tag:theconversation.com,2011:/global/topics/period-pain-33883/articlesPeriod pain – The Conversation2023-12-21T23:19:57Ztag:theconversation.com,2011:article/2183442023-12-21T23:19:57Z2023-12-21T23:19:57ZGot period pain or cramps? What to eat and avoid, according to science<figure><img src="https://images.theconversation.com/files/566750/original/file-20231219-27-7x7oaq.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938362/">Sora Shimazaki/Pexels</a></span></figcaption></figure><p>Painful periods are common. More than half of people who menstruate have some pain for up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">three days a month</a>, typically throbbing or cramping in the lower abdomen. </p>
<p>Digestive changes – such as vomiting, gas, bloating, diarrhoea and a “bubbling gut” – are also <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0538-8">common</a> around the time of menstruation. </p>
<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">treatments</a> for period pain (known medically as dysmenorrhoea). Not all these treatments are well-tolerated or work for everyone.</p>
<p>We’re learning more about food’s role in influencing <a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">inflammation</a> in our body. So, could eating or avoiding certain foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963185/">help</a> with painful periods? Here’s what we know based on high-quality research.</p>
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<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
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<h2>Foods that may relieve period pain or cramps</h2>
<p><strong>Foods containing omega-3 fatty acids</strong></p>
<p>Foods rich in omega-3 fatty acids include chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters and edamame beans. Omega-3 fatty acids are naturally present in oils including fish, cod liver, algal, krill, flaxseed (linseed), soybean and canola oils.</p>
<p>Omega-3 fatty acids <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/">affect</a> how our cells function and the signalling pathways associated with inflammation and pain. </p>
<p>Earlier this year, researchers published a <a href="https://pubmed.ncbi.nlm.nih.gov/37545015/#:%7E:text=Meta%2Danalysis%20(n%20%3D%208,0.51)%20at%20reducing%20dysmenorrhoea%20pain.">meta-analysis</a> where they combined and analysed all data available on the impact of omega-3 fatty acids on period pain. They found diets high in omega-3 fatty acids (including supplements of 300-1,800 milligrams a day) over two to three months may reduce pain, and pain medication use, in people with painful periods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open sardine can, parsley, cut lemon on wooden table." src="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sardines and other oily fish are rich in omega-3 fatty acids.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/open-can-sardines-preserves-oil-on-1636046179">BearFotos/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/are-fish-oil-supplements-as-healthy-as-we-think-and-is-eating-fish-better-212250">Are fish oil supplements as healthy as we think? And is eating fish better?</a>
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<p><strong>Foods high in vitamin D</strong></p>
<p>Foods high in vitamin D include trout, salmon, tuna and mackerel, as well as fish liver oils. Small amounts are also found in beef liver, egg yolk and cheese. Mushrooms contain varying levels of vitamin D, and you can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/">boost</a> this by exposing them to direct midday sunlight for 15-120 minutes. </p>
<p>The body can make vitamin D when it gets sunlight exposure and you can also get vitamin D from supplements.</p>
<p>Vitamin D <a href="https://pubmed.ncbi.nlm.nih.gov/24262718/">may help</a> reduce the factors that cause inflammation in the uterus. This includes levels of hormone-like molecules called prostaglandins. </p>
<p>A 2023 <a href="https://www.mdpi.com/2072-6643/15/13/2830#B11-nutrients-15-02830">meta-analysis</a> showed women who received weekly doses of vitamin D greater than 50,000 IU (or international units) had relief from period pain, regardless of how long and how often women took the vitamin.</p>
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Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
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<p><strong>Foods high in vitamin E</strong></p>
<p>Foods rich in vitamin E include seeds (particularly sunflower seeds), nuts (particularly almonds, hazelnuts and peanuts) and spinach, broccoli, kiwifruit, mango and tomato. </p>
<p>There is some evidence vitamin E supplements reduce period pain. In a well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/15777446/">trial</a> run over the course of four periods, women took vitamin E supplements (90 milligrams, twice a day) for five days, beginning two days before the expected start of the period. This significantly reduced the severity and duration of period pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman tipping out nut mix into palm of hand" src="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Seeds and nuts are rich in vitamin E.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-jar-nuts-dried-fruits-1112521214">NazarBazar/Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
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</em>
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<h2>Foods that may worsen period pain or cramps</h2>
<p><strong>Highly processed foods</strong></p>
<p>Highly processed foods include energy-dense, nutrient-poor foods such as takeaways, chips, biscuits, doughnuts, processed meats and soft drinks. </p>
<p>Research findings on the impact of a diet high in processed foods on period pain vary. A 2019 <a href="https://karger.com/goi/article/84/3/209/153726/Nutrition-as-a-Potential-Factor-of-Primary">review</a> found sugar consumption had little association with painful periods. </p>
<p>However, some observational studies (which do not involve an intervention) suggest women who eat more processed foods may have more intense period pain. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/19468949/">2009 study</a> found adolescent females who ate fast or processed foods for two days or more a week reported more period pain compared with those who did not. Therefore, eating less processed food may be something to consider. </p>
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<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
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<p><strong>Caffeine</strong></p>
<p>Foods high in caffeine include coffee, energy drinks and some processed energy bars. Caffeine intake is <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwij7LmPxfSCAxV5d_UHHRnyDyUQFnoECBIQAQ&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4222008%2F&usg=AOvVaw2mEjyMadOB1D6geQgAwckc&opi=89978449">associated with</a> menstrual pain. </p>
<p>Although we don’t know the precise underlying mechanism, researchers think caffeine may narrow blood vessels, which limits blood flow, leading to stronger cramps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired woman staring at bowl of breakfast, cereal and cup on kitchen table" src="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding coffee may help your period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-does-not-want-eat-her-151886987">Lolostock/Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">Nope, coffee won't give you extra energy. It'll just borrow a bit that you'll pay for later</a>
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<p><strong>Alcohol</strong></p>
<p>Drinking alcohol is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859868/">not</a> a recognised risk factor for painful periods. However, chronic heavy alcohol use reduces levels of <a href="https://academic.oup.com/alcalc/article/55/2/164/5734241">magnesium</a> in the blood. Magnesium is an important factor in relaxing muscles and supporting blood flow.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
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<h2>A healthy, balanced diet is your best best</h2>
<p>Having a healthy, balanced diet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">one of the best ways</a> we can support our own health and prevent future chronic conditions. This can help reduce inflammation in our bodies, thought to be the main way diet can help people with painful periods.</p>
<p>If you are looking for tailored dietary advice or a menstrual health meal plan, speak with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitian</a>.</p>
<p>It’s important to stress, however, that diet alone cannot treat all forms of menstrual pain. So if you are concerned about your painful periods, check in with your GP who can discuss your options.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
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<p><em>This article has been updated to reflect the correct date of a review that found sugar consumption had little association with painful periods.</em></p><img src="https://counter.theconversation.com/content/218344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch is an Accredited Practising Dietitian and member of Dietitians Australia. She works for Southern Cross University. </span></em></p><p class="fine-print"><em><span>Pui Ting Wong is a PhD Candidate at The University Queensland (UQ) Centre for Community Health and Wellbeing, and receives the UQ Tuition Fee Offset and Stipend Scholarship. She is also an Accredited Practising Dietitian and a member of Dietitians Australia.</span></em></p>A cup of coffee might help you kick-start your day, but it may actually make painful periods worse. Here’s what else to avoid (and eat) if you have period pain.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Lecturer, Southern Cross UniversityPui Ting Wong, PhD Candidate, culinary education and adolescent mental health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2013892023-06-11T20:52:50Z2023-06-11T20:52:50ZWhat’s a TENS machine? Can it help my period pain or endometriosis?<figure><img src="https://images.theconversation.com/files/529235/original/file-20230531-17-nf3bmd.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-close-view-girl-touch-stomach-1354368302">Shutterstock</a></span></figcaption></figure><p>If you’ve been on social media recently you might have noticed sponsored posts and ads for a variety of small, portable electrical devices. These claim to manage period or <a href="https://www.endometriosisaustralia.org/about-endo">endometriosis</a> pain safely and without drugs.</p>
<p>Most devices have a small box that generates an electrical pulse, and wires connected to sticky pads, which go on your tummy.</p>
<p>So how are these devices supposed to stop your pain? Are they safe? Do they actually work?</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CT7o8DnPaXs","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
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<h2>They’re mini TENS machines</h2>
<p>These devices use “transcutaneous electrical nerve stimulation”, better known as TENS. In other words, they apply small electrical pulses across the skin to stimulate certain types of nerves.</p>
<p>TENS machines are not new. They’ve been around since the <a href="https://patents.google.com/patent/US3817254">1970s</a> and have been used for a <a href="https://www.healthdirect.gov.au/tens">variety of painful conditions</a>, from muscular injuries to pain relief in labour. </p>
<p>However, these latest devices are compact and easy to wear discretely compared to the older models. They’re fairly simple to use, portable, you can use them at home, and they cost around A$50-200. </p>
