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What Causes the Severe Pelvic Pain of Endometriosis?

March 17, 2021

Most women expect discomfort during their monthly menstrual cycle, but severe pelvic pain that lasts for days might be caused by a condition called endometriosis.

Besides pain, endometriosis also might leave a woman unable to conceive without medical intervention. Fortunately, this condition that affects about 3 million American women is generally treatable with medication and/or surgical intervention. March is Endometriosis Awareness Month, and women’s health specialists hope to educate women about the disorder so they can get treatment and improve their quality of life.

“The estimate is that approximately 2 to 10 percent of women in their reproductive years have endometriosis,” said Dr. Linda Matonis, an obstetrician/gynecologist with Starling Physicians, an affiliate of Hartford HealthCare at The Hospital of Central Connecticut. “The exact incidence is unknown because many women have no symptoms, and others do not have a definitive surgical diagnosis because they respond to more conservative treatment.”

Endometriosis, she said, occurs when tissue that normally forms in the lining of the uterus begins to grow outside the uterus, typically affecting the ovaries, fallopian tubes and tissue lining the pelvis. Pain often begins days before the menstrual cycle and becomes increasingly worse during the cycle. Pain may extend from the pelvis to the abdomen and lower back.

“Not everyone experiences the same symptoms but the typical symptom is cyclic pelvic pain,” Dr. Matonis said. “Women with endometriosis experience terrible cramps during the days or week before their period, very painful menstrual cramps and are then pain-free for the week after their period ends.”

More subtle symptoms include deep pain during sex, painful bowel movements or urination, ovarian cysts called endometriomas, or infertility. The latter, Dr. Matonis noted, occurs when endometriosis causes scarring in the abdominal or pelvic cavity.

Help for women with endometriosis comes in various forms, based on the severity of the condition.

It can include:

• Hormonal treatment such as birth control pills or Depo-Provera to suppress the menstrual cycle. Some women take the medication continuously so they do not get a period.
• Surgery, including laparoscopy to remove the endometriosis or a hysterectomy.
• Medication to suppress the hormonal cycle and induce temporary medical menopause.

“There is also a new oral medication — GnRH antagonist — which prevents estrogen production,” Dr. Matonis said. “This works effectively against endometriosis and, therefore, helps with the pain it can cause.”

Endometriosis can also adhere to the wall of the uterus, causing heavy bleeding and/or painful cramps. It’s typically only discovered after the patient has a hysterectomy.

“Endometriosis is a complicated phenomenon,” Dr. Matonis said. “You can have very little endometriosis and have severe pain or you can have a lot of endometriosis and have no pain. The good news is that it does ‘burn out’ after menopause so will stop being a problem when the periods stop.”