When Period Pain Isn't Normal: Could It Be Endometriosis?

Medically reviewed and fact-checked by Prof. Dr. Kristina Jariene, MD, PhD, Consultant Obstetrician and Gynaecologist.

Endometriosis is still talked about far too little, and its symptoms are often dismissed as simply "part of being a woman." The truth is different: pain that prevents you from living your life is never normal.

Is It Just Normal Period Pain?

Not all menstrual pain is the same. It's important to understand the difference between primary dysmenorrhea (common period cramps) and pain caused by endometriosis.

Primary Dysmenorrhea (Common Period Pain)

• Usually begins shortly after the first menstrual periods during adolescence.
• Caused by prostaglandins, natural substances that trigger uterine contractions.
• Pain typically lasts 1–2 days.
• Usually responds well to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and heat therapy.

During the teenage years, period pain may be more intense as the body is still adjusting to hormonal cycles. However, it should never interfere with school, work, or everyday activities.

Endometriosis May Be More Likely If:

• The pain becomes worse over time.
• The pain lasts longer than 2–3 days.
• Pelvic pain begins before your period or continues between periods.
• Regular painkillers such as NSAIDs provide little or no relief.

Additional Warning Signs ("Red Flags")

• Pain during sexual intercourse.
• Pain during bowel movements or urination.
• Persistent fatigue and characteristic bloating ("endo belly").
• Difficulty conceiving or infertility.

Why Does It Take 7–10 Years to Diagnose Endometriosis?

Around 1 in 10 women may have endometriosis, yet many remain undiagnosed. Diagnosis often takes years because symptoms vary greatly from person to person, and severe menstrual pain is still too often considered "normal." In many cases, surgery is still required to confirm the diagnosis. Limited research funding has also contributed to delays in improving diagnostic methods.

How Can You Help Manage the Symptoms?

If you experience menstrual pain — particularly primary dysmenorrhea — or want to reduce symptoms, the following strategies may help:

• Take NSAIDs early: Don't wait until the pain becomes severe.
• Heat therapy: Applying warmth to the lower abdomen can help relax the muscles.
• Healthy lifestyle: Regular physical activity, quality sleep, and relaxation practices such as yoga and breathing exercises may help.
• Nutrition: An anti-inflammatory diet and limiting caffeine before your period may reduce symptoms.
• Supplements: Magnesium may help relax muscles, while omega-3 fatty acids may help reduce inflammation.

You may also be interested in: How Insulin Resistance and Anti-Inflammatory Nutrition Shape Women’s Health

Herbal Support

According to recommendations from Dr. Gabriele Balciunaite-Murziene, certain medicinal plants may help reduce inflammation, especially when started before menstruation:

Ginger: May help reduce inflammation, with effects similar to NSAIDs.

Fennel and peppermint: May help relieve menstrual cramps and reduce bloating.

Yarrow: May help reduce inflammation.

Milk thistle and dandelion: May support liver function and healthy hormone balance.

Listen to your body

Pay attention to how long your pain lasts, whether it becomes more severe over time, and whether it affects your quality of life. If it does, seek advice from a healthcare professional.

Remember: if period pain is stopping you from living your life, it is not normal.