Women with vs. without endometriosis had significantly higher odds of ovarian and endometrial cancers.
Endometriosis was tied to lower risk for breast cancer and had no association with cervical cancer.
Endometriosis was significantly associated with higher risks for both ovarian and endometrial cancers, but was not significantly associated with cervical cancer risk, according to an analysis published in CurrentOncology.
“Genomic data from cancer studies have unveiled genetic connections between endometriosis and various female cancers, namely breast, cervical, endometrial and ovarian cancers,” Ismail Abdulrahman Al-Badawi, MD, from the department of obstetrics and gynecology at King Faisal Specialist Hospital and Research Center and the College of Medicine at Al Faisal University, Saudi Arabia, and colleagues wrote. “Moreover, accumulating research from various high-hierarchy systematic review and meta-analysis reports of case-control and cohort studies has documented correlational relationships between endometriosis and certain gynecologic cancers.”
Data derived from Al-Badawi IA, et al. Curr Oncol. 2024;doi:10.3390/curroncol31010032.
Al-Badawi and colleagues evaluated data from 226,487 women with gynecologic cancer from the U.S. National Inpatient Sample database from 2016 to 2019. Of these women, 1,164 had endometriosis. Researchers analyzed associations between endometriosis and breast, ovarian, endometrial and cervical cancers.
Women with endometriosis had higher rates of ovarian (46.56% vs. 20.28%) and endometrial (34.27% vs. 13.46%) cancers compared with women without (P < .05 for both). Conversely, women with vs. without endometriosis had lower breast cancer rates (14.34% vs. 59.04%; P < .05). Researchers observed no significant difference in cervical cancer rates between women with and without endometriosis (8.68% vs. 8.32%).
In the univariate analysis, endometriosis was associated with higher risks for ovarian (OR = 3.42; 95% CI, 3.05-3.84; P < .001) and endometrial (OR = 3.35; 95% CI, 2.97-3.79; P < .001) cancers and was associated with lower breast cancer risk (OR = 0.12; 95% CI, 0.1-0.17; P < .001). Endometriosis was not significantly associated with cervical cancer risk (OR = 1.05; 95% CI, 0.85-1.28).
In the multivariate analysis, endometriosis remained associated with higher risks for ovarian (adjusted OR = 3.34; 95% CI, 2.97-3.75; P < .001) and endometrial (aOR = 3.61; 95% CI, 3.12-4.08; P < .001) cancers and was associated with lower breast cancer risk (aOR = 0.12; 95% CI, 0.11-0.15; P < .001). In addition, researchers continued to observe no significant association between endometriosis and cervical cancer risk.
“All in all, these findings emphasize the importance of tailored health care management for individuals with endometriosis, considering their unique cancer risk profiles. Notably, the present analysis does not provide causative risks, which would require clinical validation, but observes potentially relevant associations,” the researchers wrote. “Further research is warranted to unravel the underlying mechanisms driving this connection.”
Endometriosis happens when tissue normally found inside the uterus grows in other parts of the body. It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. As hormones change during the menstrual cycle, this tissue breaks down and may cause pain around the time of your period and longterm painful adhesions or scar tissue. More than 5.5 million American women have symptoms of endometriosis.
Endometriosis Symptoms
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Pain just before, during, or after menstruation is the most common symptom. For some women, this pain may be disabling and may happen during or after sex, or during bowel movements or urination. It sometimes causes ongoing pain in the pelvis and lower back. Many women with endometriosis have mild or no symptoms, though. The symptoms may be related to the location of the growths.
Just Cramps or Endometriosis?
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Most women have some mild pain with their menstrual periods. They may get relief from over-the-counter pain medications. If the pain lasts more than 2 days, keeps you from doing normal activities, or remains after your period is over, tell your doctor.
Endometriosis and Teens
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Endometriosis pain can begin with the first menstrual period. If your menstrual pain is strong enough to interfere with activities, you should consult your physician. The first step may be tracking the symptoms and taking pain medication, but ultimately the treatment options for teens are the same as for adults.
