Every month millions of women the world over snuggle up with a heat pack or sink into a warm bubble bath to soothe the cramps associated with period pain.
But for some of these women - including thousands in Australia - the pain is crippling and can dog them for years.
Many of these women pop a painkiller and suffer in silence, thinking that's their lot in life.
But their pain could in fact be a result of endometriosis, a condition that is rarely spoken about and little understood in the public domain, but one that affects one in ten women - and around a third of those suffering fertility issues.
"Women grow up thinking period pain and heavy periods are normal and they're not," explains Melbourne-based gynecologist Dr Elizabeth Farrell, who has a specific interest in the condition.
"If a person's quality of life is altered (by the pain) and they cannot function as a normal human being, then in one sense it's endometriosis until proven otherwise."
Endometriosis is a condition when the tissue that normally lines the uterus - the cells that are shed when a woman has her period - is found in other areas of the abdominal captivity but primarily in other parts of the pelvic cavity, including the ovaries, the fallopian tubes, the bowel and the bladder.
With time and as the woman menstruates, the number of endometrial cells increases. These spots will also bleed when the woman has her period, making them sticky, which sometimes causes tissues and organs to stick together.
And because the cells contain nerve endings, the condition can cause severe pain in the sufferer.
Other symptoms of the condition include heavy bleeding, fatigue, bloating, pain with passing urine or opening the bowels, and pain with sex.
Trisha Ong, 45, knows all about the pain associated with the disease. She was diagnosed with endometriosis in 2002 after suffering debilitating pain since her teenage years.
"By the time I was diagnosed it was getting to be daily pain throughout the whole cycle," she says. "... I also had crippling fatigue, which I now realise was probably related as well ... I had stopped working, I couldn't function."
The mother of two (her children are now 16 and 19) said that after having her son in her thirties, her period symptoms - crippling pain, sore breasts, hot flushes - got a lot worse, and she decided to seek help from her GP, who referred her to a gynecologist.
When keyhole surgery discovered significant endometriosis throughout her pelvic cavity and an endometrial adhesion that had stuck her left ovary to the wall of her uterus, she describes the feeling as "a relief".
"I got an an answer to the questions that had been plaguing me for years," she says.
Dr Farrell explains that because period pain is considered among the community to be normal, studies have shown that in women who have the condition, it takes up to seven years to get a diagnosis.
"I find it hideous."
But she says it's not just society who is to blame; it's also the medical professionals.
"(Patients) are just not being referred on, or if they are being referred on, they may not be referred on to someone who has an interest or someone who has the skill ... GPs are not thinking (about endometriosis), they're just saying `oh we'll give you another pain relief' ... or `we'll put you on the pill'."
An endometriosis diagnosis can only be made through keyhole surgery known as a laparoscopy, during which small incisions are made into the abdomen and the cavity explored with a laparoscope.
While a surgeon will remove as much of the tissue as possible, Dr Farrell admits it's impossible to "remove every single bit" and the endometriosis can always grow back elsewhere.
For this reason, follow-up hormonal treatment is usually advised in order to try and reduce the possibility of recurrence or minimise the activity within the endometrial cells.
Unfortunately for Ong, the laparoscopy didn't give her much relief - and the follow-up hormonal treatments left her with unwelcome side effects.
She continued to suffer crippling abdominal pain, as well as severe menstrual headaches and pain with sex.
"I used to come home and say to my husband, `I've got to go to bed' and he would fix dinner and do stuff with the kids," she says. "Looking back I feel like I lost a lot of my life as a mother over that endo experience, and as a wife too - and with friends because you put your social life on hold when you're extremely tired."
After another exploratory laparoscopy, which discovered more endometriosis and adhesions, her gynecologist suggested a hysterectomy.
Having already had her children, Ong opted to have her left ovary and uterus removed five years ago - a operation that, she says, changed her life in just 24 hours.
"The pressure relief was enormous," she remembers. "I felt like all the pain and swelling and bloating had just softened and disappeared.
"I got energy back after that surgery that I haven't had in a very long time."
But while she is happy to finally have relief from the pain, Ong admits "there's always a sadness about losing something that's given life".
"If I nurse a young baby, I always think `I can't give birth anymore'," she says.
Dr Farrell advises all women with debilitating period pain to get themselves investigated.
"I think we definitely need to have much more education on all levels - in social society and in the medical profession - that period pain is not normal," she says.
Ong, who now works in reproductive health, admits every aspect of her journey - the surgical and medical treatments - has been "difficult, really difficult".
But she is loving life on the other side.
"I'm actually doing something that I never thought I'd do and it's inspired by endo," she says.
"When I was 21 I went trekking in the Himalayas and with all this endo experience, I never thought I'd be able to do that again.
"But I'm going in four weeks time."
SYMPTOMS OF ENDOMETRIOSIS
- Pain (before or during the period; during or after sex; abdominal, back and/or pelvic pain; pain with opening bowels, passing wind or urinating; ovulation pain, including thigh or leg pain)
- Heavy bleeding; irregular bleeding; prolonged bleeding; premenstrual spotting
- Bowel or bladder symptoms, including bleeding from either
- Irregular bowel habits such as constipation, diarrhoea
- Increase in urinary frequency or change in normal function
- Infertility
- Premenstrual symptoms
- Tiredness
- Mood changes
- Bloating
Source: Jean Hailes Foundation for Women's Health
* For more information about endometriosis, visit www.endometriosis.org.au
By Caroline Berdon