<p>It’s easy to see why devices like these might be popular. <a href="https://doi.org/10.1016/j.jpag.2020.11.007">Half</a> of people with period pain say over-the-counter medication such as ibuprofen doesn’t get rid of their period pain. Most people with endometriosis <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15494">report</a> major issues with getting adequate pain relief.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
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</em>
</p>
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<h2>How might TENS work?</h2>
<p>All TENS-based devices generate small electrical pulses that feel a little like <a href="https://patient.info/treatment-medication/painkillers/tens-machines">mild electrical shocks</a>. These pulses are transmitted through the surface of the skin via the sticky pads. </p>
<p>You generally place these pads where the pain is. So for period pain that’s usually at or below the level of the belly button but above the pubic region. You can also place the pads on your lower back or even on your tailbone (sacrum). This is because some nerves near your tailbone also affect the pelvic area.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sticky pad of TENS machine on skin" src="https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529236/original/file-20230531-21-4m3nnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You place two sticky pads on your tummy or lower back.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tens-electrodes-positioned-back-pain-treatment-466080803">Shutterstock</a></span>
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<h2>Here’s what we know so far</h2>
<p>The exact mechanisms of how TENS works to reduce pain is still unclear. There are likely <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011890.pub3/full">many different pathways</a>. </p>
<p>First, we need to first talk about different types of nerves. <a href="https://www.ncbi.nlm.nih.gov/books/NBK10965/">Nociceptors</a> are nerves that send “danger” impulses about actual or potential tissue damage. Sensory nerves in your skin transmit information about things such as touch and pressure.</p>
<p>The <a href="https://www.science.org/doi/10.1126/science.150.3699.971">gate control theory of pain</a> says the spinal cord has “gates” that can be open or closed. When these gates are open, nerves can transmit these danger impulses up the spinal cord to the brain where they may be interpreted as “pain”. If these gates are closed, these impulses can’t reach the brain as easily.</p>
<p>TENS machines, especially at high frequency (greater than 50 pulses per second), tend to stimulate <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011890.pub3/full">sensory nerves</a> (the ones in your skin). These sensory nerves also send signals to your brain, but faster than the danger ones.</p>
<p>These sensory signals can close the “gates” at certain parts of the spinal cord. So if the TENS machine can stimulate enough of these sensory nerves in your skin, it will block at least some of these danger impulses from reaching the brain. The fewer danger impulses that reach the brain, the less pain you are likely to feel.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Closed farm gate across dirt track" src="https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529241/original/file-20230531-27-4m3nnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">TENS machines may close the ‘gates’ at certain parts of the spinal cord so fewer ‘danger’ impulses reach the brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-iron-farm-field-gate-red-2260337685">Shutterstock</a></span>
</figcaption>
</figure>
<p>Then there’s the concept of <a href="https://www.news-medical.net/health/What-are-Endogenous-Opioids.aspx">endogenous opioids</a> as pain relief. These are pain relieving chemicals the body makes itself. </p>
<p>TENS machines stimulate the release of these chemicals, with different types of endogenous opioids released depending on the frequency of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027071/">stimulation</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
<hr>
<h2>So does TENS work?</h2>
<p><strong>For period pain</strong></p>
<p>A systematic <a href="https://www.sciencedirect.com/science/article/pii/S155083072030286X">review</a> in 2022 found four studies looking at TENS to manage primary dysmenorrhea (period pain that occurs without any physical changes in the pelvis).</p>
<p>There was a significant reduction in period pain when high-frequency TENS (more than 50 pulses per second) was compared to sham TENS (where the machine looks the same but doesn’t deliver a pulse). </p>
<p>This is in line with an older <a href="https://www.cochrane.org/CD002123/MENSTR_transcutaneous-electrical-nerve-stimulation-for-primary-dysmenorrhoea">Cochrane review</a> that found similar benefits. </p>
<p>Pain relieving effects only tend to last while the device is active.</p>
<p><strong>For endometriosis</strong></p>
<p>Endometriosis is where tissue similar to the lining of the uterus is found outside the uterus, commonly in the pelvis. There is only <a href="https://doi.org/10.1016/j.ejogrb.2015.07.009">one</a> study of TENS for pelvic pain due to endometriosis. </p>
<p>This study compared two types of TENS – one using a higher frequency for 20 minutes twice a day, and one using a lower frequency for 30 minutes once per week. Both types used pads placed on the tailbone, and women were told to make the pulses “strong, but comfortable”. </p>
<p>Both types improved pelvic pain, pain after sex, and quality of life, but not period pain. This was a very small study (11 women in each group) and there was no control or placebo group. So we need larger studies with a proper control group before we can be sure if TENS works for endometriosis pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Is it safe?</h2>
<p>Most <a href="https://www.sciencedirect.com/science/article/pii/S155083072030286X">studies</a> report no side effects when the pads are used on the abdomen or lower spine.</p>
<p>However, if you turn up the intensity too high it <a href="https://www.tandfonline.com/doi/full/10.2147/IJWH.S220523">can be uncomfortable</a>. You could also get a rash from the adhesive on the pads.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-periods-can-come-as-a-shock-5-ways-to-support-your-kid-when-they-get-theirs-177920">First periods can come as a shock. 5 ways to support your kid when they get theirs</a>
</strong>
</em>
</p>
<hr>
<h2>Which one to buy?</h2>
<p>All TENS machines should allow you to change the <em>intensity</em> (how strong the pulse feels). Some also allow you to change the <em>frequency</em> (how often the pulses happen).</p>
<p>If you are going to use the device occasionally (less than 4-5 days per month) you may just need a device that allows you to change the <a href="https://doi.org/10.2522/ptj.20120281">intensity</a>.</p>
<p>To get the best relief, the machine should be turned up high enough so it delivers noticeable pulses, but is not painful. So you need to find your own comfort level.</p>
<p>For period pain, <a href="https://www.tandfonline.com/doi/full/10.2147/IJWH.S220523">high frequency</a> (more than 50 pulses per second) shows better results than low frequency (usually 2-5 pulses per second). So make sure the device you’re thinking of buying is either set to a high frequency or you can change the frequency.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman clutching tummy and head lying on sofa" src="https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529242/original/file-20230531-15-mlq5gp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people find it hard to manage period pain. So would TENS help?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-muslim-woman-hijab-having-acute-1616145232">Shutterstock</a></span>
</figcaption>
</figure>
<p>For people with endometriosis, it’s a little more tricky. You’ll probably going to want to use the device more often than a few days a month. </p>
<p>Unfortunately, like with taking regular opioid painkillers, with regular TENS use people can become <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027071/">tolerant</a> to its pain-relieving effect, which means it doesn’t work as well as it did when you first started using it.</p>
<p>One possible solution to tolerance is to use <a href="https://academic.oup.com/ptj/article/93/10/1397/2735589">mixed-frequency TENS</a> where both high and low frequencies are alternated. You can also slowly increase the intensity level over time. </p>
<p>TENS also doesn’t work well when people are regular <a href="https://pubmed.ncbi.nlm.nih.gov/6965549/">opioid users</a>. This is important as people with endometriosis are often using <a href="https://www.jmig.org/article/S1553-4650(20)30291-0/fulltext">opioid medications</a> to manage their pain. If you are using opioids regularly, high-frequency TENS is likely to be a <a href="https://academic.oup.com/ptj/article/93/10/1397/2735589">better choice</a>.</p><img src="https://counter.theconversation.com/content/201389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Armour does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>TENS machines for period pain are all over social media. But what are they? And do they work?Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989152023-02-08T12:46:08Z2023-02-08T12:46:08ZArtemis is a new body suit for period pain – here’s why it’s named after a Greek goddess<p>A new body suit to <a href="https://www.bbc.co.uk/news/business-64397795">control period pain</a> is in the pipeline – and it’s called Artemis. Named after the Greek goddess of chastity, hunting, childbirth and the moon, it works by combining a <a href="https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/">tens machine</a> (which provides pain relief through the use of a mild electrical current) and heat panels. </p>
<p>If it proves effective, it could be a huge benefit to women who suffer particularly with period pain – which is now acknowledged to sometimes be <a href="https://qz.com/611774/period-pain-can-be-as-bad-as-a-heart-attack-so-why-arent-we-researching-how-to-treat-it">as painful as a heart attack</a>. </p>
<p>There’s a long history in our society of period pain being played down, or just considered <a href="https://www.tandfonline.com/doi/pdf/10.1080/09612020000200260">“normal”</a> – with so much of history written by men who wouldn’t have understood – alongside the use of euphemisms to avoid even discussing it. But there’s also plenty of evidence on the historical record showing how coping with severe menstrual pain has always been a struggle for some women. </p>
<p>In her 2015 <a href="https://www.google.co.uk/books/edition/Maids_Wives_Widows/SXg7CQAAQBAJ?hl=en&gbpv=1&dq=Between+the+kidneys+and+the+womb+the+consent+is+evident+in+the+torments+and+pains+in+the+loins+which+women+and+maids&pg=PT84&printsec=frontcover">book</a> Maids, Wives, Widows: Exploring Early Modern Woman’s Lives 1540-1714, historian Sara Read notes a passage in a medical text from the 1600s – the first anatomy text to be written in English – that compares having a period to childbirth. </p>
<p>In <a href="https://shakespeare.lib.uiowa.edu/item/mikrokosmographia-or-a-description-of-the-body-of-man/">Microcosmographia. A Description of the Body of Man</a> London physician Helkiah Crooke physician, discusses “the courses” – a term for menstruation. He writes:</p>
<blockquote>
<p>Between the kidneys and the womb, the consent is evident in the torments and pains in the loins which women and maids have in or about the time of their courses. In so much as some have told me they had at least bear a child as endure that pain; and myself have seen some to my thinking by their deportment; in as great extremity in the one as in the other.</p>
