2026, Responses from General Practitioner, Dr Orna McGinn
My periods are very painful, and pain relief isn’t helping – could this be endometriosis?
Around 10% of women have endometriosis; but approximately 50% experience painful periods at some point– so yes, your period pain could indicate endometriosis. To help us assess whether this might be the case, some more information would be very helpful.
How much does the pain affect you – have you had to take time off school or work during your period?
Is the pain felt at any other time in the cycle, right through the cycle or just during the periods themselves? Is it painful to pass urine or open your bowels during your period, or can sex be uncomfortable? These can indicate endometriosis deep in the pelvis or involving the bladder or bowel.
What pain relief have you tried, and what has helped?
Is there a family history? – if a close relative (mum, sister) has endometriosis, this is associated with increased likelihood.
What tests or scans can help determine whether I might have endometriosis?
In the community, we initially now try and treat patient symptoms medically rather than wait for a confirmed diagnosis, unless the symptoms are severe or there are concerns about fertility. Endometriosis (whether suspected or confirmed) responds very well to therapies which are available in primary care, and so tests are not always needed straight away.
Blood tests: only needed if periods are heavy as well as painful, in which case a check including blood count and iron levels is usually done. There aren’t currently any blood tests which detect endometriosis itself.
Ultrasound scans have become more detailed over the past few years. They are now helpful in assessing the possibility of endometriosis and associated conditions such as adenomyosis (endometriosis within the uterus itself) or endometriomas (endometriosis-associated ovarian cysts). An ultrasound scan will usually be recommended if symptoms don’t respond to first-line primary care treatment, or if a referral to a gynaecologist is being considered.
MRI scans are used by gynaecologists to assess the site and extent of endometriosis, and are available only in secondary care.
What treatment options are available if I do have endometriosis?
Many women respond well to oral anti inflammatory treatments such as tranexamic acid (Cyclokapron) or mefenamic acid (Ponstan). Hormonal options which prevent ovulation and ‘override’ the cycle include the combined oral contraceptive pill, or a progesterone-only pill such as Cerazette. Anti inflammatories and hormonal options can be used together.
If taking the combined pill, the best option is to have as few withdrawal bleeds as possible rather than taking it in the traditional way – 3 weeks of hormonal pills and one week of placebo pills.
Instead it can be ‘tricycled’ – taken for three months at a time followed by a short break, or it can be taken every day with no break at all. Sometimes this can result in breakthrough spotting, which is easily dealt with by taking a 3-5 day break and then restarting.
Another excellent option is a Mirena IUS. This is a small plastic ‘coil’ which steadily releases a form of progesterone hormone at low dose directly into the uterine cavity. It lasts up to 8 years and is very effective at reducing pain and bleeding. It is straightforward to insert, and many GPs offer this in the community.
Can endometriosis affect fertility, and should I seek advice earlier if I want children in the future?
Endometriosis is an inflammatory condition, and if untreated (or unrecognised), fertility can be affected due to a variety of factors. Women with endometriosis can absolutely conceive naturally, but the rates are lower compared with women without endometriosis. Important factors include the stage or severity of the endometriosis, and patient age: fertility declines markedly after age 35. It is always a good idea to seek advice from your doctor early if fertility is a concern.
Would it be appropriate for me to see a gynaecologist or endometriosis specialist?
It is a good idea to seek specialist advice if symptoms are not managed with medical treatments in the community or if there are fertility concerns.
Any suggestion of severe endometriosis warrants an early referral – in addition to infertility, these symptoms include deep seated pain with sex, pain throughout the cycle or pain associated with bladder and bowel function.
What can I do day-to-day to help manage pain, fatigue, and flare-ups?
Getting to know your own pattern of functioning is important. Rest when you need to rather than trying to push on through.
Adequate sleep, good nutrition and regular gentle exercise are all vital components of managing endometriosis. Gentle stretches, walking and yoga can help.
Plan for bad days by having everything you need to hand – hot water bottle or heat pad, adequate pain relief, and sensory relaxation aids like music and aromatherapy.
Keep processed foods, sugar and caffeine to a minimum and ensure you are drinking enough fluid to stay hydrated and avoid bloating.
Learn about pain, how the brain perceives it , and how it is amplified by stress and tension – knowledge is power. Many stress reduction techniques also help the perception of pain.
Negative experiences resulting from missing work or study can add to stress and experience of pain. Letting a supportive tutor or manager know your situation in advance of flare ups can be very helpful.