Q: Good evening Dr. I am an 18 year-old girl and I have been having this problem for two years now, in my abdominal part off my stomach. I usually feel something moving. This happens during the course of the month and when I am about to menstruate, it becomes so painful and the movements get worse. I have never been pregnant and I have been to doctors but at first I was put on medication for urinary infections. After the course, the movements and the pain was still the same. The second time, I was told to go for a scan, which led to the doctors thinking I was pregnant but all the pregnancy tests came out negative. I am tired of this movements and extreme pain. Please I need your help.

A: Hi dear, sorry to hear about the pain you are going through. The first suggestion I want to make is to ensure that you are seeing a specialist – a gynecologist who will review you properly and do the needful, whatever that might be.

Extreme pain during menstruation may also be due to a condition known as endometriosis. In endometriosis, the tissues of the uterus (womb) are found outside of the uterus. They are then found in different areas of the body including:

• Ovaries
• Fallopian tubes
• Tissue lining the pelvis
• Bladder
• Bowel

The ovaries and fallopian tubes are the more common areas for endometriosis. This tissues of the uterus found outside the womb continue to act like what they are: uterine tissues. And so they thicken, break down and bleed with every menstrual cycle. Trouble is, the broken down tissues and blood now, does not have an outlet to flow out from. So, if this happens in the ovaries, cysts form. Cysts are sac-like collection of fluids, semi-solid or gaseous materials.

The symptoms of endometriosis vary from person to person, ranging from no symptoms in some people to excruciating pelvic pain, usually associated with menstrual periods.

Symptoms, generally include:

• Painful periods
• Heavy periods
• Pain during or after sex
• Bleeding in between periods
• Lower abdominal, pelvic and/or lower back pain

Other symptoms include:

• Tiredness and fatigue
• Constipation
• Blood in stool

People with endometriosis may also present with infertility or ovarian cancer.

People at risk of endometriosis include:

• Those who start having their periods at an early age
• Those who start menopause at a late age
• Those who have never had children
• Those with family history of endometriosis
• Those who have low body mass index
• Those who consume alcohol

Once a diagnosis is made, treatment typically depends on severity of symptoms and whether woman still desires to have children.

Pain relief focuses on reducing the pain associated with this condition.

Hormonal therapy works on slowing down the growth of the endometrial tissue and prevent new implants. However, once therapy is stopped, symptoms could return.

Surgery which may be to remove endometrial tissues wherever they are found (through laparoscopic or open surgery) or removing the uterus, cervix and ovaries to ensure that the primary source of estrogen which stokes the thickening of endometrial tissue is eliminated. This latter surgery is better suited for women who have completed their families.

I hope this helps you understand some more what options are available to you. Please speak with a gynecologist for a clearer picture.

I hope this helps.

Have a good night y’all 😀