Cramps: How much pain is too much?

Painful periods could be a sign of endometriosis

Women are tough. Every month we grin and bear it when cramps set in. We know some lower abdominal and even back pain is normal. But when does the pain become abnormal?

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Women’s health center of excellence

Norton Women’s & Children’s Hospital is a center of excellence for minimally invasive gynecologic surgery, committed to offering the most innovative, minimally invasive gynecologic surgery options available.

The hospital is a designated AAGL Center of Excellence in Minimally Invasive Gynecology (COEMIG)TM. The COEMIG program is focused on improving the safety and quality of gynecologic patient care and is designed to expand access to minimally invasive gynecologic procedures performed by surgeons.

When pain interferes with your normal work or household routine and activities, or when it lasts for more than a few days during your period, it’s time to talk to your OB/GYN.

One of the most common causes of painful periods is endometriosis. It affects more than 5 million women in the U.S. Endometriosis is a condition in which the cells that should be in the lining of the uterus (endometrial cells) begin to grow on the outside of the uterus. The cells typically stay in the pelvic area but can migrate to almost any other area of the body.

The biggest symptom of endometriosis is pain in the pelvic and/or lower back region, especially before and during menstruation. Some women have no symptoms at all, while others may have scar tissue or experience infertility. Approximately one-quarter of women with endometriosis will have trouble getting pregnant.

Signs you should see a doctor

  • Pain in the lower abdomen or pelvis and/or lower back, mainly during menstrual periods
  • Very painful menstrual cramps that worsen over time
  • Chronic pain in the lower back and pelvis
  • Pain during or after sex
  • Intestinal pain
  • Painful bowel movements or painful urination during menstrual periods
  • Spotting or bleeding between menstrual periods

The good news is endometriosis can be treated, and an OB/GYN can tailor treatment to each patient. Dr. Shively describes the typical treatment options for endometriosis:

  • Nonsteroidal anti-inflammatory medications, such as ibuprofen
  • Oral contraceptives or similar method, such as vaginal ring or birth control patch, to deliver hormones to the body
  • Progesterone, which comes in many forms, including pill, injection, implant and IUD
  • GnRH (gonadotropin-releasing hormone) agonist; this is typically the most effective nonsurgical treatment, putting the body into temporary menopause
  • Surgery. This is the only definitive way to diagnose endometriosis. It typically begins with laparoscopic exploratory surgery, which involves placing a camera into the abdomen so that the endometriosis can be seen. At this time, growths or scar tissue can be removed. In more serious cases, a full hysterectomy (removal of uterus and ovaries) may be needed. This is permanent and will cause a woman to start menopause.

If you are experiencing pelvic symptoms that don’t seem normal or you think you may have endometriosis, speak with your OB/GYN or call Norton Healthcare’s women’s health nurse navigator at (502) 899-6310.


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