Endometriosis and Infertility
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Sometimes the first — or only — symptom of endometriosis is trouble getting pregnant. Infertility affects about a third of women with the condition, for reasons that aren’t well understood. Scarring may be to blame. The good news is that medical treatments can help someone overcome infertility, and pregnancy itself can relieve some symptoms of endometriosis.
Endometriosis or Fibroids?
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Endometriosis is one cause of severe menstrual pain. But the pain can be caused by another condition, such as fibroids, which are noncancerous growths of the muscle tissue of the uterus. Fibroids can cause severe cramps and heavier bleeding during your period. The pain of endometriosis or fibroids can also flare up at other times of the month.
What Causes Endometriosis?
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Doctors don’t know why endometrial tissue grows outside of the uterus, but they have several theories. Heredity plays a role, and some endometrial cells may be present from birth. Another theory suggests that menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These cells are thought to stick to organs and keep growing and bleeding over time. Cells could also move to the pelvic cavity other ways, such as during a C-section delivery. A faulty immune system may fail to get rid of the misplaced cells.
The brown cells seen here are endometrial cells removed from an abnormal growth on an ovary.
Endometriosis: Who Is at Risk?
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The condition is more common in women who:
Are in their 30s and 40s
Have not had children
Have periods longer than 7 days
Have cycles shorter than 28 days
Started their period before age 12
Have a mother or sister who had endometriosis
Diagnosis: Tracking Symptoms
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Your pattern of symptoms can help to identify endometriosis, including:
When the pain happens
How bad it is
How long it lasts
A change or worsening of pain
Pain that limits your activities
Pain during sex, bowel movements, or urination
Diagnosis: Pelvic Exam
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Your doctor will do a pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An exam can sometimes reveal an ovarian cyst or internal scarring that may be due to endometriosis. The doctor also looks for other pelvic conditions that could cause symptoms similar to endometriosis.
Diagnosis: Pelvic Scans
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Although it isn’t possible to confirm endometriosis with scanning techniques alone, your doctor may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be able to detect larger endometrial growths or cysts. The scans use sound waves, X-rays, or magnetic fields with radiofrequency pulses to create the images.
Diagnosis: Laparoscopy
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Laparoscopy is the only sure way to determine if you have endometriosis. A surgeon inflates the abdomen with gas through a small incision in the navel. A laparoscope is a viewing instrument that’s inserted through the incision. The surgeon can take small pieces of tissue for a lab to examine — called a biopsy — to confirm the diagnosis.
Treatment: Pain Medicine
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Pain medications, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, often help relieve the pain and cramping that comes with endometriosis. But these drugs only treat the symptoms and not the underlying endometriosis.
Treatment: Birth Control Pills
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Oral contraceptives manage levels of estrogen and progestin, which make your menstrual periods shorter and lighter. That often eases the pain of endometriosis. Your doctor may prescribe pills to be taken continuously, with no breaks for a menstrual period, or progestin-only therapy. Progestin-only therapy can also be given by injection. Endometriosis symptoms may return after you stop taking the pills.
Treatment: Other Hormone Therapies
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These drugs mimic menopause, getting rid of periods along with endometriosis symptoms. GnRH agonists, such as Lupron, Synarel, and Zoladex, block female hormones from being made. They can cause hot flashes, vaginal dryness, fatigue, mood changes, and bone loss. Danocrine works mainly by lowering estrogen. Side effects can include weight gain, smaller breasts, acne, facial hair, voice and mood changes, and birth defects. Elagolix (Orilissa) is another type of GnHR called an antagonist. It’s sometimes used to help slow the loss of bone density. Before you start taking it, talk to your doctor about the potential risks associated with it and whether or not it can help you.
