Endometriosis: Extreme pain is not normal. Period.

I’m Dr Elise Dallas, a Babylon GP that’s passionate about women’s health and I want all women to know that excruciating periods are not normal. I want every woman who reads this blog and that suffers period-related pain to question - could I actually be suffering from endometriosis?

The truth is, the opportunity for the early management of period problems is often delayed because of period-related stigmas and myths. This often leaves women and girls embarrassed to speak out about period pain or accepting that severe period pain is ‘normal’.

And we’re not talking about small numbers of women here. Roughly 10% of women and girls of reproductive age are affected by endometriosis worldwide¹. Millions of women are so badly affected by the period pain that comes with endometriosis that they regularly need to take days off work or school.

Would you believe that it takes an astonishing average of 7.5 years² to get a diagnosis of endometriosis? And this is why I’m so passionate about empowering women of all ages to raise their concerns openly. Treatment is available, it can improve the quality of your life and very importantly, in the case of endometriosis, reduce the risk of developing long-term consequences of endometriosis going untreated.

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of the womb (called endometrial tissue) grows outside of the womb. This includes places such as the pelvis, ovaries and fallopian tubes.

This tissue is dependent on the same hormones involved in your period. So when the endometrial tissue lining in your womb bleeds during your period - so does endometrial-like tissue located outside the womb.

This bleeding can cause pain, inflammation, scarring and in some cases affect fertility too.³

The symptoms of endometriosis

Typical symptoms include:

• Period pain, which often starts a few days before your period and usually persists through the whole period, sometimes radiating to the lower back or the tops of your legs. The cyclical nature of the pain often suggests the diagnosis of endometriosis but this can progress to become chronic and continuous pain.
• Cyclical pain related to the bowels e.g. painful bowel movements during your period
• Cyclical urinary symptoms e.g. blood in your urine or pain passing urine during your period
• Pain during or after sex

How is endometriosis diagnosed?

Usually, a doctor will examine you and, if you are sexually active, would most likely do an internal examination with a speculum too. But please don't let this put you off - if you would rather we didn't then just let us know.

The most likely investigations would be an ultrasound scan and/or a diagnostic laparoscopy.

Laparoscopy is keyhole surgery done through the pelvis, however, not everyone is diagnosed using this method, with some women being started on treatment for endometriosis without requiring laparoscopy. If you have questions about this, don’t be shy to run them past your doctor or OB-GYN.

Treating endometriosis

There are a number of ways in which endometriosis can be treated and this will depend on factors such as your age, how severe your symptoms are, your desire to have children and whether pain or fertility is a priority.

Treatment options include:

• Pain relief with tablets (e.g. ibuprofen)
• Hormonal contraception (e.g. combined hormonal contraception, progesterone only pill, Mirena intrauterine system, depo contraceptive injection)
• Surgery

Some women find exercise helpful, as well as psychological therapies and counselling.

Endometriosis affects women differently and therefore treatment options that work for some may not necessarily be right for you. It can take time to work out the right treatment and you might find the treatment changes too as your priorities change throughout your life.

I think I may have endometriosis, what should I do next?

Please reach out and book an appointment with your doctor. Endometriosis is often not a straightforward picture and the common symptoms of endometriosis are similar to many other conditions, so it is not always apparent straight away that it’s the cause of your symptoms. Importantly - if you feel like you are not being heard, keep trying and don’t give up.

Keeping a menstrual diary or using a period tracking app can be a useful way to record your symptoms. This can also be used to determine the pattern of any bowel or urinary symptoms you may have so you can see if they are cyclical.

Doing this could help both you and your doctor recognise that you may be suffering from endometriosis and come to a diagnosis and management plan sooner.References

1. Zondervan, K., Becker, C. and Missmer, S., 2020. Endometriosis. New England Journal of Medicine, 382(13), pp.1244-1256.
2. Rcgp.org.uk. 2021. Menstrual Wellbeing Toolkit. [online] Available at: <; [Accessed 20 July 2021].
3. Cks.nice.org.uk. 2021. Complications and prognosis | Background information | Endometriosis | CKS | NICE. [online] Available at: <; [Accessed 20 July 2021].