Endometriosis is a condition that affects one in 10 women, according to the Royal College of Nursing. Although it can often be very painful, its symptoms and their severity can vary considerably, which sometimes makes it difficult for those with the condition to realise they could benefit from seeking treatment. Endometriosis symptoms occur because tissue similar to that which lines the inner surface of the womb begins to grow elsewhere, such as on the ovaries, fallopian tubes, bowel and tissues lining the pelvis.
Some of the symptoms of endometriosis may at first seem to overlap with normal symptoms that occur during the menstrual cycle. This is because menstruation affects women differently; some experience longer periods or heavier bleeding, some experience bloating or lower back pain while others do not. This means it is important to be aware of what is normal for you, so you can more easily identify when things feel different.
Endometriosis symptoms can also overlap with symptoms of other conditions, such as pelvic inflammatory disease or irritable bowel syndrome. This is because symptoms vary according to where the excess tissue growth is located. Common endometriosis symptoms include:
Of these symptoms, excessively heavy periods is often one of the hardest to judge. While every woman’s menstrual cycle differs slightly, there is some general guidance on what is normal.
The average menstrual cycle lasts 28 days from the first day of one period to the first day of the next. However, a menstrual cycle can be as short as 21 days or as long as 40 days. Some women experience PMS (premenstrual syndrome) as part of their menstrual cycle, which includes symptoms such as breast tenderness, headaches, mood swings, tiredness, bloating and changes in sex drive and appetite. PMS usually goes away once a period starts.
A period refers to the time during a menstrual cycle when you bleed from your vagina. This can last for three to eight days, with the bleeding being heaviest for the first two days. The colour of the blood can change from red during the heaviest days of bleeding to pink, brown or black as the bleeding lessens. On average, women lose 30–72ml of blood during a period. This is equivalent to five to 12 teaspoons of blood. A heavy period is generally considered to be the loss of 80ml or more of blood during a period and/or a period lasting seven or more days.
On a practical level, signs you can look out for that your period is excessively heavy include:
Not in all cases. According to the NHS, the cause of heavy periods is unknown in about half of women. For the remaining women with heavy periods, endometriosis is only one potential cause. Other conditions that can cause heavy periods include fibroids, pelvic inflammatory disorder and adenomyosis. In post-menopausal women, vaginal bleeding can also be a sign of cancer of the womb.
Certain medicines, namely anti-coagulants, can also increase bleeding during a period as can an IUD (intrauterine contraceptive device) or coil in the initial three to six months after insertion.
Treatment for heavy periods
Heavy periods can negatively impact your lifestyle, cause anxiety and in some instances lead to anaemia. Depending on how heavy your periods are, there are several treatment options available. One common treatment is the use of an intrauterine system (IUS), which is a small device inserted into the womb that releases the hormone progestogen. There are also medicines without hormones, such as non-steroidal anti-inflammatory drugs (NSAIDS), and medicines with hormones, such as progestogen tablets or the combined oral contraceptive pill.
If these treatments are not successful, there are also surgical options, including endometrial ablation surgery. This surgery removes the lining of the womb using small surgical instruments which are inserted through the vagina. This surgery is carried out under general anaesthetic and does not usually require an overnight stay.
You know your body and your menstrual cycle better than anyone else. If you are worried about how much you are bleeding during your menstrual cycle, have noticed your periods have become heavier or are experiencing some of the other common endometriosis symptoms we’ve discussed, such as severe period pain, then it is time to visit a doctor.
At Spire Healthcare, we have experienced consultants specialising in women’s health, who can thoroughly investigate your symptoms and where appropriate, offer treatment to resolve or reduce them.
When you visit a doctor to discuss your symptoms, they may carry out a physical examination of your abdomen and pelvis. This can help them detect the presence of fibroids. They may also recommend an ultrasound scan, which uses high-frequency sound waves to create images of the tissues within your body. This can help detect a range of conditions, including fibroids, endometriosis and cancer.
If the results of these tests and examinations are unclear and depending on your symptoms and medical history, you may be referred to a gynaecologist for further tests, such as a laparoscopy. This is a type of keyhole surgery where a small incision is made into the abdomen so that a thin tube can be passed through. This tube has a light and a camera at the end of it which allows your consultant to detect the presence of any excess tissue growth caused by endometriosis.
If you are diagnosed with endometriosis, there are several treatment options available to reduce your symptoms. Your doctor will advise you on which are best depending on how severe your symptoms are and your medical history.
Current treatment options fall into two main categories:
You are not alone with your symptoms. As mentioned earlier, endometriosis is a common condition affecting one in 10 women. Early diagnosis can help with treatment. If you are concerned, we offer a wide range of scans and tests which can help.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.
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Lux has a BSc(Hons) in Neuroscience from UCL, a PhD in Cellular and Molecular Biology from the UCL Institute of Ophthalmology and experience as a postdoctoral researcher in developmental biology. She has a clear and extensive understanding of the biological and medical sciences. Having worked in scientific publishing for BioMed Central and as a writer for the UK’s Medical Research Council and the National University of Singapore, she is able to clearly communicate complex concepts.
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Alfie has a creative writing degree from UCF and initially worked as a carer before supporting his family’s care training business with copywriting and general marketing. He has worked in content marketing and the care sector for over 10 years and overseen a diverse range of care content projects, building a strong team of specialist writers and marketing creatives after founding Cahoot in 2016.