Q: I have very painful periods. Could it be more than menstrual cramps?

Ask Our Expert About Painful Menstruation

About Our Expert

Joseph Patruno, M.D. is a
gynecologist and pelvic pain specialist at Lehigh Valley Health Network.

 

Practicing Medicine Since

1999

Education

B.A. in Psychology, 1989, Dickinson College
M.D., 1995, Brown University School of Medicine, Providence, RI

Residency in Obstetrics and Gynecology

Pennsylvania State University - Milton S. Hershey Medical Center

Board Certification

Board certified in Obstetrics and Gynecology

Teaching Awards

Outstanding Preceptor Award: Department of Family Medicine, ChristianaCare, 2005

CREOG National Faculty Teaching Award, 2003

Jefferson University Faculty Excellence in Teaching Award, 2004, 2005

Penn State University Teaching Award presented by Senior Class, 1997, 1998, 2000, 2001

Berlex Junior Faculty Development Award, 2001

APGO Solvay-Scholar Award 2000

APGO Excellence in Teaching Award, 2000, 2004

Administrative Chief Resident, 1998-1999

Outstanding Resident Teaching Award in Obstetrics and Gynecology, 1996, 1998

Parke-Davis APGO-CREOG Scholarship, 1998

Berlex Laboratories Resident Teaching Award, "Best Second Year Teaching Resident," 1997

 

• I have very painful periods. Could it be more than menstrual cramps?
  
• Are there other symptoms?
  
• How is endometriosis diagnosed?
  
• What is the treatment?
  
• I’ve heard symptoms ease during pregnancy and menopause. Is this true?

Q: I have very painful periods. Could it be more than menstrual cramps?

A: While pain during menstruation could indicate several conditions, the most common gynecologic cause is endometriosis. This condition occurs when functioning endometrial cells, normally found within the uterus, back up into the pelvis. These cells may attach to your ovaries, fallopian tubes, outer wall of your uterus and even other organs such as the bowel and bladder. The cells respond to hormones which are highest around the time of your menstrual period. When endometriosis is stimulated it leads to bleeding, inflammation, and eventually scarring within the abdominal cavity.

Q: Are there other symptoms?

A: Endometriosis can cause pain before and during periods. Other symptoms common to women with endometriosis include heavier menstrual periods, pain with intercourse (dyspareunia) and often infertility. Depending on the organs affected by lesions, you can also experience painful bowel movements, discomfort with urination, or lower back or leg pain during menstruation. Endometriosis, if left untreated can lead to chronic abdomino-pelvic pain that does not correspond to menstrual cycles. Interestingly, the severity of the pain does not necessarily correspond to the size or number of lesions.

Q: How is endometriosis diagnosed?

A: If your doctor suspects endometriosis, he or she will do a pelvic exam, feeling for tenderness and any endometrial lesions. Not uncommonly the pelvic exam reveals no significant findings. Similarly, the condition is rarely confirmed through blood tests or radiographic studies such as ultrasounds or CAT Scans. The only way to truly diagnose endometriosis is through laparoscopy—a minor surgical procedure. The doctor inserts a camera through a tiny incision in your abdomen; moving the laparoscope around, he checks for signs of endometrial extent of the disease. Additionally, endometriosis can be excised or removed at the time of this procedure. This often leads to improvement in pain symptoms and fertility.

Q: What is the treatment?

A:

Drug Treatment
At times over-the-counter pain relievers work well enough in controlling the pain of endometriosis. If your endometriosis is severe, your doctor may prescribe hormone therapy. Since endometrial cells are activated by ovulatory hormones, oral contraceptives and Depo-Provera injections, which suppress these hormones, are often effective in controlling pain and perhaps the progression of the disease. Birth control pills may be prescribed in such a way that women do not have monthly periods alleviating the monthly (cyclic) pain that many women with endometriosis must endure. Another medical option to treat endometriosis is monthly injections of DepoLupron, for three to six months. This agent induces a temporary state of menopause which leads to both short-term and long-term pain relief in many patients. A number of new medical treatments are being developed and evaluated as potential treatments for endometriosis which should become available in the near future.

Surgical Treatment
If you have infertility or severe pain, especially if it’s not responsive to drug therapy, your doctor may recommend laparoscopic surgery to identify and remove lesions. The surgeon’s goal is to remove all the endometrial lesions that can be safely removed and restore the pelvic anatomy to its normal appearance. In patients who no longer desire fertility, more definitive surgery might be recommended and include the removal of the uterus and one or both ovaries to treat endometriosis related symptoms.

Q: I’ve heard symptoms ease during pregnancy and menopause. Is this true?

A: With the hormonal changes in pregnancy, many pregnant patients with endometriosis describe less pain. Similarly, menopause, which leads to diminished hormone levels, also results in improvement in endometriosis for the same reason—you’re not ovulating or menstruating. It is controversial as to whether the use of hormone replacement therapy leads to re-activation of endometriosis in women who have undergone menopause.

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