</blockquote>
<h2>Artemis the great</h2>
<p>The connection between the pain of having a baby and having a period is very appropriate to a product named after Artemis, the ancient Greek goddess associated with both. Artemis was the goddess that was turned to during times of transition, such as menstruation, development, and marriage.</p>
<p>A virgin goddess – one of three, the others being Athena and Hestia – she was involved as girls reached womanhood, with <a href="https://www.theoi.com/Cult/ArtemisCult.html">dedications made to her</a>. <a href="https://diotima-doctafemina.org/translations/anthologies/womens-life-in-greece-and-rome-selections/ix-medicine-and-anatomy/349-hysteria-in-virgins/">These included</a> your childhood toys and, before your sexual initiation, your belt. Indeed, women would dedicate their finest clothing to Artemis when their menstrual periods began.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CktYLkdII0r/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Young Athenian girls who had not yet been through puberty were sent to an early sacred site, the sanctuary of Artemis at Brauron (about 30 miles from Athens), to <a href="https://womeninantiquity.wordpress.com/2017/03/20/the-cult-of-artemis-at-brauron/">serve at the shrine of the goddess</a>. Records show gifts given in thanks, possibly for surviving childbirth, another transition in women’s lives involving blood.</p>
<h2>Goddesses sell products</h2>
<p>From the mid-20th century onwards, it has been popular to name women’s products after famous women and goddesses from the ancient Mediterranean. For example, the name of a company developing a modern treatment for breast cancer, Atossa, dates back to around 520BC.</p>
<p>It was the name of a Persian queen, who – according to the historian Herodotus – was troubled by a lump in her breast, which was treated by the Greek doctor Democedes. In his famous <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0126%3Abook%3D3%3Achapter%3D133">Histories</a> – an account of the period up to the Persian Wars – Herodotus writes that: </p>
<blockquote>
<p>A short time after this, something else occurred; there was a swelling on the breast of Atossa, the daughter of Cyrus and wife of Darius, which broke and spread further. As long as it was small, she hid it out of shame and told no one; but when it got bad, she sent for Democedes and showed it to him. He said he would cure her, but made her swear that she would repay him by granting whatever he asked of her, and said that he would ask nothing shameful.</p>
</blockquote>
<p><a href="https://www.youtube.com/watch?v=RJWd8fiLEyQ">Some scholars</a> have read this as the first recorded instance of breast cancer, but this isn’t clear from this brief description. Nor is the nature of Democedes’ treatment. But we do know that Atossa was cured. </p>
<p>Australian company <a href="https://atossatherapeutics.com/">Atossa Therapeutics</a> is running trials of hormone therapy in patients with invasive breast cancer who are about to have a mastectomy or lumpectomy. As of January 2023, the results were looking encouraging and trials have moved to the next stage. </p>
<h2>The power of the classics</h2>
<p>An early version of the contraceptive pill, marketed as Enovid, used the mythical Ethiopian princess <a href="https://muvs.org/en/contraception/c-media/enovid-badge-id2333/">Andromeda</a> in its advertising. The story runs that after her parents went too far in boasting about her exceptional beauty, the angry gods had Andromeda tied to a rock at the mercy of a sea monster, but <a href="https://artuk.org/discover/stories/andromeda-forgotten-woman-of-greek-mythology">she was saved by the hero Perseus</a>, who then took her as his queen.</p>
<p>For the manufacturers of Enovid, using their drug meant that every woman could “free herself from the chains” of worrying about unwanted pregnancy.</p>
<p>So the solution to women’s health problems is often presented in terms of ancient Greek female figures. Using these names may support the idea of continuity across history in how women have experienced their bodies, playing down how changes in society have affected them. </p>
<p>It also shows the lasting power of the classics, even at a time when few people learn about ancient Mediterranean cultures. And at the same time, it promotes a story in which “now” we can cure anything – even conditions that have been part of women’s lives for millennia.</p><img src="https://counter.theconversation.com/content/198915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a long history in our society of period pain being played down, or just considered “normal”. But there’s plenty of evidence in the historical records that women have always experienced it.Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1913522022-11-24T19:06:08Z2022-11-24T19:06:08ZFrom sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms<figure><img src="https://images.theconversation.com/files/488439/original/file-20221006-20-jjy784.jpg?ixlib=rb-1.1.0&rect=8%2C51%2C5742%2C3776&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Period pain is a common symptom of the menstrual cycle, affecting about <a href="https://www.liebertpub.com/doi/10.1089/jwh.2018.7615">70% of young women</a> – but it’s far from the <a href="https://www.dovepress.com/the-comorbidities-of-dysmenorrhea-a-clinical-survey-comparing-symptom--peer-reviewed-fulltext-article-JPR">only symptom</a>.</p>
<p>Here are five lesser-known symptoms associated with the menstrual cycle – and what’s going on in your body to cause them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>1. Bowel disturbances (period poos)</h2>
<p>Some people experience disturbances in their bowel habits leading up to their period and this commonly manifests as <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a>.</p>
<p>This happens because when you menstruate, your body releases a special chemical called prostaglandins. Prostaglandins help the uterus to cramp, which helps push menstrual blood out of the uterus and into the vagina so it can leave the body.</p>
<p>When you get period pain (especially if a person has endometriosis) a nerve in the back called the <a href="https://youtu.be/O172DUJ-_BY">dorsal root ganglion</a> is activated. </p>
<p>This can cause a range of symptoms, including back pain. This same process can make the bowel sensitive, which can lead to bowel pain or irritable bowel syndrome and contributes to changes in bowel habits like <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a> or constipation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman sits on the toilet." src="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people experience disturbances in their bowel habits leading up to their period.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-using-her-cellphone-while-in-the-toilet-7623575/">Photo by Miriam Alonso/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>2. Stabbing pains</h2>
<p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. </p>
<p>For some, this pain can shoot up the vagina or back passage.</p>
<p>This is related to the cramping that occurs when prostaglandins are released in the body and the nerve in the back (the dorsal root ganglion) is activated. </p>
<p>This can trigger spasms of the pelvic floor muscles (a group of muscles in the bottom of the pelvis that supports the bladder, bowel and uterus).</p>
<p>Seeing a <a href="https://www.endozone.com.au/treatment/53">pelvic health physiotherapist</a> and learning to relax these <a href="https://www.endozone.com.au/treatment/pelvic-floor-muscle-relaxation">muscles</a> can help manage this type of pain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman clasps her thigh as if in pain." src="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>3. Fatigue</h2>
<p>It’s common to feel a bit run down around the time of your period. But for some people this can go beyond just regular tiredness.</p>
<p>A recent <a href="https://www.ajog.org/article/S0002-9378(19)30427-2/fulltext">survey</a> of 42,879 women showed about 70% experience this symptom. It is often <a href="https://doi.org/10.1186/s41687-020-00200-1">described</a> as feeling “exhausted”, “drained”, “tired”, “lethargic”, “worn out”, and/or “weak”.</p>
<p>Fatigue can be due to the brain’s experience of pain. We can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698023/">measure</a> changes in the brain when people experience pelvic pain. Ongoing <a href="https://youtu.be/O172DUJ-_BY">pain signalling</a> to the brain causes these changes, which results in extreme tiredness and sometimes headaches and nausea.</p>
<p>Having a <a href="https://www.endozone.com.au/endometriosis-related-fatigue">good sleep schedule</a>, exercising and eating well can help with fatigue.</p>
<h2>4. Ovulation pain</h2>
<p>Ovulation occurs when a mature egg is released from the ovary. </p>
<p>During this time, estrogen levels are high, and a lot of clear watery mucus is produced by cells in the cervix (which is why seeing extra clear watery mucus at this time is a sign ovulation is approaching). </p>
<p>Most people feel pretty good when their estrogen levels are high. But when the follicle the egg is in gets bigger near ovulation, the pressure of the follicle and its release can cause pain. This ovulation pain is sometimes called <a href="https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122#:%7E:text=Mittelschmerz%20is%20one%2Dsided%2C%20lower,doesn't%20require%20medical%20attention.">mittelschmerz</a>, which is German for “middle pain”.</p>
<p>This can feel like a sharp, relatively short-lived stabbing pain in the lower abdomen on one side.</p>
<h2>5. Mood changes</h2>
<p>Between <a href="https://doi.org/10.2147/JPR.S179409">50%</a> and <a href="https://doi.org/10.1016/j.ajog.2019.02.048">70%</a> of people who have periods experience changes to their mood leading up to or during their period.</p>
<p>But for between <a href="https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x04_Depressive_Disorders">1-5%</a> of people, the impacts on mood can be more severe and may be associated with a condition called premenstrual dysphoric disorder (PMDD).</p>
<p>This occurs when people experience severe mood changes, anxiety or depression in the week before their period, which usually improves within a few days of their period starting.</p>
<h2>When should you see a doctor?</h2>
<p>Symptoms vary so much between people, there is a huge range of “normal” and it can be tricky to decide when to follow up with your doctor. But it is worth chatting to a GP if:</p>
<ul>
<li><p>your period pain interrupts daily activities such as work, school or caring responsibilities</p></li>
<li><p>the pain associated with your cycle is severe or changes</p></li>
<li><p>you have difficulty going to the bathroom, pain with urination or bowel movements or your bowel habits change</p></li>
<li><p>you feel emotionally or mentally overwhelmed</p></li>
<li><p>you experience pelvic pain at other times (outside of your period).</p></li>
</ul>
<p>When these symptoms are severe, they can be due to conditions such as endometriosis.</p>
<p><a href="https://www.endozone.com.au">EndoZone</a> – an evidence-based website co-created with people affected by endometriosis – has a <a href="https://www.endozone.com.au/health-report-form#no-back">self-test</a> for people trying to decide if their period symptoms require further medical care, and tips on how to describe them to a doctor.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-10-girls-skip-class-because-of-painful-periods-and-most-wont-talk-to-their-teacher-about-it-150286">3 out of 10 girls skip class because of painful periods. And most won't talk to their teacher about it</a>
