Painful periods and pelvic pain – could it be endometriosis?

Key takeaways:

  • Endometriosis is a common condition that causes painful periods, and sometimes pain during sex or bowel movements.
  • Endometriosis occurs when cells similar to those in the lining of the uterus grow outside it creating inflammation, which can lead to scarring.
  • Hormonal management like birth control pills or an intrauterine device (IUD), are often effective for treating painful periods.
  • The only way to know for sure if you have endometriosis is to undergo laparoscopic surgery.


Let’s be honest: Many of us have experienced painful periods from time-to-time or been sidelined with cramps that sent us to the couch or bed armed with a heating pad and a good book. While mild cramping is a common symptom of a period, a period that causes such painful cramping that you miss school or work isn’t normal. In fact, it may be a sign of endometriosis or another gynecologic condition.

“It is very common for women to suffer for years before they are finally diagnosed with endometriosis,” shares Brooke Winner, M.D., a minimally invasive gynecologic surgeon and the Medical Director for Gynecologic Surgery at Swedish Medical Center. “Many women have tried to seek help but are told that painful periods are normal. While mild cramps are common, severe pain is not. If you are not getting answers from your primary care doctor, reach out to an OB/GYN or a minimally invasive gynecologic surgery specialist.”

In honor of World Endometriosis Month this March, we sat down with Dr. Winner to learn more about this common condition and how you can find relief.

What causes endometriosis?

Endometriosis is when cells that are supposed to be in the lining of the uterus (where your periods come from) are growing outside the uterus. 

Every month, when the uterus sheds it lining and a woman starts her period, if she has endometriosis, extra cells and blood become trapped in the abdomen. This causes pain, and over time it can cause scarring as things become stuck together and are pulled and tugged in an unnatural way. 

What are the most common symptoms of endometriosis?

Signs of endometriosis can begin with painful periods. Following that, a woman may begin to experience pain with intercourse and uncomfortable pressure with bowel movements. Pelvic pain between periods can also be a red flag, especially if it doesn’t let up.

Are there any symptoms of endometriosis that women find surprising?

Women are often surprised to find that pain with intercourse and bowel movements are related to endometriosis. These are also the symptoms that women are hesitant to discuss. It’s important to remember that your provider wants to know about all symptoms you’re experiencing.

“Our offices are safe, open and judgment-free spaces. Please let us know what you’re feeling so we can best help you!” encourages Dr. Winner.

How is endometriosis diagnosed?

Sometimes, endometriosis lives in a big pocket on the ovaries called an endometrioma, which is an ovarian cyst filled with endometriosis. That will show up on an ultrasound, whereas small spots of endometriosis will not.

The only way to know for sure if someone has endometriosis is to do a laparoscopic surgery that looks inside the belly with a camera.

“If we see something that looks like endometriosis, we take it out and send that tissue off to the lab to be looked at underneath the microscope - that's the gold standard for diagnosing endometriosis,” says Dr. Winner.

How is endometriosis treated?

According to Dr. Winner, “We can try and treat the pain of endometriosis with over-the-counter medications like Advil, Aleve or Tylenol. We can also try to stop or regulate periods with birth control like pills, the patch, the vaginal ring or the medicated intrauterine device (or IUD).”

“Not everyone who we think might have endometriosis has to have surgery,” reassures Dr. Winner. “There are many things we can try first to see if we can lessen the symptoms and get people back to their normal activities.”

Sometimes, stopping periods with birth control also helps controls the pain. But, sometimes the medication does not work; or women don't tolerate the hormonal side effects; or they are trying to get pregnant. In any of these cases, laparoscopic surgery is an option.

What are surgical options for treating endometriosis?

If a conservative approach doesn’t work, or you’re eager to start a family, your doctor may recommend surgery that only removes the endometriosis and leaves the uterus and ovaries in place. 

“Removing endometriosis surgically is very effective for pain relief and also improves fertility,” adds Dr. Winner. “Laparoscopic surgery is outpatient and usually only takes a few weeks to recover.”

“These surgeries can be done by both general OB/GYNs and surgical sub-specialists who have completed extra surgical training for laparoscopic procedures. For complex cases, I recommend seeking out a provider who treats endometriosis frequently and has a practice focused on surgery,” she adds.

For women that are done having children or have decided for sure they don't want to become pregnant, they may choose a hysterectomy with excision of endometriosis. Depending on the situation, the ovaries can be left in place, so a hysterectomy does not mean you go through menopause, but it does mean you would never have another period.

Does endometriosis impact fertility?

Dr. Winner assures readers that not all cases of endometriosis will affect a woman’s ability to get pregnant. And, if it does, you can take comfort in knowing there’s a clear (and often effective) path forward to help you get pregnant.

“Women with more severe endometriosis can get scarring, which may block their fallopian tubes or cause them to swell,” explains Dr. Winner. “Minimally invasive gynecologic surgeons like myself can work closely with your fertility specialists to come up with a plan that’s right for you.”

Find relief

Endometriosis affects many women. Fortunately, there are many approaches that can help you find relief from painful periods and other symptoms. Talk to a gynecologist about your symptoms. Together, you can find a way to feel like yourself again and not be limited by the pain of your period each month.

And, Dr. Winner encourages you to seek out the help you need. You can schedule an appointment with Dr. Winner or her partner, Dr. Jessie Marrs, by calling (206) 386-6060.

“If you are not getting answers from your doctor, don't hesitate to get a second opinion with a minimally invasive gynecologic surgery specialist.”

Find a gynecologic surgeon near you.


Find a doctor

Whether you require an in-person visit or want to consult with a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow-up as needed. If you need to find a doctor, you can use our provider directory.

Find out the latest updates on how we’re handling COVID-19.

Related resources

Gynecological surgery FAQs, Part I: Laparoscopy

Severe menstrual camps: You don’t need to suffer

HPV vaccines and regular screenings can reduce cervical cancer risk

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

About the Author

Whether you are seeking gynecological advice, need help navigating your way through the menopause stage of life or researching a recent breast cancer diagnosis, the Swedish Women's Health Team is committed to helping women find the information they need to live happy and healthy lives.

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