Determining if the experiences you’re having during your period are normal can be a challenging task. This is especially true for younger women, including teenagers, who haven’t had as many periods as older adults. Pain, such as abdominal cramping, can be subjective and hard to compare from person to person. Additionally, the topic of the menstrual cycle is not one that many individuals find easy to discuss with their families, friends, or healthcare providers. Because of this, it can be difficult to determine if a symptom you’re having during or around your period (or even outside of the range of your period) is normal.
We recently conducted our Endometriosis In America survey to find out more about the symptoms, side effects, treatment experiences, quality of life alterations, and other issues women with endometriosis are navigating. Overall, over 1,200 women with endometriosis or its related symptoms participated in the survey. Nearly 70% of respondents said they started experiencing endometriosis symptoms when they were a teenager, and over 75% said they thought their endo symptoms were related to their menstrual cycle. Similarly, 70% and 65% of individuals said that when their symptoms worsen during or before their menstrual period, respectively. When an individual or their healthcare provider think endometriosis symptoms are just an extension of the menstrual cycle, it can take years to realize that the underlying cause is endometriosis.
What is a normal period?
Although each individual’s period can vary, there are some common experiences that are associated with the menstrual cycle. A woman will experience menstrual flow roughly every 21 to 35 days, and her whole period will often last two to seven days in total. Medical contraceptive use, pregnancy, age, and other underlying health conditions may impact the frequency and duration of the menstrual cycle, as well as the amount of blood flow.1 It is extremely common to have some abdominal or pelvic discomfort before or during your period, with some research suggesting that this happens to over 90% of teenagers.2 Pain around your menstrual cycle is called dysmenorrhea. Typical, non-endometriosis-related dysmenorrhea is often relieved after taking over-the-counter pain medications. In some cases, this pain may be alleviated by medical contraceptive therapy.3
In addition to dysmenorrhea, other symptoms of a typical period include:2,4
Constipation or diarrhea
Muscle or joint pain
What is abnormal to experience during your menstrual cycle?
Pain that is severe in nature, especially when it’s enough to make you miss work or school, is not a sign of a regular period – Especially if it is not relieved by over-the-counter pain medications or other medical options proposed by your healthcare provider. Additionally, pain that is experienced during sex or after a pelvic exam, as well as chronic (long-term or recurring) pelvic pain that happens at times not around your menstrual cycle, are signs of an abnormal menstrual cycle. If your mood, energy levels, or daily life is impacted by your period or by chronic pelvic pain, it’s important to check in with a healthcare provider, as this may be irregular.3,4
Common symptoms of endometriosis
According to survey respondents, endometriosis symptoms can occur around the time of the menstrual cycle; However, oftentimes, symptoms are present outside of this window. Roughly 45% of respondents said that they experience endometriosis-related symptoms every day, and another 25% said they experience symptoms a few times a week, regardless of menstrual cycle status.
The most common endometriosis-related symptoms reported were:
Feeling tired or lacking energy
Dull, throbbing, or sharp pain in your lower abdomen or pelvic area
Bloating (“endo belly”)
Abdominal pain or cramping unrelated to periods
Pain with bowel movements
Pain with sexual intercourse
Nausea or vomiting
Each symptom listed above was reported by 70% or more of respondents, with the most common, fatigue, being reported by 97% of participants. However, the symptom that was reported to be the most challenging to manage was dealing with dull, throbbing, or sharp pain in the lower abdomen or pelvic area.
In general, it can be hard to determine whether or not your period is normal, especially if you are younger or aren’t comfortable talking about your menstrual cycle with loved ones or healthcare providers. Because of this, abnormally severe menstrual pain and other seemingly menstrual cycle-related issues may not be evaluated, and a diagnosis of endometriosis may not be made until a long time later. Overall, if you are experiencing severe pain that is preventing you from living your daily life, or symptoms outside of your menstrual cycle window, it may be time to check in with a healthcare provider to determine if endometriosis is a possibility.
Menstrual Cycle: What’s Normal, What’s Not. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186. Published May 11, 2016. Accessed December 8, 2018.
Parker MA, Sneddon AE, Arbon P. The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG: An International Journal of Obstetrics and Gynaecology. 9 Dec 2009; 117(2). Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2009.02407.x. Accessed Deccember 8, 2018.
Do You Have Endo? Endometriosis Research Center. https://www.endocenter.org/do-you-have-endo/. Accessed December 8, 2018.
Symptoms of Menstruation. The Society of Obstetricians and Gynaecologists of Canada: Your Period. https://www.yourperiod.ca/normal-periods/symptoms-of-menstruation/. Accessed December 8, 2018.