Learn the Difference Between Painful Periods, Endometriosis and IBS

If you have pain in your pelvic area, it may be difficult to know what’s causing your discomfort. Maybe you feel nauseous or constipated, or have diarrhea. You may have mild to severe cramping during your period. Or perhaps you have pain during intercourse or during a bowel movement. These symptoms can range from inconvenient to incapacitating, and the causes can vary as well.

PMS and Painful Periods

It’s not uncommon to have the discomfort of premenstrual syndrome, or PMS, around the time of your period. More than 50 percent of women who menstruate say they have some kind of pain one to two days each month. During your period, hormone-like substances cause your uterus to contract so it can shed its lining. This contraction is what causes cramping.

Pain and other symptoms, such as nausea, constipation and diarrhea, can occur before your period starts. Additionally, you may have emotional discomfort before your period, including anxiety, depressed mood, irritability and moodiness. These symptoms usually dissipate after your period begins.

This cyclical timing helps distinguish PMS from other conditions. But while some pain during periods is common, if over-the-counter medication such as ibuprofen is ineffective and your symptoms prevent you from doing regular daily activities, it’s time to talk with your doctor.

Endometriosis

Unlike PMS, pain from endometriosis is not caused by contractions of the uterus. Instead, it occurs when cells from the uterus are implanted outside of the uterus, sometimes in the pelvic cavity, bowel or bladder. The implantation causes inflammation, which in turn creates pain.

Pain during your period is the most common sign of endometriosis, but you may also feel pain during intercourse, a bowel movement or urination. You may have irregular cycles, with a period every two or six weeks, or even skipping entire months. In general, the pain of endometriosis is cyclical, which is one way to distinguish it from other conditions, such as irritable bowel syndrome (IBS). However, some women with endometriosis have constant pain.

Endometriosis is a tricky condition because its symptoms are similar to other conditions, and some women may not realize that their “bad periods” are not normal, but symptoms of a more serious condition.

While endometriosis cannot be prevented, it can be treated. Hormone therapy, such as hormonal contraceptives (i.e. birth control pills, injections, patch or ring), inhibit ovulation to suppress the secretion of hormones. Another type of medicine, a GnRH agonist, works in the brain to inhibit stimulation of the ovaries. This powerful medicine is only given after a diagnosis of endometriosis is made through surgery, when the doctor can clearly see signs of inflammation and scarring.

Pregnancy also has the side effect of suppressing the ovaries. Although endometriosis can cause scarring in the Fallopian tubes, possibly making it more difficult to get pregnant, the condition does not affect the pregnancy once it occurs.

The removal of the ovaries and uterus is the ultimate way to treat endometriosis. This option is not usually recommended for younger patients, but may be suitable for older patients who no longer plan to become pregnant.

IBS

While its symptoms can be felt in the pelvic area, IBS affects the large intestine, causing abdominal cramping, bloating, constipation and diarrhea. Unlike painful periods and most cases of endometriosis, the pain from IBS doesn’t coincide with your period. Instead, its symptoms may appear as frequently as several times a week and continue over the course of months. IBS may be diagnosed if you have abdominal pain that overlaps with your bowel movements (i.e. more or less pain after a bowel movement, and changes in the appearance or frequency of your bowel movement).

Dietary and lifestyle changes, medicines to treat symptoms, probiotics and mental health therapies are used to help manage IBS.

Whether your pelvic area pain comes from your period, endometriosis, IBS or another condition, it’s time to get answers. If pain keeps you from living your life, make an appointment to talk with your gynecologist today.