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<img src="https://counter.theconversation.com/content/191352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca O’Hara received funding from the Department of Health (Commonwealth) and Jean Hailes for Women’s Health for the development of EndoZone. </span></em></p><p class="fine-print"><em><span>Louise Hull received funding from the Department of Health (Commonwealth) and Jean Hailes for Women's Health for the development of EndoZone. She is affiliated with Endometriosis Australia (Medical Advisory Board). </span></em></p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. For some, this pain can shoot up the vagina or back passage.Rebecca O'Hara, Grant Funded Researcher: Endometriosis, Robinson Research Institute, University of AdelaideLouise Hull, Professor and Endometriosis Group Leader, The Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1785912022-04-11T19:01:35Z2022-04-11T19:01:35ZEndometriosis: How advocacy, awareness and algorithms could shorten the long wait for diagnosis and treatment<figure><img src="https://images.theconversation.com/files/456541/original/file-20220406-22-icfn7.jpg?ixlib=rb-1.1.0&rect=409%2C34%2C5119%2C3438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite the prevalence of endometriosis, people often live with pain and other symptoms for years before being diagnosed.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/endometriosis--how-advocacy--awareness-and-algorithms-could-shorten-the-long-wait-for-diagnosis-and-treatment" width="100%" height="400"></iframe>
<p>Endometriosis affects an estimated <a href="https://www.endofound.org/endometriosis">200 million people worldwide</a>. Despite its prevalence, those living with the disease often wait an average of <a href="https://doi.org/10.1177%2F1750481318771430">7.5 years</a> between start of symptoms and diagnosis. This delay is due to a variety of reasons, including <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">medical dismissal, a low prioritization of the condition and its overall misrepresentation</a> in research funding, policy and media.</p>
<p>Although often represented as a women’s reproductive disease, endometriosis also appears in people who have had hysterectomies, transgender men, genderfluid and non-binary people, pre-menstrual and post-menopausal people, and in rare cases, <a href="https://doi.org/10.1016/j.prp.2011.10.007">cisgender men</a>. </p>
<p>Its symptoms commonly include pain with menstruation, as well as chronic pain, infertility, pain with sexual intercourse, fatigue and more. Despite this full-body impact on one’s <a href="https://doi.org/10.1016/j.fertnstert.2011.05.090">quality of life</a>, endometriosis is commonly associated with just having “bad periods.”</p>
<p>We are four authors from three countries looking at different aspects of endometriosis diagnosis, awareness and patient advocacy. This article emerges from a <a href="https://www.eventbrite.com/e/young-people-endometriosis-social-perspectives-on-the-delay-to-diagnosis-tickets-237420941427#">joint online presentation</a> of our research looking at potential ways to improve awareness and patient care, and promote faster diagnosis.</p>
<p>Our methods include social scientific and qualitative research including interviews, surveys, focus groups, participant observations and collaborations with people living with endometriosis. We identified some clear changes that are needed to promote awareness of the disease, and subsequently reduce diagnostic timelines.</p>
<h2>Widespread endometriosis education</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A powerpoint slide showing the results of Maria Tomlinson's survey and quotes from young people about endometriosis." src="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Maria Tomlinson’s research surveyed young people about their awareness and knowledge of endometriosis.</span>
<span class="attribution"><span class="source">(Maria Kathryn Tomlinson)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our research suggests that endometriosis education is severely lacking, meaning that many people who have the condition do not even know it exists. </p>
<p>In focus groups with 77 16- to 19-year-olds in the United Kingdom, Maria found that only 28 had heard of endometriosis before. Of these, two were able to accurately define it. Most of those who had heard of the disease had done so through friends and family, with some also hearing about it on social media or the internet. None of them had been told about it in their formal education.</p>
<p>Eileen’s survey of 271 people with endometriosis showed that only nine people (3.3 per cent) heard about endometriosis from grade school (elementary, junior or high school) with a few mentioning that they had heard about it briefly in nursing school.</p>
<p>Although Eileen’s interviews and surveys showed that social media can be very beneficial to people who live with endometriosis, Maria’s focus groups showed that social media is not very effective at reaching people who do not have the condition. People with endometriosis often put enormous amounts of work into <a href="https://theconversation.com/what-is-endometriosis-patients-turn-to-social-media-for-information-and-support-160852">sharing endometriosis information online</a>, but it often does not reach the broader population.</p>
<h2>Accurately represent menstrual pain and endometriosis pain</h2>
<p>As Mie identifies in her fieldwork on menstruation among teenagers and interviews with endometriosis patients from Denmark, the normalization of menstrual pain is one of the main factors delaying diagnosis for people with endometriosis. </p>
<p>Although not everyone who has endometriosis menstruates or has menstrual pain, <a href="https://doi.org/10.1177/0884217503261085">it is one of the most common and symptoms, and one of the earliest</a>. Many people are encouraged to use painkillers and hormonal contraceptives to manage their pain, instead of having it investigated. Being prescribed birth control pills without a thorough investigation of symptoms, or consideration for gender identity, were also concerns identified by participants in Maria’s focus groups.</p>
<figure class="align-center ">
<img alt="Cropped image of a pharmacist's hands holding birth control pills with a woman seen from behind" src="https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people are encouraged to use painkillers and hormonal contraceptives to manage their pain instead of having it investigated.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Maria’s participants also explained how they believe menstrual product advertisements undermined the severity of menstrual pain. They thought that more realistic representations of painful periods might encourage more young people with periods to seek medical help when needed. </p>
<p>Mie’s work identifies the often cyclical nature of endometriosis symptoms as something that can discourage patients from seeking care, as they feel their symptoms are not as extreme when they are not menstruating. Better awareness that cyclical symptoms can also indicate diseases might help patients seek care earlier.</p>
<p>Eileen’s social media analysis shows that people with endometriosis often use social media to represent their lived experiences of menstrual pain and endometriosis with complexity, in contrast to common media representations. </p>
<figure class="align-center ">
<img alt="A word cloud resonding to the question 'What does 'endometriosis' mean to you?' The most prominent words are pain, time and life." src="https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&rect=12%2C6%2C1172%2C661&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A word cloud responding to the question, ‘What does endometriosis mean to you?’</span>
<span class="attribution"><span class="source">(Eileen Mary Holowka)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In a recent example, Amy Corfeli from the podcast and social media platform <a href="https://www.instagram.com/p/CasRLDBuR52/">@in16yearsofendo</a> used Instagram, Twitter and <a href="https://medium.com/@amycorfeli/dear-greys-anatomy-your-endometriosis-info-needs-updating-4fbb942e616b"><em>Medium</em></a> to address inaccuracies in the television show <em>Grey’s Anatomy</em>’s representation of endometriosis. Unfortunately, <em>Grey’s Anatomy</em> has a larger platform, but social media pages like Amy’s, <a href="https://www.instagram.com/endoqueer/">@endoQueer</a> and <a href="https://www.instagram.com/endo_black/">@endo_black</a> attempt to bring more nuance and diversity into the media depictions of endometriosis.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CasRLDBuR52","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Improving diagnostic time</h2>
<p>Endometriosis is an “invisible” condition, meaning it cannot be seen by just looking at someone. Including endometriosis in grade school curricula, covering it more extensively in medical school, and representing it more broadly in media, would help make the disease more apparent so people with symptoms seek care sooner.</p>
<p>However, the burden of care cannot be on patients alone, particularly for a condition like endometriosis which comes with <a href="https://endometriosis.org/resources/clinical-books/googling-endometriosis-david-redwine/">a long history of patient-blaming</a>. Interventions are needed on the medical side, but limited resources, long wait times, suboptimal diagnostic techniques and knowledge, and the low prioritization of endometriosis all <a href="https://theconversation.com/1-in-10-women-are-affected-by-endometriosis-so-why-does-it-take-so-long-to-diagnose-141803">increase diagnostic delays</a>. </p>
<p>It is possible that interventions such as the <a href="https://findingendometriosis.eu/">FEMaLe</a> (Finding Endometriosis using Machine Learning) project, co-ordinated by Ulrik, could help improve diagnosis in the future. This project, emerging out of Denmark, aims to develop and demonstrate a platform that uses algorithms to detect and help diagnose and treat people with endometriosis, in collaboration with their health-care providers. </p>
<p>In order to develop this kind of work, a multidisciplinary approach to endometriosis is needed, including not only medical research, but also the kind of qualitative work outlined in this story.</p><img src="https://counter.theconversation.com/content/178591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Mary Holowka receives funding from the Canadian Social Sciences and Humanities Research Council and is a member of the Endometriosis Educational Organization of Canada.</span></em></p><p class="fine-print"><em><span>Dr. Maria Kathryn Tomlinson receives funding from the Leverhulme Trust under Grant ECF-2019-232. Her project is entitled "Menstrual Activism in the Media: Reducing Stigma and Tackling Inequalities".</span></em></p><p class="fine-print"><em><span>Mie Kusk Søndergaard receives funding from the Danish Cancer Society and University of Southern Denmark. She has previously collaborated with the Danish endometriosis association Endometriose Foreningen. </span></em></p><p class="fine-print"><em><span>Ulrik Bak Kirk receives funding from the EU under the H2020 Research and Innovation Action for the 'Finding Endometriosis using Machine Learning' (FEMaLe) project (grant agreement ID: 101017562).</span></em></p>People living with endometriosis wait an average of 7.5 years for a diagnosis. Social science researchers are working to identify ways to help reduce this timeline.Eileen Mary Holowka, PhD Candidate, Communication Studies, Concordia UniversityMaria Kathryn Tomlinson, Leverhulme Early Career Researcher, Department of Journalism Studies, University of SheffieldMie Kusk Søndergaard, PhD fellow, Department of Public Health, University of Southern DenmarkUlrik Bak Kirk, PhD Fellow, FEMaLe Coordinator, Aarhus UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1502862020-11-22T18:55:16Z2020-11-22T18:55:16Z3 out of 10 girls skip class because of painful periods. And most won’t talk to their teacher about it<figure><img src="https://images.theconversation.com/files/370482/original/file-20201120-13-8ni9iq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-young-latina-woman-menstrual-pain-1115375693">Shutterstock</a></span></figcaption></figure><p>More than one-third of young women in a nationwide survey said they <a href="https://www.jpagonline.org/article/S1083-3188(20)30360-0/pdf">missed at least one class</a>, either at school or university, in the past three months due to menstrual symptoms, including pain and fatigue. </p>