Treatment: Excision
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During a laparoscopy, the surgeon may remove visible endometrial growths or adhesions. Most women have immediate pain relief. A year after the surgery, though, about 45% of women will have a return of symptoms. The likelihood of symptoms returning rises over time. Hormone therapy started soon after surgery may improve the outcome.
Treatment: Open Surgery
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Severe cases of endometriosis may require laparotomy, or open abdominal surgery, to remove growths, or a hysterectomy — removal of the uterus and possibly all or part of the ovaries. Although this treatment has a high success rate, endometriosis still recurs for about 15% of women who had their uterus and ovaries removed.
Getting Pregnant With Endometriosis
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Many women with endometriosis don’t have trouble getting pregnant. But laparoscopic surgery can improve the pregnancy rate of women who have moderate to severe endometriosis. In vitro fertilization is an option if infertility persists. The sperm and egg are combined in a lab and the resulting embryo is implanted into the uterus.
Coping With Endometriosis
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Although there is no way to prevent endometriosis, you can make lifestyle choices that will help you feel better. Regular exercise may help relieve pain by improving your blood flow and boosting endorphins, the body’s natural pain relievers. Acupuncture, yoga, massage, and meditation also may help ease symptoms.
An End to Endometriosis?
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For most women, endometriosis recedes with menopause. Some women find relief from endometriosis during pregnancy. In some cases, symptoms may simply go away. About one-third of women with mild endometriosis will find that their symptoms resolve on their own.
Researchers are testing an experimental injection for endometriosis in macaques. Image credit: Anna Efetova/Getty Images.
Endometriosis affects around 10% of females of reproductive age worldwide.
In people with endometriosis, tissue similar to the endometrium, or uterine lining, grows outside the uterus, causing severe period pain and heavy bleeding, and, in some, infertility.
This tissue can form lesions, scar tissue, and organ adhesions.
Although currently available treatments can help to alleviate symptoms, there is currently no cure for endometriosis.
New research has shown that a monthly antibody injection that reduces lesions, scar tissue, and organ adhesions in monkeys with endometriosis.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
According to the World Health OrganizationTrusted Source (WHO), endometriosis affects around 10% of people who menstruate, some 190 million people globally.
Symptoms, including severe pain during menstruation, heavy menstrual bleeding, back and pelvic pain, pain during intercourse, and, in some people, problems with fertility, occur when tissue similar to the endometrium, or uterine lining, grows outside the uterus.
InflammationTrusted Source leads to the formation of lesions and scar tissue, so the condition tends to worsen over time.
Although these treatments can alleviate the symptoms, the condition is currently regarded as incurable.
Now, a Japanese study has found that a monthly injection of an engineered antibody that targets interleukin-8 (IL-8), an inflammatory cytokineTrusted Source, can reduce lesions, scar tissue, and organ adhesions in monkeys with endometriosis.
The research, published in Science Translational Medicine, suggests that this might lead to the first disease-modifying therapy for people with endometriosis.
Dr. Steven Vasilev, a board-certified integrative gynecologic oncologist and medical director of Integrative Gynecologic Oncology at Providence Saint John’s Health Center, professor at Saint John’s Cancer Institute in Santa Monica, CA, not involved in this study, explained for Medical News Today:
“Endometriosis in monkeys closely simulates [the] behavior of human endometriosis, making this an excellent model.”
In this study, the researchers used monkeys with spontaneous endometriosis and others with endometriosis induced by transplanting endometrial tissue into the peritoneumTrusted Source.
The researchers developed an antibody — AMY109 — that binds to IL-8. They further engineered it so that it could target IL-8 multiple times, meaning the antibody had to be administered only once a month.
They injected AMY109 into one group of monkeys with endometriosis every 4 weeks for 6 months. A control group was given similar injections that did not contain the engineered antibody.
Dr. Vasilev told MNT that there was supporting evidence that this approach could work.
“An immunologic basis for the genesis and progression of endometriosis is already theorized and IL-8 is one of the known key proinflammatory cytokines in this process, and fibrosis in general,” he noted.
