Endometriosis is a chronic condition where tissue similar to the uterine lining (endometrium) grows outside the uterus, on organs like the ovaries, fallopian tubes, bowel, or bladder. Unlike the uterine lining, this misplaced tissue cannot exit the body during menstruation. This leads to inflammation, scarring, and adhesions, which are bands of fibrous tissue that can bind organs together. Pain is a primary symptom, often following specific patterns or triggered by events.
Pain During the Menstrual Cycle
For many, pain is most intense during menstruation, known as dysmenorrhea. This severe menstrual pain is a hallmark symptom, often worse than typical period cramps and debilitating enough to disrupt daily activities.
During menstruation, the misplaced tissue responds to hormonal changes, thickening and attempting to shed, similar to the uterine lining. This process outside the uterus causes inflammation and irritation in surrounding tissues, leading to significant pain. High levels of prostaglandins, which trigger uterine contractions and inflammation, contribute to the severity of these cramps.
Mid-cycle pain, often referred to as ovulation pain or “Mittelschmerz,” can also be severe. This pain occurs around the time an egg is released from the ovary. Hormonal fluctuations during ovulation can activate endometriotic lesions, leading to increased inflammation and pain. If endometriosis has caused adhesions or cysts (endometriomas) on or near the ovaries, ovarian swelling and movement during ovulation can pull on these adhesions or aggravate the cysts, causing sharp pain.
Pain may also be experienced in the days leading up to menstruation, known as premenstrual pain. This discomfort is often linked to hormonal shifts that precede the menstrual period. As the body prepares for menstruation, endometriotic implants can become inflamed and more sensitive, increasing pain even before bleeding begins.
Pain with Bodily Functions
Endometriosis can cause significant pain during specific bodily functions due to the location of endometrial implants and the inflammation they generate. Deep dyspareunia, or painful intercourse, is a common and distressing symptom. This pain often results from deep penetration, as implants on ligaments (e.g., uterosacral) or in the cul-de-sac (behind the uterus) can be stretched or compressed. The pain can be sharp, burning, or a deep ache, and its intensity may vary depending on sexual positions and the extent of the lesions, with inflammation and fibrosis contributing.
Painful bowel movements, medically termed dyschezia, are another frequent symptom, particularly if endometriotic lesions are on the bowel or rectovaginal septum. Individuals may experience severe cramping, sharp pain, or tenesmus (the feeling of needing to pass stool even when the bowel is empty). This pain can be mistaken for irritable bowel syndrome (IBS) due to overlapping gastrointestinal symptoms, but endometriosis-related bowel pain tends to worsen around menstruation.
Painful urination (dysuria) can occur when endometriosis affects the bladder. Symptoms can include burning, urgency, and bladder spasms, which may intensify during menstruation. Endometriotic implants on the bladder wall cause irritation and inflammation, leading to these urinary symptoms. Microscopic blood may even be present in urine during a period, indicating bladder tissue involvement.
Chronic Pelvic Pain
Beyond specific cyclical or functional pain, many individuals with endometriosis experience chronic pelvic pain. This pain is not confined to particular times but can be a persistent, nagging, or severe ache that fluctuates in intensity but is always present. It often manifests as a dull ache, sharp pain, or burning sensation in the lower abdomen and pelvis. This discomfort can significantly impact daily life.
A contributing factor to chronic pelvic pain in endometriosis is central sensitization. This phenomenon involves changes in how the brain and spinal cord process pain signals, amplifying them. Constant pain input from endometriotic lesions can lead to increased excitability of central nervous system neurons, causing even mild stimuli to be perceived as very painful. This heightened sensitivity means pain pathways remain “turned on,” perpetuating pain even when initial inflammatory triggers are less active.
Other Triggers for Severe Pain
Several other factors can trigger or exacerbate severe pain, leading to sudden flare-ups. Physical activity can worsen pain, especially if endometrial implants are near muscles or joints. Movements or exercises that put pressure on the pelvic region can irritate sensitive endometriotic tissue, increasing discomfort.
Stress plays a significant role in pain perception and can intensify existing endometriosis pain. When stressed, the body releases hormones like cortisol, which can increase inflammation and lower the pain threshold. High stress levels can make current endometriosis pain feel more severe and may contribute to the growth and spread of endometrial tissue.
Dietary factors may also influence endometriosis pain for some individuals. Certain foods can trigger inflammatory responses, potentially worsening symptoms. Red meat, processed foods, trans fats, alcohol, and caffeine have been linked to increased inflammation or hormonal imbalances that can exacerbate pain. Conversely, a diet rich in anti-inflammatory foods like fruits, vegetables, and omega-3 fatty acids may help reduce pain.
General inflammatory flare-ups, not directly tied to the menstrual cycle or specific bodily functions, can also lead to sudden and severe pain. These acute episodes can be triggered by various factors, including hormonal fluctuations, increased systemic inflammation, or lack of rest. Such flare-ups represent periods of significantly worsened symptoms, where pain levels intensify and may last for hours to weeks.