35 years old with lots of different pains

Molly is a 35 year old patient of mine. When she was 28, she had bad period pain and was trying to become pregnant. She had a big operation with excision (cutting out) of endometriosis and then had 2 children.

Molly came to see me again recently with lots of different problems, sure that she had her endo back again. Sex was painful, period were painful, she was going to the toilet all the time, there were frequent headaches and her bowel was very irritable. At her laparoscopy, I found only 2 small areas of endo. Otherwise all had healed very well from her previous surgery. She felt confused that she had so much pain, but very little new endometriosis. I explained that there is a much 'bigger picture' to endometriosis than just the black lesions in the pelvis.

Women who have EVER had endo, have a higher chance of getting several other painful conditions. Molly had a painful uterus (the period pain), interstitial cystitis (the bladder troubles and painful intercourse), chronic migraine (the headaches), food intolerances and a sensitised bowel. She doesn't need any more surgery and she doesn't need any hormonal treatment/Lupron.

We are treating her problems with dietary changes (her bladder and irritable bowel), amitriptyline (for her headaches and bladder) and a mirena iucd (her period pain).

Is my period pain normal?

Women only know what their own period feels like. They can't compare it with their friend's period pain. Sometimes they wonder if their periods are really normal and they are just weak in some way. It's a dreadful feeling to wonder if 'its all in your head'.

Normal period pain should only last 1-2 days, and it should go away almost completely on the oral contraceptive pill and period pain medications like ibuprofen or naprosyn taken early before the pain is bad.
If your period pain lasts longer than this, or if these medications dont help you, then it is not normal period pain.
An ultrasound scan is usually normal in most women with endometriosis.