The AMY109 injections had no adverse effects on the menstrual cycles of the monkeys, and they experienced no other side effects. But there was an improvement in their endometriosis.
The monthly subcutaneous injection of AMY109 reduced the volume of lesions and also diminished both fibrosis and adhesions.
“The authors developed a long-acting recycling antibody against IL-8 called AMY109 which objectively reduced inflammation and fibrosis associated with disease progression,” said Dr. Vasilev.
Unlike current hormone treatments, this anti–IL-8 antibody reduced fibrosis and adhesions in monkeys without affecting hormone secretion and menstruation.
However, the researchers were unable to confirm whether AMY109 also reduced the pain that the condition causes, or whether it improved fertility.
Dr. G. Thomas Ruiz, OB/GYN lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, not involved in this study, expressed some caution about the findings, but also a measure of hope:
“It’s too soon to extrapolate to humans. But given the commonalities between primates and people, the data indicates it may be time to start human trials.”
And he stressed that it is very early days still: “We first need to establish safety and dosing for humans. Once that is completed, small trials will commence on volunteers.”
“Once stage 2 trials show safety and benefit, they can proceed to larger phase 3 trials to again analyze data across a large population,” he added. “Finally, the data will be reviewed by the FDA [Food and Drug Administration] for it to assess safety and efficacy.”
There is currently no cure for endometriosis, so treatments are targeted at managing symptoms, as Dr. Vasilev explained.
“There is a pressing need for disease-modifying drugs or biological agents to treat endometriosis,” he admitted. “Current pharmacological treatments, and newest clinical developments, are largely based on hormonal manipulation.”
“These are fraught with side effects and are limited to possibly providing pain relief but cannot cure the disease,” noted. Dr. Vasilev.
Surgery to remove lesions and adhesions is an option for those with severe endometriosis. It usually results in relief of pain, but at least one-thirdTrusted Source of those with the condition will need further surgery for continued problems.
This experimental antibody injection, might, according to Dr. Vasilev, help reduce the recurrence of endometriosis after surgery:
“Surgical excision is currently a cornerstone in [the] therapy of endometriosis. Surgery itself, in addition to the natural course of endometriosis, can produce fibrosis as part of the healing process. Reducing post-surgical fibrosis by modulating IL-8 may be an additional benefit in the multi-disciplinary medical and surgical management of endometriosis.”
So, if similar beneficial effects are seen in people, this finding could lead to the first disease-modifying treatment for endometriosis.
Although there is a long way to go before the antibody might be licensed for human use, this discovery should give hope to people with endometriosis.
Data published in Cell Reports Medicine showed that endometriosis was genetically linked to ovarian cancer.
Specifically, the researchers found that endometriosis had a strong and causal relationship with two types of epithelial ovarian cancer (EOC): clear cell (CCOC) and endometrioid (ENOC). There was also a slightly weaker relationship with high-grade serous ovarian cancer.
“Genes identified in this study will be investigated further to better understand their roles in disease development and progression.” Sally Mortlock, PhD
Healio spoke with Sally Mortlock, PhD, a postdoctoral researcher at the University of Queensland Institute for Molecular Bioscience in Brisbane, Australia, to learn more about the findings and their implications for the future treatment of both diseases.
Healio:What prompted this study?
Mortlock: Previous studies have reported a higher incidence of EOC in women with a history of endometriosis. We wanted to better understand this potential link between the diseases. Our research aimed to look for genetic risk factors in common to both diseases and shared biological pathways leading to disease.
Healio: Why is it important to investigate this topic?
Mortlock: Despite endometriosis being one of the most common medical issues facing Australian women, with 1 in 9 women of reproductive age having the disease, our understanding of factors contributing to the disease is still limited and it can take an average of 7 to 12 years to diagnose. Ovarian cancer, whilst less common, is the deadliest gynecological cancer due in part to resistance to therapies and the absence of effective early detection strategies. More information about how these two diseases develop and their associated risk factors is needed to advance our understanding so we can develop better early detection and treatments.
