Severe period pain - is endometriosis the cause?

If a woman is in a lot of pain or has cramps in her lower belly, it might be caused by severe period pains or an illness.

Fibroids are a common cause of pain in the lower belly. Other possible causes are growths, surgical scars or inflammation of the fallopian tubes. Pain during sex, or bowel problems, nausea and vomiting, could be a sign of endometriosis. Pain when urinating may also suggest endometriosis.

What is endometriosis?

The term endometriosis comes from the word “endometrium,” the lining of the womb. In endometriosis, this tissue also grows outside of the womb, usually in the lower belly or pelvis. Endometrial tissue can grow on the outside of the womb or in the wall of a fallopian tube. It often also affects the ovaries, the connective tissue in the pelvis, and the space between the womb and the intestines. It is not exactly clear why it happens.

Like the tissue inside the womb, the “endometrial implants,” as they are called, also react to hormones and thicken throughout the menstrual cycle and are then shed together with blood. But unlike menstrual bleeding, the detached tissue cannot leave the abdomen through the vagina.

This can cause infections, cysts and adhesions. The pain will vary depending on where they develop. Some women’s bodies will remove the tissue without them noticing, though.

What are the signs of endometriosis?

Endometriosis often causes cramp-like pain and can spread from the lower belly to the back and the legs. It may also cause nausea, vomiting or diarrhea. The symptoms often occur during a woman’s period, but that is not always the case.

The signs of endometriosis differ depending on where the endometrial tissue is. For example, endometrial implants growing in the muscle layers of the womb stop it from contracting properly. Women will then usually have heavy and long periods. Endometriosis of the ovaries or fallopian tubes often affects fertility. Endometrial implants near the vagina or the bowels can cause pain during sex.

Everyday life with endometriosis

Severe endometriosis can have a big impact on quality of life and everyday abilities, and might even stop some women from getting pregnant. Frequently recurring pain can get you down and make you irritable and tired. Very severe symptoms make normal daily life impossible.

Pain during sex also affects relationships, because most women have less sexual desire and many avoid sex. Both partners often start to feel guilty.

Treatment is worth it

Even though endometriosis is so common, a lot of the time it is diagnosed very late. Many women think that they just have very painful periods. They often only go to see a doctor if the pain starts when they are not on their period or if they cannot get pregnant. Endometriosis can generally be treated with painkillers, hormonal contraceptives or stronger hormone products. While painkillers only relieve symptoms, hormonal treatments can slow down the growth of the endometrial implants.

Surgery may also be an option for some women. It is difficult to predict how endometriosis will develop. It rarely disappears on its own, but after menopause it will usually go away for good.

You can find detailed information about endometriosis and possible treatments at

Photos: Panthermedia:
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Updated on December 17, 2019

Next planned update: 2021


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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