<p>More than three quarters of young women said they had problems concentrating due to their period. Around half said they didn’t feel like they had performed as well on a test or assignment due to their symptoms. </p>
<p>We used a nationwide online survey to collect information from 4,202 teenagers and young women in Australia, aged 13 to 25, who were either at school or at tertiary education like university or TAFE.</p>
<p>More than half (60%) of the women in our survey said they wouldn’t feel comfortable speaking to a teacher or lecturer about how their period was affecting them. </p>
<h2>How period pain affects education</h2>
<p>Many young women experience menstrual symptoms. Almost <a href="https://www.liebertpub.com/doi/abs/10.1089/jwh.2018.7615">three quarters report</a> regular period pain, around half report fatigue, and more than one third report emotional changes such as mood swings. Studies show <a href="https://bmjopen.bmj.com/content/9/6/e026186">these menstrual symptoms</a> can cause women to miss work or school and some previous <a href="https://pubmed.ncbi.nlm.nih.gov/10418884/">studies</a> in teenagers show it may potentially impact academic performance. </p>
<p>We wanted to understand how menstrual symptoms might be affecting young women in Australia with regard to their education, and how they manage these.</p>
<p>We asked young women about how often they got period pain and other menstrual symptoms, how it impacted their attendance or classroom performance, and explored how useful they found the sexual and reproductive education they had previously received. </p>
<p>In our survey, <a href="https://www.jpagonline.org/article/S1083-3188(20)30244-8/fulltext">nine out of ten young women</a> reported having had period pain in the past three months, and half reported pain every month. This is similar to <a href="https://pubmed.ncbi.nlm.nih.gov/19874294/">previous findings</a> in teenagers in Australia. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CHx4WeNnW6M/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
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Read more:
<a href="https://theconversation.com/period-pain-is-impacting-women-at-school-uni-and-work-lets-be-open-about-it-118824">Period pain is impacting women at school, uni and work. Let's be open about it</a>
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<p>Their pain scores, which tended to be moderate to severe for most, didn’t change as they got older.</p>
<p>More than one-third of young women said they missed at least one class in the past three months due to their menstrual symptoms. This was almost identical no matter if they were at school or at university. </p>
<p>The negative impacts of periods also included missing sport and social activities. But more than half (60%) of young women said they wouldn’t feel comfortable speaking to a teacher or lecturer about how their period was affecting them. </p>
<p>Pain was the biggest factor in predicting how much their education would be affected, with higher pain scores having a much greater negative impact. This is a concern as it often occurs at a crucial time in their academic lives during their final schooling years. Absenteeism at this time can have <a href="http://www.telethonkids.org.au/globalassets/media/documents/research-topics/student-attendance-and-educational-outcomes-2015.pdf">long-term consequences</a> due to exams and assignments in the senior years often determining which courses can be studied at tertiary education. </p>
<h2>Many accepted pain as ‘normal’</h2>
<p>Most of the <a href="https://www.jpagonline.org/article/S1083-3188(20)30360-0/pdf">young women in our study</a> didn’t seek medical advice for their pain, even when it was severe. This is similar to what has been found in the <a href="https://srh.bmj.com/content/41/3/225">past</a>. </p>
<p>As their pain got worse they were more likely to think it was abnormal but weren’t any more likely to seek medical attention. This is probably due, at least in part, to the fact most young women think pain is <a href="https://pubmed.ncbi.nlm.nih.gov/21771164/">normal</a> and they just need to put up with it. </p>
<p>Unfortunately, this belief can often be reinforced when they speak to a <a href="https://www.jpagonline.org/article/S1083-3188(19)30360-2/fulltext">medical</a> <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-123">professional</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
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<p>Only about half of young women at school had heard of endometriosis — a <a href="https://www.endometriosisaustralia.org/about-endo">chronic condition</a> in which cells similar to those that line the uterus grow in other parts of the body. It can cause significant pain, fatigue and reproductive issues.</p>
<p>Only about half of young women said they would seek medical advice if they had pelvic pain when they didn’t have their period. This is despite over half (55%) reporting they did experience pelvic pain (pain similar to their period but when not menstruating) at least once a month. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teenage on the ground near lockers with her head on her knees." src="https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/370483/original/file-20201120-19-10o03h3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many young women think period pain is normal and they should just bear it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-depress-female-student-college-519826039">Shutterstock</a></span>
</figcaption>
</figure>
<p>Severe period and pelvic pain when not menstruating are <a href="https://www.nature.com/articles/s41598-020-73389-2">very common early signs</a> of chronic pelvic pain (such as endometriosis), and delays in diagnosis <a href="https://pubmed.ncbi.nlm.nih.gov/23739215/">may worsen outcomes</a> for young women.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-are-affected-by-endometriosis-so-why-does-it-take-so-long-to-diagnose-141803">1 in 10 women are affected by endometriosis. So why does it take so long to diagnose?</a>
</strong>
</em>
</p>
<hr>
<h2>Women need better education</h2>
<p>Education on menstrual health is incorporated into the Australian <a href="https://www.acara.edu.au/curriculum/foundation-year-10/learning-areas-subjects/health-and-physical-education">Foundation to Year 10 Health and Physical Education (HPE) curriculum</a>. This positions health and physical education teachers as critical in providing students with evidence-based information in a relevant, timely and age-appropriate manner.</p>
<p>Yet the extent to which this is occurring in schools is unknown. Research reports Australian <a href="https://doi.org/10.1080/03630242.2019.1610827">teachers are uncomfortable</a> <a href="https://doi.org/10.1080/14681811.2012.678324">addressing menstruation</a>. This often results in periods being taught as a <a href="https://doi.org/10.1080/713668302">negative and troublesome part of growing up</a>. </p>
<p>The young women we surveyed highlighted their schools’ shortcomings in educating them on how to manage period pain. One 16-year-old Victorian student said:</p>
<blockquote>
<p>There was no practical information such as relieving symptoms and the use of sanitary items, only the biological effect on the body such as how hormones come into play. Personally that was not useful and I can’t remember much about it. </p>
</blockquote>
<p>The young women saw a lack of support for period pain during their education and the negative impacts this may have. An 18-year-old student from Western Australia said:</p>
<blockquote>
<p>In particular, no advice was given on dealing with pain (mine ended up being extreme) or what the process (if any) was at school for having menstrual pain taken seriously and treated as a consideration in test writing or sport class.</p>
</blockquote>
<p>Teachers need to be more aware of potential impacts of period pain on education outcomes. And the curriculum must be expanded to focus on mitigation strategies for period pain. </p>
<p>There are some <a href="https://pubmed.ncbi.nlm.nih.gov/28349513/">promising</a> <a href="https://www.pelvicpain.org.au/schools-ppep-program/">menstrual</a> <a href="https://periodtalk.com.au">education</a> programs, both in person and online, that have been developed to tackle these shortcomings, including some that also include <a href="https://www.theage.com.au/national/victoria/breaking-the-period-talk-taboo-20181122-p50hlk.html">parents and boys</a>. Currently these programs are often ad-hoc, and need to be adopted as a consistent part of the school curriculum.</p>
<p>It is critical menstruation and period pain transcend being a girl’s or women’s issue alone and include all genders, as well as parents and caregivers, who are often called on to support and inform young people.</p><img src="https://counter.theconversation.com/content/150286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Armour receives funding from U by Kotex for work on menstrual education unrelated to these studies. He is a member of the clinical advisory comittee for Endometriosis Australia. </span></em></p><p class="fine-print"><em><span>Kathryn Holmes has received funding for menstrual education research from U by Kotex but it is unrelated to the main study in this article.</span></em></p><p class="fine-print"><em><span>Kelly Parry receives funding from U by Kotex for work on menstrual education unrelated to these studies. </span></em></p>A nationwide online survey collected information from 4,202 teenagers and young women in Australia, about how their periods affected their education – either at school, university or VET.Mike Armour, Senior research fellow, Western Sydney UniversityKathryn Holmes, Professor of Education, Western Sydney UniversityKelly Ann Parry, Sessional Lecturer, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1418032020-08-11T02:09:51Z2020-08-11T02:09:51Z1 in 10 women are affected by endometriosis. So why does it take so long to diagnose?<figure><img src="https://images.theconversation.com/files/349540/original/file-20200727-29-y0780w.jpg?ixlib=rb-1.1.0&rect=44%2C44%2C4876%2C3105&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Endometriosis is a debilitating, chronic condition that affects <a href="https://www.endometriosisaustralia.org/research">1 in 10 women</a> worldwide. It occurs when tissue <a href="https://www.endofound.org/endometriosis">which has similar properties to the womb lining,</a> ends up in the body and attaches to organs, forming a patch of tissue called a <a href="https://www.jeanhailes.org.au/health-a-z/endometriosis/symptoms-causes#">lesion</a>.</p>
<p>The condition can cause chronic pelvic pain, bowel and bladder dysfunction, and pain during sex. Painful symptoms can often make it hard for women to work or study, which has long-term socioeconomic impacts.</p>
<p>Unfortunately, women with endometriosis can wait up to <a href="https://academic.oup.com/humrep/article/27/12/3412/650946">10 years</a> for a diagnosis. But why does it take so long?</p>
<h2>Diagnosis is difficult</h2>
