Painful Periods, Painful Sex – Endometriosis, the Silent Dis-ease.

176 million women have been diagnosed with endometriosis, a debilitating illness that can leave a woman in excruciating pain, create infertility and affect the fabric of her life both physically and emotionally.  Impacting a woman’s ability to live pain-free on a daily basis creates issues around her womanhood, being a supportive partner, mother, friend and contributing member of society.  Although this number may seem low in the grand scheme of existing illnesses, it is estimated the numbers are truly 90% of women are suffering from a mild to severe form of endometriosis with only 10% experiencing symptoms or effects of its mysterious nature. The severity of pain is not a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or experience no pain at all.

Endometriosis (en-doe-me-tree-O-sis) is often associated as being a painful condition in which the endometrial lining of the uterus grows outside your uterus  (known as an endometrial implant) and attaches onto reproductive organs, the bowels and/or the pelvic cavity.  In endometriosis, displaced endometrial tissue (known as lesions) continue to act as they normally would during menstruation by thickening, breaking down and bleeding with each menstrual cycle. In essence, once a women is in her menstrual cycle or in ovulation, she may begin to experience mild discomfort to severe pain as those lesions attempt to menstruate from their migrated location.  Unable to expel itself from the body, the surrounding tissue can become irritated.  Lesions growing inside the pelvic cavity can create adhesions in the pelvic wall and organs, fusing them together like cobwebs. These adhesions can create scar tissue causing irreparable damage if not detected early.

When endometriosis affect the ovaries, cysts called endometriomas (also know as chocolate cysts) may form.  These fluid-filled sacs develop directly on the ovaries and contain old blood that was unable to expel during menstruation.

More often than not, endometriosis is not immediately diagnosed. Pelvic pain can have many different causes and endometriosis can often disguise itself as bowel obstruction, appendicitis, ovarian cysts, ectopic pregnancy, pelvic inflammatory disease, diverticulitis, fibroids, IBS and many others masking the conditions. It is important to address this with your doctor as soon as possible if you experience any or all of the following symptoms:

  • Painful Periods (dysmenorrhea): The first sign, although not acknowledged often enough, is painful menstruation.  A woman’s monthly cycle is not meant to be painful – period. Some women have become so accustomed to the pain, it has become a societal expectation.  The result is silent suffering using painkillers to have a pain-free quality of life. The pain however can become worse over time to the point where a woman is unable to carry on her normal daily duties and in extreme conditions may faint.
  • Painful Sex ( dyspareunia): Pain during or after sex is another indication.  Sex is meant to be enjoyable, not painful!
  • Painful Bowel movements or urination:  These symptoms can often disguise themselves as attributes of a woman’s monthly menstrual cycle or IBS. 
  • Infertility: Often the most commonly diagnosed time for endometriosis is when a woman discovers she is unable to conceive and is in seek of assistance/treatment.
  • Excessive bleeding: A woman may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).

Endometriosis is a non-contagious condition that has many undetermined theories as it relates to the cause of the illness. Why one woman develops endometriosis over another still remains a mystery:

  • Retrograde Menstruation: This was once thought to be the reason but has proven to be incorrect. The theory indicates retrograde menstruation, as mentioned previously is blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. 
  • Embryonic cell growth: The cells lining the abdominal and pelvic cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop. 
  • Endometrial cells transport: The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Surgical scar implantation: After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Immune system disorder: It is possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.
  • Estrogen/progesterone in the body:  Hormonal imbalances are the leading causes of the progression/stability of the growth of Endometriosis.  Arguments have led to the effects of the birth control pill and its influence on endometriosis which usually is a hidden factor during ovulation since it prevents the egg from releasing into the uterus.  When a woman is pregnant all development and symptoms cease due to the hormones in the body, however the condition may present itself after birth if she is not on any hormones (making room for hormone imbalance) or is on hormones for contraception (making the illness).
  • In Utero: Studies suggest Endometriosis could be linked genetically in the female fetus when formed in utero and may have acquired the endometrial cells from birth.

In the next instalments we will explore the complications, forms of treatment, nutritional changes and emotional aspects of Endometriosis.  Remember to consult your physician regarding any signs or symptoms you may be experiencing.  Although this article is designed to provide a general overview, it is important to be proactive in your own self-care so that you are making the right choices for your lifestyle and overall well-being.

Northrup, Christiane. Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing. New York: Bantam, 1998. Print.
The Mayo Clinic
Endometriosis Research Center 
World Endometriosis Research Foundation
Endometriosis Foundation of America
Endometriosis Association

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Nadine M. Woods
Nadine M. Woods' postnatal experience has inspired the education and awareness philosophy of the Maternal Goddess Organization. As a communications professional, combined with her search for information post birth, she now dedicates herself to enhancing the culture surrounding postnatal maternal health. With a focus on the woman’s experience of motherhood, Nadine is a strong advocate of understanding the recovery period in a healthy and realistic way. By connecting women to important resources, she believes a well-prepared supportive family, creates a strong mother whose impact extends to a deeper connection with herself as a woman, her children and her partner. Nadine is also the founder and head designer for Mayana Genevière Inc. A socially responsible intimate apparel lifestyle brand dedicated to embracing the beauty of postnatal recovery.
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