatments to ease your pain.
Asking for help early could save you from a life time of pain like my poor friend experienced.
References
Evans, S (2010) Endometriosis and pelvic pain. Adelaide. Dr Susan F Evans Pty Ltd.
Melli Tilbrook is a Physiotherapist at Adelaide Physiotherapy and Pilates Studio, Beulah Park
