Many women have cramps during their period, and that is usually normal. The difference with endometriosis is not so much in the pain itself, but in how severe it is, how long it lasts and how much it limits your life. Pain that brings your work, school or daily life to a standstill is not a given, even though it is often experienced that way.
I notice that many women spend years doubting whether their pain is normal or not. That doubt is understandable, because you only have your own experience to compare it with.
Below you read what normal period pain is, when pain may point to endometriosis, which other signals can fit and when to have it assessed.
What is normal period pain?
Normal period pain consists of cramps low in your belly around the first days of your period, which can usually be eased with a painkiller, a hot water bottle or movement. You should still be able to function. The pain generally fades after the first days and does not keep getting worse over the years.
Most women know some form of period cramps. That is because your womb contracts to shed its lining, and those contractions can hurt for a while.
With normal period pain you can often still go to work or school. You do not have to stay home sick, and with simple measures the pain stays bearable.
Do you recognise that? Then there is usually little reason for concern. It becomes different when the pain structurally limits your life.
When does pain possibly point to endometriosis?
Pain may point to endometriosis when it is so severe that you cannot function, when ordinary painkillers barely help, when the pain increases over the years or when you also have pain outside your period. Endometriosis means that tissue resembling the womb lining grows outside the womb, which can cause inflammation and pain. A blood test cannot prove endometriosis.
The difference often lies in a combination of features, not in a single signal. The table below sets normal period pain and pain that may fit endometriosis side by side.
| Feature | Normal period pain | Pain that may fit endometriosis |
|---|---|---|
| Can you function? | You can usually go to work or school, possibly with a painkiller | The pain regularly stops your life, you stay home |
| Timing in the cycle | Mainly the first days of the period | Also before or after the period, sometimes mid-cycle |
| Course over the years | Stays roughly the same or becomes milder | Gradually increases or becomes more severe |
| Response to painkillers | Simple painkillers usually ease the pain | Painkillers barely help or are insufficient |
| Accompanying complaints | Little to no other complaints | Pain during sex, bowel or bladder complaints, fatigue |
Do you mainly recognise the right-hand column? Then it is useful to discuss your complaints with your GP. If you want more background, read our extensive pillar on endometriosis: symptoms, diagnosis and what blood tests add.
Which other signals fit endometriosis?
Besides severe period pain, other complaints can also fit endometriosis, such as pain during sex, bowel or bladder complaints around the period, heavy blood loss, ongoing fatigue and pain that also occurs outside your period. Endometriosis is a condition with many faces, and not everyone has the same combination.
The following signals, together with period pain, can give a broader picture:
- Pain during or after sex
- Bowel complaints around your period, such as pain when passing stool
- Bladder complaints or pain when urinating during your period
- Heavy blood loss or large clots
- Ongoing fatigue that does not match your rest
- Lower belly pain that also persists outside your period
If you also lose a lot of blood, that can slowly deplete your iron. In that case, also read our article on heavy periods: causes and when to test.
Endometriosis is on average only recognised after years, partly because complaints are dismissed as ordinary period pain. The better you know your own pattern, the easier it is to have the conversation with your GP. It helps to track over a few cycles when the pain starts and what does or does not bring relief.
None of these signals proves endometriosis on its own. Together they do indicate that it can be useful to have your complaints assessed further.
When do you go to the GP?
Go to the GP if your period pain makes work or school impossible, if painkillers do not help, if the pain increases over the years or if you have other complaints alongside the pain such as pain during sex. Pain that stops your life is not normal, even though it is often played down. You do not have to wait until it becomes unbearable.
Get in touch with your GP in any case if you recognise this:
- The pain makes working, studying or exercising impossible
- Ordinary painkillers do not ease the pain or barely do
- Your pain has become more severe over the years
- You have pain during sex or when passing stool around your period
- You feel increasingly tired or low because of the ongoing complaints
The GP can map your complaints and refer you to a gynaecologist if needed. A doctor makes the diagnosis of endometriosis based on your story and possibly imaging, not based on a blood test.
So a blood test cannot prove or rule out endometriosis. A hormone test can help to look at other causes of your complaints. The Hormones Women panel can shed light on look-alike complaints around your cycle, as an addition to the conversation with your GP.
Do you also want practical tools for dealing with your complaints? Then read our article on living with endometriosis: recognising and tackling symptoms.
Frequently asked questions
Can you prove endometriosis with a blood test?
No, a blood test cannot prove or rule out endometriosis. A doctor makes the diagnosis based on your complaints and possibly imaging, such as an ultrasound or keyhole surgery. A hormone test can help to look at other causes of your complaints.
How do I know if my period pain is still normal?
A handy guide is whether you can still function. If you can go to work or school with a painkiller, the pain is usually still normal. If the pain stops your life or painkillers do not help, it is useful to have it assessed.
From what age can you get endometriosis?
Endometriosis mainly occurs in women during their fertile years, so from the teens to the menopause. Complaints can already start around your first periods. Severe pain at a young age is not a natural part of growing up, so discuss it with your GP.
References
- Thuisarts.nl. I have endometriosis. Dutch College of General Practitioners. Available via thuisarts.nl.
- NHG. NHG guidance and information on menstrual complaints. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
- Endometriose Stichting. Information on endometriosis and recognising complaints. Available via endometriose.nl.
- World Health Organization (WHO). Endometriosis. 2023. Available via who.int.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For a diagnosis of endometriosis, discuss your symptoms with your GP or gynaecologist.
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Lunarahealth
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