What it is
Most periods cramp. The lining releases prostaglandins, the uterus squeezes, and it aches for a day or two.
Pain that puts you in bed is a different question. So is pain that ibuprofen used to control and no longer does. Endometriosis, adenomyosis and fibroids all show up this way.
Pain that started with your very first periods and pain that started in your thirties point in different directions. Dr. Mueller asks when it changed.
What you might notice
- Cramps starting a day or two before the bleeding
- Missing work or school most cycles
- Anti-inflammatories that used to work and now do not
- Pain low in the back or down the thighs
- Nausea, vomiting or loose stools with the cramps
- Deep pain with sex, or pain with bowel movements during your period
- Pain creeping earlier in the cycle each year
How Dr. Mueller finds the cause
- 1
Your pain history
When it started, where it sits, and what you have already tried.
- 2
Pelvic exam
Finds where the tenderness actually is.
- 3
Pelvic ultrasound
In the office, looking for fibroids, adenomyosis and ovarian cysts.
- 4
Treatment trial
Anti-inflammatories or hormonal treatment, with a set date to reassess.
- 5
Laparoscopy, if needed
If pain continues, a camera through the navel is how endometriosis gets confirmed.
Questions people ask
- Is it normal for periods to hurt?
- Some cramping is normal. Pain that stops you working or sleeping is not, and it usually has a cause worth finding.
- Could this be endometriosis?
- It can be. Endometriosis often makes cycles painful years before anything shows on a scan.
- Will an ultrasound show endometriosis?
- Usually not. It does show fibroids, cysts and adenomyosis, which is why it is still the first test.
- Does birth control fix it?
- Hormonal treatment quiets the lining and helps many people. Dr. Mueller uses it here for the pain, not for contraception.
- Should I stop my ibuprofen before the visit?
- No. Keep taking what you take. Just tell Dr. Mueller the dose and whether it works.
- How long before I know if treatment is working?
- Give a medication trial two to three cycles. If nothing shifts by then, the plan changes.