6 things an endometriosis specialist wants you to know about your pelvic pain – from diagnosis, to treatment options

When it comes to unexplained pelvic pain, too many of us are left without answers for too long. 

But it’s not normal to live in pain. And often – for one in ten of us in the US, in fact – it’s endometriosis.

Dr. Mona Orady is a leading endometriosis specialist and gynecologic surgeon with nearly 20 years of experience and more than 10,000 minimally invasive surgeries under her belt. 

Her approach is evidence-based and patient-first, built on clear diagnosis and tailored treatment, including the use of the MyReceptiva™ test, the only test currently available that can reliably detect inflammation associated with endometriosis.

Here, she shares what she most wants you to know about endometriosis and pelvic pain, from pre-diagnosis to treatment, and why getting clarity on the source of your pain is the first step toward getting relief.

What to know about endometriosis and pelvic pain

1. There can be several different types of endometriosis pain in the pelvis

There are several types of endometriosis pain, and not all of them show up the same way.

Dr. Orady says: “The classic symptom of endometriosis that everyone knows is dysmenorrhea, or painful periods. The problem is that patients think that painful periods are normal, which they are not. Mild cramping only during bleeding is normal.”

Other types of endometriosis pain centered in the pelvis can include:

• Pain before your period even starts
• Painful bowel movements and bloating
• Bladder pain or feeling like you constantly need to pee
• Pain during sex, especially with deep penetration
• A history of painful periods that seemed to get better over time

Some women also report lower back pain, and even leg pain that radiates down from the pelvis, too.

This broad range of symptoms helps explain what type of pain endometriosis can cause, and why it’s so often overlooked.

2. Not everyone with endometriosis has painful periods

Does bad period pain mean endometriosis? The answer is – not always.

Dr. Orady says: “So not everyone with endometriosis has painful periods. 

About 20% of patients with endometriosis don’t have painful periods but may have other symptoms, and a small percentage have no symptoms at all. 

That 20% will say they have minimal to no pain with their menstrual cycles”.

You might have other pelvic pain symptoms, or no symptoms at all.

But if you are dealing with unexplained pelvic pain, GI issues, urinary pain, or discomfort with sex with minimal discomfort during your bleed — you could still be dealing with endometriosis, and pushing for testing and a proper evaluation is your next step.

3. Your pelvic pain is valid, so insist on it being taken seriously

Knowing how to talk to your doctor about endometriosis pain can make all the difference.

Dr. Orady says: “As a woman, often our pain and other symptoms of endometriosis are not taken seriously. 

In order to make sure they are taken seriously, we have to insist on being heard, and insist that our pain and symptoms are deeply impacting our life, and that they need to be diagnosed and treated.

If you feel that your current provider is not listening to you or acknowledging the symptoms that you have, then you should seek out another provider that can address your concerns more directly.”

If you’re not sure how to talk to your doctor about endometriosis pain, start by tracking your symptoms, writing down your concerns, and being clear about how the pain affects your daily life.

Ordering a MyReceptiva™ test to take to your provider can help take the next step to determining whether there’s inflammation associated with endometriosis.

4. Treatment for pelvic pain should be tailored to the specific source

Just as endometriosis and pelvic pain don’t look the same for everyone, treatment shouldn’t be a one-size-fits-all either.

If endometriosis is suspected or confirmed, you have options for pain management, and your care should depend on your specific pain pattern.

Dr. Orady says: “There are several treatments available for endometriosis pain, and it depends mostly on what the source of pain is.” 

For example:

• Pelvic pain or pelvic floor tension might be treated with vaginal dilators, pelvic floor therapy, botox, or red light laser therapy.
  
• Nerve-related pain may respond well to nerve modulators or targeted nerve blocks, like pudendal nerve blocks.
  
• Bladder issues could benefit from bladder instillations that help calm the nerves involved and reduce overall pelvic pain.
  
• Bowel symptoms might be eased with a high-fiber diet, laxatives, or treatment for SIBO (small intestine bacterial overgrowth), which is commonly seen in people with endo.

The key is identifying which systems are involved, and tailoring your treatment plan from there.

5. Surgery is just one option that might help some people

Surgery to remove endometriosis isn’t always a first step for helping pelvic pain, but for many, it can offer relief, especially if medical treatment hasn’t helped.

Surgical excision — when done by an experienced specialist — can remove endometrial tissue, reduce inflammation, and improve symptoms across the board.

Dr. Orady outlines four types of patients she typically recommends surgery for:

• Patients who have already failed medical treatment, or they’ve tried medical treatment and still have significant pain.
• Patients who are trying to get pregnant or are dealing with unexplained infertility, so medical treatment is not an option.
• Patients with significant structural damage in their pelvis
• Patients who do not tolerate medical therapy.

6. Endometriosis won’t be cured by hysterectomy alone

Can endometriosis be cured by hysterectomy? In most cases no – particularly when it comes to the very specific aspect of relieving pelvic pain.

Dr. Orady says: “It is an extreme misconception to think that a hysterectomy will cure their pelvic pain, and patients often come to me requesting a hysterectomy for their pelvic pain.

Unfortunately, because by definition endometriosis is outside the uterus, removing the uterus is not the solution for endometriosis or related pain.

The solution for pain related to endometriosis is to remove the endometriosis itself, rather than the uterus”. 

Unexplained pelvic pain? You don’t have to suffer in silence

Your symptoms are real. So is endo. Let’s test.

Whether you’re just starting to explore what’s going on, or you’re ready to take the next step towards confirming or ruling out endometriosis, you don’t have to do it alone.

Dr. Orady and other specialists are working every day to help people like you get clear answers via the MyReceptiva™ test, which can help uncover inflammation linked to endometriosis.

With a detection rate of over 90%, it can help guide your next steps towards a diagnosis for your pain.

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