My daughter has to take painkillers during her periods — I'm worried she might have endometriosis

How do I find out if this bad period pain is endometriosis?

Dr Phil Kieran: "Endometriosis can be suspected based on symptoms and examination, but a definitive diagnosis is usually based on surgical inspection of the abdominal cavity and sampling of an area of endometrial tissue outside the uterus."

My teenage daughter has to take painkillers during the early stages of her period. Endometriosis runs in the family, and I'm worried she might have the condition. She doesn't want to go to the doctor, saying the pain goes away after a few days. What would you suggest?

Painful periods are unfortunately very common with some studies suggesting it is present in up to 90% of women to some extent. The pain can be due to the normal functioning of the reproductive system, or it can be a sign that there is an underlying problem like endometriosis.

With regular menstrual cycles the lining of the uterus (endometrium) thickens and if pregnancy doesn’t occur the lining comes away from the wall of the uterus and expelled through the vagina. During this process, pain can be caused by the tightening of the uterus muscles or inflammation due to changes in hormones, such as prostaglandin.

For many females,  the pain at this time is severe enough to make completing everyday tasks, such as work or school, difficult.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus and attaches to other areas in the body. These out-of-place cells can be stuck to the bowel or the bladder, and when the endometrium in the uterus is thickening during a normal cycle, the cells in these areas will respond the same way. 

This can cause swelling and symptoms if the tissue presses on other organs or pulls on those organs. When it is time to have a period, these cells break down the same way the tissue in the uterus does, but they can’t easily find a way out, leading to increased inflammation and pain.

Endometriosis can be suspected based on symptoms and examination, but a definitive diagnosis is usually based on surgical inspection of the abdominal cavity and sampling of an area of endometrial tissue outside the uterus. Because of the risks associated with surgery, we often treat endometriosis without a definitive diagnosis.

The treatment will usually involve anti-inflammatory medication and possibly hormonal contraception. Hormonal contraception can control the menstrual cycle in a more predictable way, meaning that you have fewer or lighter periods. This, in turn, reduces the frequency of the inflammation.

In some extreme cases, patients will need surgery to remove or burn away the patches of endometriosis, but this is rarely needed.

The first step for your daughter is to go to the GP. It would be a good idea to write down the symptoms before you go in so you have a clear picture of when, how severe, and how often the pain is present. 

She will likely have an examination of her abdomen and possibly a vaginal and rectal examination if she has pain in either of these areas around the time of her periods. 

I understand she doesn’t think she needs help, but talking through the options with a doctor, she may find that some of the suggestions are acceptable, and she may not need to experience such pain.

If you have a question for Dr Phil Kieran, please send it to [e-mail]