<p>Endometriosis can only be diagnosed through surgery, and in Australian public hospitals it is common to have to wait <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery">up to a year</a> for this procedure. This is partly because surgery for endometriosis is classified as category 3 - the lowest-priority elective surgery in Australia. </p>
<p>To diagnose the condition, lesions need to be surgically removed and analysed by a pathologist. The operation is performed by keyhole surgery, but it can have significant financial and health impact on sufferers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/endometriosis-costs-women-and-society-30-000-a-year-for-every-sufferer-124975">Endometriosis costs women and society $30,000 a year for every sufferer</a>
</strong>
</em>
</p>
<hr>
<p>Surgery costs are covered in public hospitals, but long wait times mean women who can afford it <a href="https://www.aihw.gov.au/reports/chronic-disease/endometriosis-prevalence-and-hospitalisations/contents/table-of-contents">are more likely to use private hospitals for endometriosis surgery</a> than for other diseases. </p>
<p>Then, to have a pathologist analyse the lesions removed during surgery and provide a diagnosis <a href="https://www.medibank.com.au/health-support/hospital-assist/costs/laparoscopy/">can cost A$5,546</a> with only <a href="http://www9.health.gov.au/mbs/search.cfm?q=endometriosis&Submit=&sopt=S?">a fraction covered by Medicare</a>, leaving patients out of pocket. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three surgeons over an operating table" src="https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351933/original/file-20200810-24-jchnld.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As there aren’t any non-invasive ways to diagnose all forms of endometriosis, women often suffer for longer than they need to.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Non-invasive imaging by ultrasound and magnetic resonance imaging (MRI) can often detect lesions on the ovary (endometrioma), and deep lesions that invade the bowel or bladder. But while this <em>indicates</em> endometriosis, lesions analysed by a pathologist are still considered the gold standard for a formal diagnosis. </p>
<p>Ultrasounds and MRIs also can’t detect lesions that are on the surface of organs (superficial) and are thought to be an early stage of the disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516">1 in 10 women with endometriosis report using cannabis to ease their pain</a>
</strong>
</em>
</p>
<hr>
<p>A prior lack of endometriosis research funding in Australia has hampered progress towards developing non-invasive screening tests. But newly developed tests may incorporate emerging evidence that endometriosis has several <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15894">distinct subtypes</a>, each with a specific diagnostic and treatment profile. Recognition of distinct subtypes has <a href="https://www.frontiersin.org/articles/10.3389/fonc.2011.00012/full">improved and informed the treatment of breast cancer</a>, and this might also be true for endometriosis. </p>
<p>Until such tests are developed, some clinicians are advocating for a <a href="https://doi.org/10.1016/j.ajog.2018.12.039">diagnosis based on symptoms instead of lesions</a>, but this hasn’t been standardised or validated yet.</p>
<h2>“It just comes with being a woman…”</h2>
<p>Normalisation of period pain means women often wait <a href="https://academic.oup.com/humrep/article/27/12/3412/650946">two to three years</a> from the onset of symptoms before seeking medical help. And public awareness of endometriosis and its symptoms are low. This explains why only <a href="https://academic.oup.com/humrep/article/27/12/3412/650946">38% of women</a> with suspected endometriosis present to their GP each year. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman choosing a sanitary pad from a box containing sanitary items." src="https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349547/original/file-20200727-37-149li07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A taboo around periods and the normalisation of period pain can mean women are silenced and suffer longer.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Even if a woman does present to her GP with symptoms, a lack of education in GPs and general gynaecologists can result in late referral and misdiagnosis. This can add more than <a href="https://doi.org/10.1016/j.rbmo.2018.09.006">two years</a> to a diagnosis journey. While Australian data is lacking, European women with suspected endometriosis have <a href="http://dx.doi.org/10.1016/j.rbmo.2016.02.003">very low rates of GP referral</a> for diagnostic testing (12%) or to a gynaecologist (44%).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-and-womens-diseases-its-common-and-important-to-include-mens-perspectives-78678">Sex and women's diseases: it's common and important to include men's perspectives</a>
</strong>
</em>
</p>
<hr>
<h2>Biases come into play</h2>
<p>In the diagnosis and treatment of endometriosis gender, race and socioeconomic biases come into play. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349545/original/file-20200727-37-jjgu8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Due to biases, salary, race and gender can impact the time it takes a woman to receive an endometriosis diagnosis.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>If a man reported to his general practitioner (GP) with severe pelvic pain, he would likely be sent for tests immediately. This is because there probably isn’t a “normal” underlying reason for his <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845507/">pain</a>. But in cases of endometriosis, pelvic pain can be confused with menstrual cramps, resulting in delays for further tests. </p>
<p>A woman’s annual salary may impact her diagnosis time too. Those who can afford private healthcare can access specialist gynaecologists quickly, and can avoid the long waiting lists for diagnostic surgery. </p>
<p>In fact,<a href="https://www.aihw.gov.au/getmedia/a4ba101d-cd6d-4567-a44f-f825047187b8/aihw-phe-247.pdf.aspx?inline=true">65% of endometriosis hospitalisations</a> in Australia are either self-funded or funded by private healthcare. But even with private healthcare, women with endometriosis pay, on average, <a href="https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0223316&type=printable">$3,670 a year in out-of-pocket expenses</a> for tests, treatments and surgeries. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-check-have-scientists-found-the-cause-of-endometriosis-120665">Research Check: have scientists found the cause of endometriosis?</a>
</strong>
</em>
</p>
<hr>
<p>Despite a having a similar disease incidence, <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15692">women of colour</a> are less likely to be diagnosed than Caucasians. In fact, <a href="https://www.aihw.gov.au/getmedia/a4ba101d-cd6d-4567-a44f-f825047187b8/aihw-phe-247.pdf.aspx?inline=true">Australian Indigenous women</a> are 1.6 times less likely to be admitted to hospital for endometriosis. This may be due to difficulty accessing health care, the costs associated with treatment, and cultural differences in health-seeking behaviour.</p>
<h2>Hope for the future</h2>
<p>The Australian government’s <a href="https://www.health.gov.au/resources/publications/national-action-plan-for-endometriosis">National Action Plan for Endometriosis</a> outlines a roadmap to overcome many of these diagnostic hurdles. </p>
<p>It was developed in consultation with the <a href="https://www.acendo.com.au/">Australian Coalition for Endometriosis</a> and includes public health campaigns and educational resources for both the general public and GPs. It also supports research into the innovation of new diagnostic tools and the development of centres of excellence for diagnosis and treatment of endometriosis. These centres will enable early access to specialised care and appropriate screening and diagnosis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman smiling slightly looking into a golden sky." src="https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349549/original/file-20200727-15-1is946x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Though the current research investment for Australian endometriosis research is only 0.2% of the annual cost of endometriosis in Australia it’s an important start to transform endometriosis patient outcomes.</span>
</figcaption>
</figure>
<p>The Action Plan was accompanied by the greatest investment to date in Australian endometriosis research by <a href="https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-endometriosis">Australian</a> and <a href="https://hudson.org.au/latest-news/us2-07-million-awarded-to-tackle-endometriosis/">international</a> funding bodies. </p>
<p>The current research investment (totalling A$14.55 million) for Australian endometriosis research is only 0.2% of the annual cost of endometriosis in Australia (A$7.4 billion). But it is an important start to transform endometriosis patient outcomes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-surgery-for-endometriosis-heres-what-you-need-to-know-102254">Considering surgery for endometriosis? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Steps to take if you think you have endometriosis</h2>
<ol>
<li><p>Know the many and varied <a href="http://endometriosis.org/endometriosis/symptoms/">symptoms of endometriosis</a>. Period pain that cannot be relieved by over-the-counter anti-inflammatories such as naprogesic is not normal. Nor is painful sex</p></li>
<li><p>document your menstrual cycle and symptoms – several apps are available, but a diary also works </p></li>
<li><p>ask your GP for a referral to a specialist endometriosis gynaecologist</p></li>
<li><p>if a pelvic ultrasound is needed, ensure it is done by a sonographer who specialises in detecting deep infiltrating endometriosis</p></li>
<li><p>if your concerns are not addressed, seek a second (or third) opinion.</p></li>
</ol>
<p><em>Transmen and non-binary people can also be affected by endometriosis. This community already experiences delays to healthcare, often exacerbated when they seek help for conditions not matching their outward gender.</em></p><img src="https://counter.theconversation.com/content/141803/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Gargett receives funding from National Health and Medical Research Council, Department of Defence (USA), Endometriosis Foundation of America, CASS Foundation, Ferring Research Innovation, Clue-Utopia Research Innovation </span></em></p><p class="fine-print"><em><span>Caitlin Filby receives funding from Endometriosis Foundation of America, Clue-Utopia Research Innovation and is currently supported by Department of Defence (USA). </span></em></p><p class="fine-print"><em><span>Fiona Cousins currently receives funding from the CASS Foundation and has previously been funded by Ferring Pharmaceuticals and the Medical Research Council.</span></em></p>Endometriosis affects 10% of women, but many live with painful symptoms of the condition for years without a diagnosis. A lack of non-invasive screening tools and normalisation of period pain both play a role in this.Caroline Gargett, NHMRC Leadership Fellow and Head of Women's Health Theme, The Ritchie Centre, Hudson Institute of Medical Research, Hudson InstituteCaitlin Filby, Postdoctoral Scientist, Endometrial Stem Cell Biology, Hudson InstituteFiona Cousins, Postdoctoral Research Scientist, Endometrial Stem Cell Biology, Hudson InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1187852019-06-28T09:47:10Z2019-06-28T09:47:10ZPeriod pain: don’t let it stop you exercising<figure><img src="https://images.theconversation.com/files/281749/original/file-20190628-94696-1h1ly7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/682028083?src=Bj7_iUZV3fr44dMZedfRTw-1-69&studio=1&size=medium_jpg">Jacob Lund/Shutterstock</a></span></figcaption></figure><p>Girls and women experiencing period pain often avoid physical activity, but our <a href="https://www.sciencedirect.com/science/article/pii/S1551714419300503">latest study</a> suggests that doing exercise might actually provide pain relief. </p>