Healio: Were any of the findings surprising?
Mortlock: We found that individuals carrying certain genetic markers that predispose them to having endometriosis also have a higher risk of certain EOC subtypes, namely CCOC and ENOC. We were able to identify 19 independent locations on the genome that contained genetic markers that increased risk for both diseases. We found different genetic markers were shared between endometriosis and different types of EOC, and by looking at the genes in these locations we get a better understanding of the link between the diseases and clues into biological pathways driving the different ovarian cancer types.
Healio: How will your findings impact clinical care?
Mortlock: Our findings give us a better understanding of risk factors and biological pathways contributing to these diseases that can be used to inform better diagnosis and treatments. We identified genes in this study that are linked to both diseases and could be drug targets to treat both endometriosis and EOC in the future, and genes that could disrupt the link between the two diseases. Knowledge of the relationship between endometriosis and ovarian cancer may also inform targeted screening for ovarian cancer in the future.
Healio:Considering these findings, what steps need to be taken to make progress in the treatment of endometriosis and EOC?
Mortlock: Genes identified in this study will be investigated further to better understand their roles in disease development and progression.
Healio: Is there anything else you would like to add?
Mortlock: Whilst there is significant overlap in genetic risk factors between endometriosis and ovarian cancer, the risk of women with endometriosis developing ovarian cancer is not substantially different from other women. Overall, studies have estimated that 1 in 76 women are at risk of developing ovarian cancer in their lifetime and having endometriosis increases this slightly to 1 in 55, so the overall risk is still very low.
Endometriosis affects as many women as diabetes and asthma yet it has not received the same level of attention or funding. Funding for the next generation of researchers is limited and highly competitive, competing against more well-known diseases. It is important to ensure that the next generation of researchers in endometriosis is not lost. Such a loss could limit future scientific discovery in a disease that affects so many women.
Reviewed By Valerie A. Flores, MD, assistant professor, Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine – Yale New Haven Hospital, New Haven, Connecticut
Endometriosis is a painful disorder that commonly affects the pelvic region but can impact many other body sites as well. An estimated 10% of U.S. girls and women of reproductive age suffer from this under-diagnosed condition.
While endometriosis is generally seen as a disease of adult women, who may not be diagnosed until they are unable to get pregnant and then go for fertility testing, the condition has been found in preadolescent girls. The disease is likely driven by a combination of factors, including genetics, reproductive hormones, and the immune system. Lifestyle and environmental factors may also have an impact.
Once considered to be a disease confined to the female reproductive tract, driven by a woman’s menstrual cycle and associated with severe menstrual pain, endometriosis is now seen as a chronic, systemic, disease that triggers inflammation in different parts of the body – not unlike rheumatoid arthritis. It can affect the nerves to increase a woman’s overall sensitivity to pain and cause scarring, bleeding, and debilitating inflammation at any time of the month and at multiple different locations, including the heart, brain, diaphragm, spleen, kidneys, and lungs.
The classic hallmark of endometriosis has been abnormally severe pain at menstruation. But this normal monthly process should not involve long-lasting excruciating pain or pain that worsens over time, as in endometriosis, noted Margaret Nachtigall, MD, of NYU Langone Health in New York City. “It is certainly reasonable to seek medical attention, especially because there is often a good solution such as a continuous birth control pill, which might be able to alleviate the pain, as well as other good treatment options.”
What Happens in Endometriosis?
Most commonly, the disease has been thought to develop when tissue from the lining of the womb – i.e., the endometrium – escapes from the uterus through the fallopian tubes into the pelvic cavity and continues to grow there.
Implants from this “retrograde menstruation” may then attach to the ovaries, fallopian tubes, or surface of the uterus, as well as the intestines, bladder, rectum, or the space behind the uterus.
