Excessive menstrual cramps could be a sign of endometriosis

Do you know menstrual cramps, which women both naturalize as something that is part of life? Well, it shouldn’t be seen like that, especially if they are intense and frequent. Menstruation is a physiological function of a woman, just like peeing, pooping, breathing. When any of these last situations generate some serious discomfort, something is soon suspected and treatment is sought. The same behavior would have to occur when menstruating and feeling a lot of pain.

But the normalization of women’s pain has caused diseases such as endometriosis to be neglected by science, medicine and many patients for many years.

Having some type of colic is common: during menstruation there is a decrease in blood in the wall of the uterus, and this usually causes some pain that tends to improve with comfort measures or pain relievers. But those pains that progressively worsen with each cycle and sometimes become disabling cannot be naturalized.

It is precisely this trivialization that makes many women and people with a uterus take up to ten years, according to international scientific studies, to diagnose endometriosis and initiate appropriate treatment.

By the way, have you ever heard of endometrium? It is the name we give to the tissue that covers the inner wall of the uterus. It is expelled during menstruation in the form of bleeding, but if part of this tissue falls into the ovaries or abdomen, it causes inflammation, such as endometriosis.

Exams started ‘another day’

Endometriosis is a complex disease that we are beginning to understand a little better about only now, with more research being carried out. But it’s hard to believe how a disease that keeps women out of work, and girls out of school hasn’t been a major public health issue before, has it?

In addition to research, it was only in the last decade that imaging tests began to be able to detect foci of endometriosis. Before, it was necessary to do a biopsy, through videolaparoscopy, which is a less invasive surgery, but still a surgery.​

With the greater visibility of the disease and more availability of tests, the number of diagnoses naturally grew. The disease affects about 10% of the Brazilian female population, according to Anvisa (National Health Surveillance Agency), and is more frequent among people between 25 and 35 years of age.

But it’s not that much easier today either. Even though specific ultrasound and resonance exams are available, they need to be performed by trained professionals, because most endometriosis lesions present in a subtle way, which is difficult to visualize. In addition to the few specialized radiologists, exams are not always available in the public health network, the SUS (Unified Health System).

The professional needs to have a good experience, be obsessive and meticulous in the search for lesions, explains doctor Marcelo Pedrassani, a specialist in gynecology-obstetrics and diagnostic imaging. And it is essential to have more advanced equipment that provides excellent image resolution. “Many times patients have only lesions between 0.5 and 1 cm”, he pointed out. But this size has no direct relationship with the severity of symptoms, see?

surgery saga

Businesswoman Flávia Tonani, 43, discovered that she had endometriosis in 2000, shortly before her 21st birthday. She had been menstruating for 10 years, with a lot of blood, intense cramps, a lot of weakness. “Sometimes I even needed to go to the hospital to be medicated”. The final diagnosis was made with videolaparoscopy. The cyst she had on her left ovary was large (the size of an orange), compressing her intestines and causing severe pain.

The “treatment” recommended in her case was to take contraceptives directly, without a break, to avoid menstruation and reduce pain. And so Flavia did for many years. After the age of 30, already married, she looked for a gynecologist because she wanted to get pregnant. She resumed her menstrual cycle without hormones and with that the suffering returned.

“I couldn’t get out of bed in so much pain.” In 2020, she had the second laparoscopy and the cyst was now in the left ovary. Stopping her period didn’t stop her illness, it just masked a compromising breakthrough.

This time, Flávia had to remove her left ovary. “He was all compromised and if I hadn’t discovered this cyst, it could rupture and the surgery would be more complicated.” Flávia was grateful for the discovery, but also sad and frustrated for not being able to “fulfill the dream of generating a life”, she said.

Last year, follow-up exams indicated that endometriosis had spread to the intestines. It was then that she began a different treatment with a nutritionist. “I saw the disease from an angle I had never seen before: healthy eating, physical activity, self-knowledge, taking care of myself and doing something that gave me pleasure, all of this is part of the treatment”.

Understanding what she had and what was happening in her own body was a key turning point in Flávia’s life, who today no longer has motherhood in her plans. “It’s a pain overcome”, in her words.

There is no consensus on treatments

Today it is already known that treatment must be individualized, as each woman is unique, and this raises questions about the maxim that has been sold for decades: that “living without menstruating” is the best of all worlds, or that monthly bleeding is something useless. After all, for that, a person needs to use artificial hormones for life.

“If there were more women scientists researching or even if we were listening more to what people with a uterus have to say about this situation, we would not be using the contraceptive pill as a panacea”, highlighted gynecologist Halana Faria, from the profile Gynecologia Feminista. Today, studies already point out that cutting the menstrual cycle can generate other problems and diseases, in addition to not solving endometriosis, in this case.

Even today, when a woman says that she has a lot of acne, feeling pain during her menstrual period and even when she receives the diagnosis of endometriosis, she is likely to hear from most gynecologists that contraceptive or cycle block will solve the situation.

“This statement doesn’t even have scientific support and starts from an idea that menstruation is a problem and that a great favor you do is to help women get rid of it”, said gynecologist Bel Saide, from the Natural Gynecology profile, reinforcing that hormonal drugs do not treat the disease itself. Another myth that the doctor fights is that menstruation feeds endometriosis and therefore would have to be suppressed.

In fact, there is no consensus in the medical literature regarding the benefit of stopping menstruation. For the gynecologist Halana, this can be something justifiable if the person feels so much colic to the point of impairing their quality of life, but this will not always be the proposed treatment. “What patients tell me is that they feel good when they menstruate, because it feels natural, physiological, even though it has some effects,” she added.

no miracles

“Every day women come to me because they do not want to use hormones or have already done so and realized that they did not solve the problem”, says gynecologist Bel Saide.

As it is a disease that involves many factors, in addition to lifestyle, an integral and multidisciplinary view of women is important. Some experts advocate, for example, a special look at food, restricting foods that generate inflammation.

There are very symptomatic patients who undergo exams and have almost no focus of endometriosis. Others have abdominal cavities filled with foci of endometriosis, without showing any symptoms.

Some women can have the diagnosis and go without medication, accompanying endometriosis with possible complementary therapies, because only a third of them, according to doctor Halana Faria, will have an exacerbation of symptoms. Concern arises if the disease progresses and affects other organs adjacent to the uterus: fallopian tubes, ovaries, bladder, ureter, and bowel. “But in 70% of cases it will stop or regress spontaneously”, emphasizes the gynecologist.

The most urgent thing is to have good health professionals, family doctors, general practitioners, who investigate and understand the disease. That gynecologists in general do the true and adequate listening of women and people with uterus, of patients’ complaints.

Halana warns that the identification of period pains can have two bad extremes: never investigating what is behind the pains or arriving at a late diagnosis; or start doing a lot of exams, getting too suspicious, and discovering focuses that will actually regress or stop and won’t become problems.

It is also necessary to be attentive to medicalization disguised as “naturopathy”, ponders Halana, with courses and miraculous recipes for complex issues. But, of course, we must question and criticize the way health is offered today – based on heteronormative standards, which exclude the existence of trans women and homosexual relationships, and continue to see women as mere reproducers – and guided by commercial interests.