<p>Period pain <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)63018-8/fulltext">affects</a> around 90% of women. It can interfere with daily life by limiting activity – and is a common reason for being absent from school or work.</p>
<p>During the menstrual period, the womb contracts to help expel its lining. Fatty substances called prostaglandins trigger these contractions. And more prostaglandins mean more severe cramps.</p>
<p>Cramps usually occur at the start of a menstrual period – or just before – and may continue for two to three days. In addition to pain, symptoms can include nausea, vomiting, tiredness, back pain, headaches, dizziness and diarrhoea.</p>
<p>Most women rely on over-the-counter drugs for pain relief, including ibuprofen (an anti-inflammatory) and paracetamol (an analgesic). Doctors can also prescribe oral contraceptive pills to decrease pain and relax the muscles. However, these drugs don’t provide everyone with pain relief and – like all drugs – they have side effects.</p>
<p>Physiotherapy is also sometimes recommended as a treatment for period pain. When we <a href="https://www.sciencedirect.com/science/article/pii/S1836955314000046">reviewed</a> the evidence of physiotherapy we found single trials to support the use of heated abdominal patches, TENS (an electronic device that emits a mild electric current) and yoga. Acupuncture and acupressure, when compared with a placebo, weren’t found to be effective.</p>
<h2>Lack of evidence</h2>
<p>When conducting our review, we didn’t find a single trial that looked at exercise as a therapy for period pain, so we conducted <a href="https://www.sciencedirect.com/science/article/pii/S1551714419300503">our own</a>. We recruited 70 women who regularly experienced period pain and randomly allocated them to an aerobic exercise group or a control group (they managed their pain as they normally would). </p>
<p>Pain was measured on a scale ranging from zero (no pain) to 100 (unbearable pain). At the start of the study, women in both groups experienced moderate pain (60, on average). But, at the end of the seven-month trial, women in the exercise group reported mild pain – 22 points less than women in the control group. Experts consider a 20-point reduction in pain to be “<a href="https://insights.ovid.com/article/00006396-200111000-00006">clinically important</a>”.</p>
<p>The women in the exercise group also experienced a statistically significant improvement in their quality of life and their daily functioning, such as going to work or climbing stairs. </p>
<p>Exercise has what is known as a “<a href="https://jamanetwork.com/journals/jama/article-abstract/207060">dose response</a>”: the more you do, the greater the health benefits. We do not know yet if this also applies to period pain. For our study, we prescribed aerobic exercise at 70-85% of women’s highest heart rate for 30 minutes, three times a week, with appropriate warm-up and cool-down exercises. This is pretty intense. It might be possible that pain relief could be achieved with exercise at a lower “dose”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280958/original/file-20190624-97799-1wdh7la.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exercise may have a dose response.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/141941632?src=YnWS8QKy1gUbCLWby8XQtw-1-65&studio=1&size=medium_jpg">Monkey Business Images/Shutterstock</a></span>
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<p>The findings from a recent <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306987718308909">pilot study</a> conducted in Hong Kong chime with our own. Researchers found that women who exercised had decreased prostaglandin and pain compared with women who did not exercise. The researchers are now planning a bigger study to confirm these findings.</p>
<p>All these findings suggest that, rather than avoiding PE or the gym, girls and women might want to consider getting involved to see if they provide some pain relief. After all, there’s nothing to lose.</p><img src="https://counter.theconversation.com/content/118785/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exercise can help relieve period pain.Leica Sarah Claydon-Mueller, Senior Lecturer, Anglia Ruskin UniversityPriya Kannan, Assistant Professor, Hong Kong Polytechnic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890352017-12-21T19:08:18Z2017-12-21T19:08:18ZWhat happens to endometriosis when you’re on the pill?<figure><img src="https://images.theconversation.com/files/200321/original/file-20171221-17746-18ppccs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When it comes to managing endometriosis, what works for one woman may not be the best choice for another.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/L1kLSwdclYQ"> Imani Clovis</a></span></figcaption></figure><p>Between 1% and 10% of Australian women have <a href="https://www.ncbi.nlm.nih.gov/pubmed/28444957">endometriosis</a>, a condition where the tissue that normally lines the uterus, the endometrium, grows outside the womb. </p>
<p>There is typically a delay of six to seven years between <a href="https://www.ncbi.nlm.nih.gov/pubmed/21718982">first symptoms and diagnosis of endometriosis</a>. The disease is most commonly progressive, so if women have symptoms and it goes untreated, it may grow and worsen.</p>
<p>The only way to definitively diagnose endometriosis is through key-hole surgery or laparoscopy, where a surgeon examines the pelvis for signs of the disease. This invasive procedure requires general anaesthesia and hospitalisation. </p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
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<p>Many women with period pain, especially adolescents, who <em>could</em> have endometriosis but don’t have a (laparoscopy-confirmed) diagnosis are prescribed the pill to reduce their pain. These women may only be diagnosed with the disease once they stop taking the pill and their symptoms return or increase.</p>
<p>While early diagnosis is ideal, endometriosis is thought to be less likely to progress while women are taking the pill, making a delayed diagnosis less worrying. </p>
<p>But when it comes to managing endometriosis, not all contraceptives are equal. And what works for one woman many not be the best choice for another.</p>
<h2>What causes endo pain?</h2>
<p>Most women experience “retrograde menstruation”, when menstrual blood and endometrial cells move back up the fallopian tubes and into the abdomen. In women with endometriosis, the endometrial cells <a href="https://www.ncbi.nlm.nih.gov/pubmed/20573927">attach to pelvic or abdominal organs</a> – including the ovaries, bladder and bowel – and start to grow. </p>
<p>During menstruation, these “rogue” endometrial cells form lesions that bleed in the same way as the lining of the uterus. This results in a vicious cycle of inflammation and scarring within the abdomen which causes infertility, painful periods, painful sex and persistent pelvic pain that lasts throughout the menstrual cycle.</p>
<p>Endometriosis can be difficult to diagnose, particularly in its early stages. While the disease is common, many women have painful periods that are <em>not</em> caused by endometriosis. The only way to tell for sure is to have surgery, which women are rightly reluctant to commit to unless symptoms become severe. </p>
<h2>Contraceptive treatments</h2>
<p>Pain from endometriosis can be treated surgically by removing the lesions. If it is all removed or destroyed, then 80% of women will experience improvement in their pain symptoms. Endometriosis will regrow in <a href="https://www.ncbi.nlm.nih.gov/pubmed/12923150">about one-third of women</a> over the next five years, so multiple surgeries may be needed.</p>
<p>In women with infertility, there is almost a doubling of natural pregnancy rates after surgery for endometriosis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-arent-responsible-for-endometriosis-nor-should-they-be-expected-to-cure-themselves-24223">Women aren't responsible for endometriosis, nor should they be expected to cure themselves</a>
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<p>An alternative approach is to use <a href="https://www.ncbi.nlm.nih.gov/pubmed/27817837">hormonal contraceptives</a> to <a href="https://www.ncbi.nlm.nih.gov/pubmed/24366116">suppress menstruation</a> or replace it with a milder version of menstruation, called a “withdrawal bleed”. Suppressing menstruation stops the lesions bleeding and prevents new endometrial cells reaching the abdomen. </p>
<p>The most common form of hormonal contraceptive is the combined oral contraceptive pill, which contains oestrogen and a progesterone-like hormone, progestin. The pill is <a href="https://www.ncbi.nlm.nih.gov/pubmed/16006440">safe to use</a> in the long term, doesn’t cost much, is generally well tolerated, and also protects against pregnancy.</p>
<p>The combined pill is often prescribed as the first line of treatment, with the aim of reducing pain. If it controls symptoms (pain), then the assumption is that underlying disease is not progressing. </p>
<p>Withdrawal bleeds while on the combined pill are generally much lighter than regular periods. They don’t involve significant endometrial shedding, which in theory reduces the risk of endometriosis. </p>
<p>If the combined pill is taken continuously without the sugar pills, some women’s menstrual bleeds stop altogether. This can <a href="https://www.ncbi.nlm.nih.gov/pubmed/27817837">reduce or eliminate</a> period pain and, hopefully, control the disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200325/original/file-20171221-17738-1miacp4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some women are more affected by the side effects of the pill than others.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/767017978?src=ZDhRzxojtmRXx3o8k7uDAA-1-71&size=medium_jpg">Fongbeerredhot/Shutterstock</a></span>
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<p>However, endometriosis is an oestrogen-dependent disease. So, taking oestrogen and having regular hormone exposure with monthly bleeds could result in ongoing pain symptoms and disease progression. If this is the case, progesterone-only pills are another option. </p>
<p>Progesterone-only pills such as Microlut, Provera, Dimetriose and Visanne contain progestin and no oestrogen. They suppress endometrial growth and often stop menstruation. </p>
<p>But they don’t suit everyone. Some women report <a href="https://www.ncbi.nlm.nih.gov/pubmed/22419284">significant side effects</a> from progesterone-only pills, such as changes in mood, fluid retention (bloating, weight gain, breast enlargement), reduced libido, increased hair growth, oily skin and acne. The side effects vary, depending on the type of progestin, and the woman’s individual reaction. </p>
<p>Another option is the Mirena intra-uterine device (IUD), which releases progestins directly into the uterus. It is highly effective at stopping uterine endometrial growth and reducing menstruation. </p>
<p>A possible side effect is unpredictable bleeding and spotting, which some women find unacceptable. </p>
<h2>What we don’t know</h2>
<p>There is a shortage of good evidence-based science around the use of the pill to treat endometriosis symptoms. Much of what we know is based on an understanding of how hormones drive endometrial growth, coupled with practical clinical experience and observation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pregnancy-doesnt-cure-endometriosis-so-where-does-this-advice-come-from-88951">Pregnancy doesn't 'cure' endometriosis, so where does this advice come from?</a>