Unlike normal menstrual tissue, which leaves the body during a woman’s period, this “ectopic tissue” is trapped in the pelvis with no way to exit. Under the influence of hormones regulating the monthly cycle, this ectopic tissue expands and swells, causing bloating, inflammation, scarring, and pain, which is usually more severe and longer lasting than that of typical monthly cramps
Some affected women have no pain and are diagnosed only during investigation for other diseases or when being evaluated for causes of infertility.
More recently, another source of these external deposits has been identified: immature endometrial stem cells produced in bone marrow and at other sites, which travel to distant locations like the brain, heart, diaphragm, or lungs and grow into endometrial-like tissue, causing inflammation, scarring, and pain wherever they take up residence.
The inflammation may be linked to the way a woman’s immune system functions, since some sufferers have other immune-related conditions such as asthma, eczema, and other allergies or intolerances. Other factors may be the overproduction of estrogen and fatty hormone-like compounds called prostaglandins, which can cause inflammation and muscle cramping.
How Does Endometriosis Cause Infertility?
The pain of endometriosis can interfere with day-to-day activities as well as fertility, since the displaced tissue can cause inflammation, affecting the eggs, or adhesions, making it harder for the sperm and egg to unite. Scarring may block the ovaries and fallopian tubes, and the inflammation can damage the egg and trigger changes in the uterine lining that make it less receptive to implantation of an embryo.
About 30% to 40% of women with endometriosis become infertile. In more advanced disease, endometriomas — cysts formed by endometrial tissue growing in the ovaries — may develop, which can negatively impact the ability to become pregnant.
Early Diagnosis of Endometriosis
It is important to get diagnosed early before the disease progresses. The severity of pain, however, does not always indicate how far the endometriosis extends or what stage of growth it has reached.
Typical Symptoms
Pain in the lower abdomen around the time of menstruation and usually with severe cramps
Painful urination or bowel movements or rectal bleeding during menstruation/cyclically
Pain in the lower abdomen or back at other times, usually cyclic, or unexplained pain at other body sites
Pain during sexual intercourse
Periods that last more than 7 days
Shorter than usual intervals between periods
Fatigue
Gastrointestinal problems such as diarrhea, constipation, and nausea during menstruation
Mood swings and depression
If you have one or more of these symptoms, ask your doctor about getting investigated for endometriosis.
Sometimes surgery may be needed to help with treatment of endometriosis-associated pain.
Risk Factors for Endometriosis
Having a close relative with endometriosis, which suggests an inherited predisposition
Starting menstruation before age 12
Intervals between periods of less than 27 days, leading to more periods per year and thus greater exposure to ovarian hormones
Anatomical abnormalities in the uterus
Allergic conditions such as asthma or eczema
Low body mass index
Asian race
Heavy consumption of red meat
Overcoming Reluctance to Seek Help
Gender-based misconceptions may cause some girls and women to brush off their symptoms as normal and avoid seeking help. No woman who suspects she might have endometriosis should allow female stereotyping to condemn her to decades of pain and possible infertility, Nachtigall stressed. “If an individual’s physician is not going to evaluate for endometriosis, there are many excellent physicians who do regularly see and take care of patients for endometriosis.”
Ask for a referral – or act as your own advocate for getting tested or find someone to advocate for you. The Endometriosis Association can help you find the information and support and connect you with other women who suffer from the condition.
There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.
But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.
1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.
The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).
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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.
Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.
The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.
Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.
Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.
2. Your period brings days of pain that make it practically impossible to leave your bed.
Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.
There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.
Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.
3. You never know when your period is going to show up.
Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.
Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.
On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.
Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.
PCOS and uterine polyps be behind irregular bleeding, too.
4. Your period decides not to show up for a while.
While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.
“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.
It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.
5. You’re dealing with a lot of unexpected spotting between periods.
It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.
If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.
More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.
6. You experience debilitating mood issues before your period.
When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)
But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.
