It’s Endometriosis Awareness Month and I’d be remiss if I didn’t give voice to the painful struggle as many as ten percent of women face on a monthly basis. This internal physical challenge is not easy to deal with nor does it have a quick fix.

Working with women of all ages, I have consistently heard negative commentary about menstruation. Whether young adolescents dreading its onset, 20 and 30-somethings experiencing irregular cycles, inconsistent bleeding, the symptoms of PMS, and decisions about family planning, to women “of a certain age” who are dealing with the unpredictability of menopause…one rarely hears how magnificent menstruating is.

It must always be acknowledged and should be discussed with a medical provider when the monthly cycle includes excruciating pain, heavy bleeding (or no bleeding at all), and discomfort with intercourse, urination, or bowel movements. These symptoms could signal a condition called Endometriosis.


Explaining Endometriosis

To explain the term, the endometrium is the lining of the uterus, which, thanks to hormonal changes during the cycle, builds up with blood and healthy tissue, and nourishes a fertilized egg should it implant. In that case, the lining will not shed, hence one of the first signs that pregnancy has occurred – a missed period. On the other hand, if fertilization has not occurred, blood and tissue are shed each month during menstruation.

In the case of Endometriosis, the uterine lining is not shedding, or not shed entirely, because it is growing in other parts of the body besides the uterus. For blood and endometrial tissue to grow on the ovaries, in the fallopian tubes, and even on the intestines, is not normal.

Your body wants to shed uterine lining (endometrium) through the course of menstruation. But when it builds up in other areas, it can be abnormally retained and cause extreme pain and discomfort. It can also negatively impact fertility.

Diagnosing Endometriosis

Endometriosis is diagnosed with a pelvic exam, which can help pinpoint the area of pain, whether it is confined to the uterus, or has traveled to other organs. As discussed above, a certain amount of discomfort is normal for most women experiencing menstrual bleeding, but extreme pain anywhere is usually a signal to consult a medical provider, no matter its genesis.

A pelvic exam may progress to other diagnostic means of knowing whether a woman has endometriosis and deciding on treatment modalities. Laparoscopy enables a provider to view the entire pelvic area with a slender instrument inserted into a tiny incision in the abdomen.

If necessary (or possible), bits of endometrium can be removed during this procedure. There is always the chance that it returns, and more invasive surgery might be indicated. That is a decision to be made between the patient and provider, as it could impact the ability to conceive in the future.


One Treatment Option

Hormonal therapy is also a treatment option and can help alleviate many of the symptoms of Endometriosis. Since hormones are responsible for the buildup of the endometrial lining in the first place, controlling hormone levels can greatly impact both the consistency of the tissue lining and the length of the cycle.

Thinner, less clotty blood is easier and less painful to shed, and shorter cycles mean less time for lining to build up. Again, treatment of Endometriosis with hormone therapy is a decision to be made with medical consultation, considering the pros and cons, and whether a woman is considering pregnancy now or in the future.

Assessing pain with menstruation is a very subjective process. What is “normal” to one woman, might not be considered as such by the next. However, when pain with menstrual bleeding, or at any time during the cycle for that matter, becomes extreme, inhibits activities, requires bed rest, or taking time off from work or school, it is something to discuss with a medical professional.


For the majority of women, cycles proceed from beginning to end and then begin again with little or no disruption to daily life. Embracing that is to embrace wellness. However, irregularities do occur. If pain and/or heavy bleeding are your “norm”, it is important to seek medical help with diagnosis and treatment and to ultimately take control of your reproductive health.

I have conveyed throughout my career how very normal, healthy, and body-affirming menstruation is and should be. It is the renewing life cycle that keeps us alive as a species. Now that is some kind of awesome power all females possess with and without them dealing with Endometriosis.