Severe Period Pain – when pain is not just 'part of it'

What is endometriosis?

Endometriosis is a chronic, benign condition in which tissue similar to the lining of the uterus grows outside the uterus – for example on the ovaries, the peritoneum or elsewhere in the pelvis. These so-called lesions respond to hormonal changes throughout the menstrual cycle. This triggers inflammatory reactions that can cause pain and other symptoms.

Endometriosis is not uncommon. Estimates suggest that around one in ten women of reproductive age is affected. Yet on average, several years pass between the first symptoms and a confirmed diagnosis. This can change – if pain is taken seriously and assessed early.

If you would like to know more about how we support patients with this condition, please visit our page on endometriosis care or find out more about our gynaecology practice in Dormagen.

Typical symptoms – and why they deserve attention

Endometriosis can present in very different ways. Not every woman experiences the same symptoms, and the intensity of pain does not necessarily reflect the extent of the condition. Even small lesions can cause significant discomfort.

Common signs that may point to endometriosis include:

• severe or worsening period pain
• pain before menstruation begins
• persistent lower abdominal pain outside of the period
• pain during sexual intercourse
• pain during bowel movements or urination, particularly around the cycle
• pronounced fatigue

None of these symptoms automatically confirms endometriosis – but each of them deserves attention and a gynaecological assessment. If you are experiencing similar symptoms alongside an unfulfilled wish to have children, you may also find our page on fertility consultation helpful.

Why severe period pain is often not recognised early enough

One reason for late diagnosis lies in a widespread misconception: period pain tends to be seen as an inevitable part of being a woman. Some women hear this from friends, family or even in medical settings. As a result, symptoms are endured for years without anyone looking more closely.

There is also a diagnostic reason: endometriosis is not always visible on ultrasound. A clear scan result therefore does not rule out endometriosis. What matters most is listening carefully – the nature, timing and pattern of pain often provide crucial clues.

Severe period pain that limits daily life is not a normal part of the menstrual cycle. It is a signal that should be taken seriously.

How endometriosis is diagnosed

The starting point is always a detailed conversation. When does the pain occur? How long does it last? Has it changed over time? These questions help build a clear picture of what is happening.

Depending on the situation, a gynaecological examination and an ultrasound may follow. If particular findings are present or if symptoms persist despite treatment, further investigations may be appropriate.

A definitive diagnosis is often only possible through a laparoscopy – a keyhole procedure in which lesions can be directly identified and removed. However, this step is not necessary in every case. Whether it is the right approach depends on the severity of symptoms, the level of distress and individual treatment goals.

Treatment: step by step and individually tailored

The treatment of endometriosis is guided primarily by the nature of the symptoms and the extent to which daily life is affected. There is no one-size-fits-all solution – the approach is discussed and adapted together with the patient.

The aim is to reduce pain and improve quality of life over the long term. A complete cure for endometriosis is not possible in the medical sense, but good symptom control is achievable for many women.

Hormonal therapy as a first step

In many cases, treatment begins with a hormonal approach. The aim is to reduce the activity of endometriosis lesions and dampen inflammatory reactions.

A progestogen – a hormone that resembles the body's own progesterone – is commonly used for this purpose. Progestogens counteract the build-up of the uterine lining and can slow down the hormonal activity of lesions. This helps to reduce cycle-related inflammation and relieve pain.

A continuous progestogen therapy is well-tolerated and well-researched for many women. In many cases, it is an effective first step – without the need for further imaging or surgery.

It is worth noting that not every case of endometriosis requires the same treatment path. What matters is how well symptoms can be managed with the chosen approach.

If you have questions about hormones and your cycle more broadly, these can also be discussed in our hormone consultation.

Further steps – when necessary

If symptoms persist or worsen despite hormonal treatment, further investigations or a surgical procedure may become appropriate. Surgery is used selectively today – ideally at experienced centres with the necessary infrastructure.

It is one part of an overall treatment concept, but not a guarantee of lasting freedom from symptoms. After a procedure, ongoing treatment may still be needed. We remain involved in the follow-up care – with clear communication in both directions.

Understanding endometriosis as a chronic condition

Endometriosis is a condition that can fluctuate over time. Phases with fewer symptoms may alternate with more active phases. The goal of treatment is therefore not a one-time fix, but long-term support.

Women with endometriosis benefit from a consistent gynaecological point of contact – one that is familiar with the condition, takes changes seriously and considers treatment options together with the patient. This is a personal concern at the heart of our practice.

Conclusion: getting your pain assessed – sooner rather than later

Severe period pain is not something you simply have to accept. The earlier symptoms are assessed by a gynaecologist, the better the chances of avoiding unnecessary limitations and finding the right path forward.

If you are experiencing symptoms that concern you – whether that is severe pain during your period, discomfort during intercourse or ongoing fatigue linked to your cycle – it is worth having it looked at. You do not need to assess this on your own.

If you would like to take the next step together, you are very welcome to book an appointment here.

References

• AWMF Clinical Guideline on Endometriosis (S2k), Registration No. 015-045, German Society of Gynaecology and Obstetrics (DGGG), current version: www.awmf.org
• European Society of Human Reproduction and Embryology (ESHRE): Guideline on Endometriosis, 2022. www.eshre.eu
• Endometriosis Research Foundation (Stiftung Endometriose Forschung): Information for patients and healthcare professionals. www.endometriose.de