“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.
Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)
Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.
7. You have excruciating migraines before or during your period.
If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.
It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.
If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.
No matter what your period problem may be, you don’t have to suffer in silence.
You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.
If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.
Most people are pretty open about the “joys” that come with having a period, like cramps, bloating, and sore boobs. But there’s one period side effect people really need to discuss more often, because maybe sharing the burden can at least make the load a little lighter: period poop.
Everyone’s situation is different, but it’s not uncommon for your regular poop habits to take a temporary vacation when you’re on your period, or be suddenly replaced with a whole lot of diarrhea, or both. “Many women do get bowel changes just before or during their period,” Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF.
You’ve probably noticed this and dismissed it as just one of those body things, but there’s an actual biological cause you should know about.
“The reason that this happens is largely due to hormones,” says Dr. Staller. Pre-period constipation could be a result of an increase in the hormone progesterone, which starts to increase in the time between ovulation and when you get your period. Progesterone can cause food to move more slowly through your intestines, backing you up in the process.
So what about that diarrhea, though? Hormone-like substances called prostaglandins could be to blame for that. The cells that make up the lining of your uterus (known as endometrial cells), produce these prostaglandins, which get released as the lining of your uterus breaks down right before and during your period. If your body makes a lot of prostaglandins, they can make their way into the muscle that lines your bowels. There, they can cause your intestines to contract just like your uterus and push out fecal matter quickly, causing diarrhea in the process, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF. (Fun fact: These prostaglandins are also responsible for those painful cramps you might get every month.)
Of course, this can all vary in different people. But if you notice you experience constipation or diarrhea right around your period like clockwork, this may be why.
Having certain health conditions can also exacerbate period-related bowel changes.
For example, if you struggle with Crohn’s disease, which can often cause diarrhea, or IBS-D (a form of IBS that causes people to have diarrhea), your body’s release of prostaglandins during your period may cause you poop even more than usual. But if you suffer from IBS-C (IBS that causes people to have constipation), you may find yourself struggling even more to have a BM on your period as progesterone further slows your bowels’ activity. Since ulcerative colitis can lead to both diarrhea and constipation, you might experience an uptick in either during your period.
And unfortunately endometriosis can lead to pain during bowel movements around your period, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. Endometriosis is a disease where endometrial tissue that normally grows inside the uterus (or, as is up for debate, tissue similar to endometrial lining) grows outside of the uterus. This tissue can attach to your bowels and start trouble. “You then have bleeding around that area, and that can cause pain when you have a bowel movement,” Dr. Greves explains.
If your poop gets weird on your period, there are a few things you can do to cope.
The most important step is knowing what’s normal for you on your period and doing what you can to minimize any additional triggers. For instance, if you always get diarrhea during your period, and you know that coffee tends to make you poop more, it’s a good idea to cut back a little when you’re actually on your period, Dr. Farhadi says. You can also take Immodium on the first day of your period in anticipation of diarrhea, or carry it with you in case it strikes, he says. If you deal with constipation during your period, try upping your fiber and water intake in the middle of your cycle, when constipation-prompting progesterone levels start rising.
If you’re really having a hard time with poop issues on your period, talk to your doctor. They may be able to recommend next steps or refer you to a specialist who can. Your period is already annoying enough without spending forever on the toilet, either basically pooping water or straining hard to go in the first place.
A new study suggests that women with endometriosis, a painful gynecologic disease, may be at higher risk for coronary heart disease. Mayo Clinic reproductive endocrinologistDr. Gaurang Daftary says the 20-year study of nurses in Massachusetts is the first study to investigate whether these two conditions are related. He says, “The analysis shows the possibility that coronary artery disease later in life may be associated with a history of endometriosis earlier in life. So, it is an intriguing finding.”
