When does menstrual pain stop being normal?
Endometriosis affects between 10% and 15% of Spanish women, of whom 30% will have difficulties in becoming pregnant.
The menstrual cycle can provide information about different aspects of health, although on its own it does not allow any disease to be diagnosed. Regularity and duration can give us clues about hormonal and reproductive health, while certain alterations can serve as a warning for stress, weight loss or excessively intense exercise. Changes or extreme symptoms can also give signals to investigate disorders such as perimenopause, polycystic ovary syndrome, anaemia, thyroid disorders or, of course, endometriosis.
Identifying the symptoms of endometriosis
As Dr Débora Labios, head of the Gynaecology and Obstetrics Unit at the HLA Vistahermosa hospital, explains, the most characteristic symptom of endometriosis is intense menstrual pain, especially when it limits usual activity or worsens over time.
It is also advisable to pay attention to persistent pelvic pain during sexual intercourse or when going to the toilet – especially if it appears or worsens with menstruation – and to difficulties in achieving a pregnancy.
At each stage of life, different symptoms prevail: in adolescents, this disease usually manifests mainly as very painful periods that may force them to miss classes, while in adulthood, pelvic pain or discomfort during sexual intercourse may become more important. Therefore, diagnosis must be based on the set of information that the patient can provide during the consultation.
Pregnancy and endometriosis
Approximately 30% of women with endometriosis have difficulties in becoming pregnant, according to the American Society for Reproductive Medicine (ASRM). In Spain, moreover, there is some overlap between the average age of motherhood (33.2 years old) and the average age of diagnosis of the disease (37 years old), bearing in mind that between seven and eight years may elapse from the appearance of the first symptoms to obtaining the diagnosis.
What is certain, in the words of Dr Débora Labrios, is that there is no exact relationship between the extent of endometriosis and fertility. This disease can make pregnancy more difficult for multiple reasons: altering the anatomy of the pelvis, affecting the fallopian tubes or ovaries, causing inflammation or reducing ovarian reserve. But, on the other hand, there are also many cases in which a natural pregnancy has been possible despite the disease.
Can it be cured?
Endometriosis cannot be definitively cured with medicines, but it can be treated, both with hormonal contraceptives and progestogens –which can reduce ovarian activity and relieve pain–, or, in some cases, treatments that produce a temporary suppression of ovarian function can also be used. The choice depends on the symptoms, age, desire for pregnancy, possible side effects and contraindications.
To treat the most severe cases, or in those in which the patient does not wish to have more children, a hysterectomy is usually the last option. This surgery, which consists of removing the uterus and sometimes also the ovaries, does not guarantee the disappearance of the disease, and therefore is never presented as a definitive cure.
Against stigmatisation
Menstrual pain is common in more than two out of three women, according to a WHO study, and in many people it causes iron-deficiency anaemia due to heavy blood loss. These figures affect more than two billion women worldwide, making it an issue that deserves special attention in conversations between women, to promote the detection of irregular symptoms and normalise the adaptation of daily activity to the needs of the cycle.
Warning symptoms in menstruation
Menstruation can cause discomfort, but we should not assume that it is normal to suffer symptoms that limit our quality of life. Doctor Débora Labios, head of the Gynaecology and Obstetrics Unit at the HLA Vistahermosa hospital, advises paying attention to the following symptoms:
