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Normal or Not? Finding the Cause of Painful Periods

6 Minute Read

By Dr. Nithya Gopal, Director of Ob/Gyn at Viva Eve

More than half of women who menstruate have some pain for 1 to 2 days each month. Usually, the pain is mild and can be alleviated with a few over-the counter pills like Advil or Tylenol. But for some women, the pain is so severe that it keeps them from doing their normal activities for several days a month. 

Painful periods and abnormal bleeding can be caused by many different conditions – including uterine fibroids. However, there could be other potential causes. Painful periods can sometimes be a sign of more serious health issues— but, that is not always the case. I always tell my patients that if their monthly cycle pain interferes with their daily activities and affects their quality of life, it is definitely time to visit your doctor and run a few tests.

Finding the cause of painful periods

At Viva Eve, we always recommend that you consult a physician to pinpoint the exact cause of your menstrual symptoms. Many women assume they have uterine fibroids and yes, that could be the culprit. However, it is important to know that up to 20 percent of women with symptoms that are similar to those of uterine fibroids actually have a different uterine condition called adenomyosis (ad-uh-no-my-oh-sis)

What is adenomyosis?

Adenomyosis occurs when the lining of the uterine cavity — called the endometrium — migrates into the muscular layer of the uterus. This “displacement” of cells into the wrong layer creates massive amounts of inflammation, which causes severe pain and heavy bleeding. The surrounding muscle of the uterus swells and forms fibrous tissue in response to the inflammation. One of the key symptoms of adenomyosis is an enlarged uterus. This inflamed or swollen area within the uterine muscle wall, called an adenomyoma, feels very much like a fibroid on physical examination. The condition may affect the patient’s entire uterus or it can be localized to one area.

About a third of the women who have adenomyosis experience uncomfortable and painful symptoms. These symptoms — like heavy menstruation, pelvic pain, and frequent urination — can be severe. If left untreated, heavy bleeding experienced by patients with this condition can cause chronic anemia and fatigue. The disease can also severely affect the patients’ quality of life due to chronic pain and bleeding.

Another issue is that adenomyosis symptoms can mimic those of a slightly different condition – endometriosis, — that is why sometimes it may take patients years to arrive at the correct diagnosis and treatment plan. With endometriosis the cells grow outside the uterus and usually in the ovaries, the cavities of the pelvis, and the supporting ligaments of the uterus.With adenomyosis the cells grow within the walls of the uterus. 

There are several overlapping symptoms, causes, and results, but effective treatment options are different. Both adenomyosis and endometriosis are the result of abnormal endometrial growth in the wrong place. In cases that are more severe and complex, both can occur at the same time. 

How is adenomyosis diagnosed?

Because the symptoms of fibroids and adenomyosis are so similar, misdiagnosis is incredibly common. That is why it is recommended that a patient sees a gynecologist or practice specializing in the treatment of both fibroids and adenomyosis, with the expertise to distinguish the two conditions. Adenomyosis can be diagnosed based on several factors:

  • Patient symptoms (severe cramps, heavy prolonged bleeding, pressure, bloating)
  • Pelvic exam that reveals an enlarged uterus
  • Ultrasound imaging of the uterus
  • Magnetic resonance imaging (MRI) of the uterus

Based on patient symptoms, your doctor may recommend that a sample of the uterine lining be collected under sedation, for the purpose of ruling out other potentially serious health conditions.

How is adenomyosis treated?

Women who have been diagnosed with adenomyosis are often offered the following treatment options:

  • Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Anti-inflammatory medications, such as ibuprofen (Advil, Motrin, Ibuprofen, Naproxen) may help to control the pain and even reduce menstrual blood flow. I usually advise my patients to start taking an anti-inflammatory medicine one to two days before their period begins and continue taking it during their period as needed.
  • Hormone medications. Hormone therapy can be used to help ease any symptoms associated with significantly heavy or painful periods. The treatment only works while the patient is using the hormones. Symptoms return once the treatment stops. Hormone treatment is generally only used for less than six months, as the side effects are similar to those of menopause.
  • Hysterectomy, the surgical removal of the uterus, is used to treat a wide variety of issues, from symptoms of fibroids and adenomyosis to endometriosis to cancer. Removing the ovaries is not necessary to control adenomyosis, so usually just the uterus is removed. A hysterectomy is a major operation that I only recommend if other treatment options have been unsuccessful, and no other method would work for the patient’s specific symptoms.
  • Uterine artery embolization (UAE). Also known as uterine fibroid embolization (UFE), UAE is commonly known as a treatment for uterine fibroids. However, it can also be used to treat adenomyosis. Adenomyosis patients who underwent the UAE procedure report significant improvement in their symptoms and in quality of life. UAE is a procedure that has been proven very effective in the treatment of adenomyosis.

The technique used to treat adenomyosis is virtually the same as the one used to treat uterine fibroids. The procedure is performed while the patient is conscious or minimally sedated, but feeling no pain. It does not require general anesthesia. The interventional radiologist makes a tiny incision in the wrist or the groin area and inserts a catheter into the artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries blocking the blood supply to the affected tissue causing it to shrink and the symptoms to subside.

Make sure you’re dealing with UFE experts for treatment

It is really important to see a doctor or a practice that specializes in the treatment of fibroids and adenomyosis. Specialized practices have the necessary imaging equipment and experience to provide you with a correct diagnosis. I also urge all of my patients to seek a second opinion, especially when deciding on a major surgery like hysterectomy. 

The doctors at Viva Eve have years of experience treating both uterine fibroids and adenomyosis with UFE. Importantly, Viva Eve offers its patients integrated specialty care, where several specialists work together to determine the best treatment option for each patient. We will partner with you to determine the best way to treat your problematic fibroids or adenomyosis.

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