Dr. Daftary says the study also showed “that hysterectomies in younger women definitely change the overall risk profile and increase the risk of heart disease. Women with endometriosis often end up with a hysterectomy. What women can take away from the study is to be their best advocate to prevent a hysterectomy — especially the removal of ovaries as they are the critical hormone producing organs that should not be lost — even if it means making lifestyle changes.”
US firm claims its small ‘holistic’ herb packages ‘aid to correct’ endometriosis
A health expert said the ‘pearls’ were ineffective Rex
Women are being warned about the dangers of a “womb detox” product after health experts said it could cause irritation and even toxic shock syndrome.
US firm called Embrace Pangaea is selling “Herbal Womb Detox Pearls” online, claiming the products “aids to correct” conditions such as endometriosis, ovarian cysts and thrush.
The pearls – small balls of perfumed herbs – are sold in one or two-month packages, with packages on sale for between $85 (£59) and $480 (£335).
Another package – claims to promote “vaginal tightening”, which it says works by “tightening the womb” so the “vaginal canal will shrink”.
The company says the herb pearls are designed to “cleanse the womb and return it to a balance state” by flushing out “toxins”.
In a blogpost, the company said the pearls could be issued in the same way natural solutions like oranges and lemons can be used to counteract a cold.
But a sexual health expert insisted that not only were the “pearls” ineffective, but they could be dangerous.
The ‘herb pearls’ could cause infection as a breeding ground for bacteria
Dr Jen Gunter, a US gynaecologist, wrote a blog post debunking the company’s claims and saying these types of products – and the herbs used in them – have not been tested for vaginal use.
She wrote: “Your uterus isn’t tired or depressed or dirty and your vagina has not misplaced its chakra.
“They want no real help from you unless there is something wrong and they will tell you there is something wrong by bleeding profusely or itching or cramping badly or producing an odour.”
She explained that the vagina was like “a self-cleaning oven” and putting anything like this in the vagina for long periods of time will increase the likelihood of bad bacteria growing and causing infection.
She also said it would increase the risk of toxic shock syndrome – a potentially fatal syndrome caused by bacteria.
It is not possible to reach the womb from the vagina without using force. The cervix (or neck of the womb) is designed to only open during ovulation and childbirth.
Tamieka Atkinson, the owner of Embrace Pangaea, told theIndependent: “Our product is not a drug by any means, and we make no claims of curing, diagnosing, or treating disease.
“Embrace Pangaea is a holistic company that provides high-quality herbal detoxes and information to educate clients about natural living.
“Our Herbal Womb Detox Pearls is simply a natural herbal alternative that women can make a conscious and informed decision in using. With all our clients, we do advise them that we are not medical professionals, and that they should seek assistance from their doctor.
Vagina facials on This Morning
“As for our products doing more harm than good, there are various women that received positive benefits from using our product.”
She said it was “absolutely correct” that the vagina is self-cleaning but said “this self-cleaning ability can get reduced due to a person’s lifestyle”.
Endometriosis is the result of implantation of menstrual products from the endometrium that are not cleared by the immune system. To determine whether endometriosis is associated with inflammatory bowel disease (IBD) — also an autoimmune-related disorder — investigators in Denmark conducted a nationwide cohort study involving 37,661 women (mean age, 38.6 years) hospitalized with endometriosis during a 40-year period.
During >492,000 person-years of follow-up, the standardized incidence ratio was 1.5 for ulcerative colitis and 1.6 for Crohn disease. The risk for ulcerative colitis was highest among women diagnosed with endometriosis between the ages of 25 and 34. The risk for Crohn disease was highest among women diagnosed before age 25. The mean interval between endometriosis diagnosis and diagnosis of IBD was 10.8 years for ulcerative colitis and 9.8 years for Crohn disease. Risks for IBD remained elevated after >20 years of observation and were even higher when the analysis was confined to women with surgically verified endometriosis.
Comment: These data suggest a shared immunologic basis for endometriosis and IBD. Patients with endometriosis and clinical features associated with IBD should undergo gastrointestinal evaluation.
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