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<p>We presume that long-term suppression of menstruation with the pill halts the progression of endometriosis. Unfortunately, a good clinical trial investigating this would be impossible to run since it would include doing laparoscopies on some women who don’t have symptoms, which would be unethical. </p>
<p>We also suspect, but don’t know for certain, that once significant scarring and damage has occurred due to ongoing disease, the pill is much less likely to be effective in suppressing symptoms. </p>
<p>If the pill is effective in controlling symptoms, women may only be diagnosed with endometriosis once they stop taking it. This creates a paradox whereby treating young women for their pain results in a delay in diagnosing the disease. But because endometriosis is less likely to progress while women are taking the pill, such a delay is less worrying than if the symptoms went unmanaged. </p>
<p>Ultimately, individual variability plays a large role in the symptoms women experience with endometriosis and the response to the various contraceptives available on the market. So it’s important to discuss the best course of treatment with your doctor. </p>
<p>You may need to shop around to find a GP or gynaecologist who specialises in treating endometriosis. Don’t be afraid to ask how much they know about the disease and their attitude towards various treatments to see if they’re the right fit for you.</p><img src="https://counter.theconversation.com/content/89035/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Rogers receives funding for endometriosis research from NHMRC and NIH. He is a Board Director for the Jean Hailes and acts as a consultant for Bayer AG.</span></em></p><p class="fine-print"><em><span>Premila Paiva receives research funding from Endometriosis Australia and the Royal Women’s hospital Foundation.</span></em></p><p class="fine-print"><em><span>Martin Healey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many women are prescribed the pill without a definitive diagnosis of endometriosis.Peter Rogers, Professor of Women’s Health Research, Department of Obstetrics and Gynaecology, & Director of Research, Royal Women's Hospital, The University of MelbourneMartin Healey, Clinical Associate Professor in the Department of Obstetrics and Gynaecology, The University of MelbournePremila Paiva, Senior Research Fellow in the Department of Obstetrics and Gynaecology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/622902017-02-06T01:00:57Z2017-02-06T01:00:57ZHealth Check: are painful periods normal?<figure><img src="https://images.theconversation.com/files/148355/original/image-20161202-25689-1kfvw51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The majority of women experience some cramping for one to two days in their periods.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>The experience of having periods varies between women. They can be light and completely painless for some, but completely debilitating for others.</p>
<p>The majority of women experience some cramping for one to two days during their period, and this is normal. Teenage girls are also more likely to suffer from painful periods compared to adult women, <a href="https://www.acog.org/-/media/For-Patients/faq046.pdf">particularly adult women who’ve had children</a>. But painful periods in adolescence usually improve over time.</p>
<p>However, some women have period pain that isn’t easily managed and that requires them to take time off school or work. Pain to this extent is not normal, and needs to be investigated.</p>
<h2>Why periods cause pain</h2>
<p>A period is the shedding of the endometrium - the lining of the womb (uterus). Every month, the uterus prepares itself for pregnancy by growing a thick lining that has a rich blood supply, awaiting implanting of an embryo.</p>
<p>When pregnancy does not ensue, the body produces a period, the by-product of the endometrium. During this time the blood vessels open, the lining sheds off the uterine wall, and the uterine muscle contracts to expel the blood and tissue. </p>
<p>During these mild contractions, it’s common for women to feel a lower abdominal cramping sensation as blood products are expelled through the uterine body and out of the cervix before it makes it way out the vagina.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150846/original/image-20161219-24284-sgag4y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A period is the shedding of the lining of the womb (uterus), called the endometrium.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>The contractions are <a href="http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/basics/causes/con-20025447">triggered by hormone-like compounds</a> produced by the body called prostaglandins, which are the main source of pelvic pain associated with menstruation. Higher levels of prostaglandins have been associated with more severe menstrual cramps.</p>
<p>Cramping is usually strongest in the first one to two days of the period, then settles for the remaining four to five days.</p>
<p>Pain during periods is called dysmenorrhoea, and there are two types: primary and secondary. </p>
<p>Primary dysmenorrhoea refers to pain with periods, that begins soon after girls start menstruating. This tends to get better as the teenager gets older. The cause of this pain is not known, but <a href="http://www.aafp.org/afp/1999/0801/p489.html">hormonal fluctuations</a> are thought to be implicated. </p>
<p>The main medications used to treat this pain are non steroidal anti-inflammatory drugs (NSAIDs), such as <a href="https://theconversation.com/weekly-dose-ibuprofen-just-because-its-freely-available-doesnt-make-it-safe-56346">ibuprofen</a> (Nurofen) or naproxen (Naprogesic). They work by blocking the action of prostaglandins. </p>
<p>Secondary dysmenorrhoea generally refers to period pain resulting from a medical disorder in the reproductive system. Instead of period pain improving over time, it worsens. This can be due to several conditions, the most common of which is endometriosis.</p>
<h2>What is endometriosis?</h2>
<p>Endometriosis is a condition in which tissue similar to the lining the endometrium (womb), grows outside of the womb. It can grow on the ovaries, bowel, and in some rare cases has even been found outside of the pelvis such as the lungs. The hormones that trigger a period cause bleeding at these sites of implanted endometrial tissue, and this causes pain. </p>
<p>Endometriosis usually causes period pain to start earlier and last longer than what is commonly experienced with menstruation. Sometimes the pain doesn’t go away when the period ends. Women with endometriosis can describe pain at the the time of ovulation, or pain with sex. Another problem associated with endometriosis is <a href="https://jeanhailes.org.au/health-a-z/endometriosis/fertility">infertility</a>.</p>
<p>It is a common condition <a href="http://www.tandfonline.com/doi/abs/10.1080/01674820400002279">affecting 16% to 61% of women</a> of reproductive age experiencing symptoms. An estimated <a href="https://www.us.elsevierhealth.com/robbins-basic-pathology-9781437717815.html">100 million women worldwide</a> suffer from endometriosis. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150856/original/image-20161220-24274-10wp1jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The oral contraceptive pill is often used to help with endometriosis symptoms.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Women themselves may be unaware of endometriosis, or think their pain is normal. Many tend to tolerate the pain, which is can also <a href="http://qhr.sagepub.com/content/18/4/522.abstract">occur in teenagers</a> and young adults. </p>
<p>Although the exact <a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1000274">cause of endometriosis is unknown</a>, there are a number of theories such as retrograde (opposite to the intended direction) flow of endometrial tissue out of the womb through the fallopian tubes, and this tissue can implant in the pelvic cavity in locations outside of the womb.</p>
<p>The way nerves interpret pain in the pelvis also plays a role. It is an unusual disease in that some women can have a lot of endometriosis and have very few symptoms, whereas others can have only a small amount of disease and suffer from quite severe symptoms. </p>
<p>Affected girls and women often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860000/">face negative impacts</a> on their education or careers. There may be reduced productiveness at work or study as a result of the pain and discomfort caused by endometriosis. </p>
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<p><em><strong>Further reading: <a href="https://theconversation.com/women-with-endometriosis-need-support-not-judgement-37340">Women with endometriosis need support, not judgement</a></strong></em></p>
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<p>Treatment includes hormonal tablets such as the oral contraceptive pill. The progestogen implant or intrauterine device, are also helpful for some in reduction of pain with periods. But these treatments don’t work for everyone.</p>
<h2>How will I know if I have endometriosis?</h2>
<p>Diagnosis of endometriosis can only be made via keyhole surgery. If it is seen surgically, and removed, women <a href="https://www.ncbi.nlm.nih.gov/pubmed/15482763">often have an improvement</a> in their symptoms. But symptoms can return. Although it is not a deadly disease, the disruption it causes to women and society can be distressing – and as it is chronic, persisting throughout the woman’s menstrual life.</p>
<p>One <a href="http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0412.2003.00168.x/abstract">study found an average delay</a> of nearly four years before women with endometriosis sought medical help for their symptoms, and this delay brings about much anxiety and distress over the uncertainty of their own condition and how it can be resolved.</p>
<p>Many women are told their period pain is normal, but at keyhole surgery <a href="http://www.sciencedirect.com/science/article/pii/S0029784402027230">a number of these women</a> with pelvic pain actually have endometriosis. However, making a decision to pursue surgery is a difficult one, as this carries minor risks such as bladder, bowel and vessel injury as well as anaesthetic risks. Care for women needs to be individualised in terms of whether the risks of surgery outweigh the symptoms experienced.</p>
<p>There are a number of different conditions which contribute to period pain. These include pain from the intestines, bladder and kidney, muscles and bones (including hip and back pain). There are also conditions that cause pain from the nerves in the pelvis and back. </p>
<p>Psychological conditions <a href="https://www.ncbi.nlm.nih.gov/pubmed/21801301">can also be responsible</a> for or contribute to <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2007.01530.x/abstract">pelvic and period pain</a>. </p>
<p>If you have severe period pain affecting your school, work, or quality of life then you should seek help, by first consulting your GP.</p><img src="https://counter.theconversation.com/content/62290/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Deans receives funding from AGES as part of research grants</span></em></p>Period pain usually begins soon after a girl starts menstruating, but commonly gets better as she gets older.Rebecca Deans, Paediatric and adolescent gynaecologist at Royal Hospital for Women and Sydney Children's Hospital, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.