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Severe Menstrual Cramps Are Not Normal
Severe menstrual cramps may indicate endometriosis. Dr. Thomas Fromuth, board-certified physician with UPMC OBGYN of Lancaster, discusses endometriosis.
Featuring:
Thomas Fromuth, MD
Thomas Fromuth, MD is a board-certified OBGYN physician with UPMC OBGYN of Lancaster. Dr. Fromuth received a medical degree from Jefferson Medical School in Philadelphia, PA, and completed his OBGYN residency at Strong Memorial Hospital, University of Rochester. Along with being a member of the American College of Obstetricians and Gynecologists, Dr. Fromuth is also a member of AAGL (Elevating Gynecologic Surgery) and the Endometriosis Foundation of America. Transcription:
Alyne Ellis (Host): Are you dreading that time of the month again? If you really hurt when you menstruate; you might have endometriosis. What are some of the other symptoms? And what are your treatment options? Here to tell us more is Dr. Thomas Fromuth, a Board-Certified Physician with UPMC OBGYN of Lancaster. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Alyne Ellis. So, Dr. Fromuth, let’s start with this. What is endometriosis?
Thomas Fromuth, MD (Guest): Endometriosis is actually a very common disease that not enough people know about. It’s a disease that’s unique to women. And in very general terms, it means that cells that are normally on the inside of the uterus, have gotten out of the uterus and started growing on other organs, generally in the pelvis and almost anywhere in the body.
Host: And not to scare people, this is not related to cancer?
Dr. Fromuth: No, not at all. It’s a disease of women young and old and is more of a chronic disease. Certainly not a cancer.
Host: What are some of the most common symptoms of endometriosis?
Dr. Fromuth: The most common symptom is extremely severe menstrual cramps. Not the cramps that bother you but the ones that incapacitate you, where you are missing school and you are missing work and you literally can’t move because you are on the floor in the fetal position because it hurts so much.
Host: And there are other symptoms too, like pain during sexual activity for example?
Dr. Fromuth: Endometriosis is a disease that can progress over time and get you more symptoms to include yes, you’re right, pain with intercourse, pain between your periods, pain when you empty your bladder or bowel. All of them can be really life altering.
Host: I was fascinated by the fact that you could also have for example, allergies that develop over time with this.
Dr. Fromuth: Certainly allergies or let’s say the immune response is in some way related to the progression of the disease. Though someone who has seasonal allergies isn’t thought to be at any more risk than anybody else for endometriosis.
Host: But you could also have something like a yeast infection or asthma possibly develop with this and maybe even later in life, infertility. Is that correct?
Dr. Fromuth: Certainly infertility. But again asthma, allergies; not typically something that’s started with endometriosis. But definitely infertility though I have to say, there’s a lot of misinformation about infertility and endometriosis. And I think it’s important that people know that endometriosis does not equal infertility, 60% of women who have endometriosis will go on and have pregnancy without a problem.
Host: But now this is a progressive disease so, does it show up first in teenagers for example, when they are first developing into women and having menstrual periods?
Dr. Fromuth: You are right, it is progressive we think. And you’re also right that the very first people that develop this are our adolescents but unfortunately, it’s just not known in the general population that this disease can occur in an adolescent. It’s unfortunately, thought that this is something that happens later on. But a young woman, a girl, who is just beginning her periods can have endometriosis from the very beginning.
Host: And what do you about it if you start to get these symptoms, what do you recommend?
Dr. Fromuth: Well focusing just on the adolescent, because I think that’s our population of women that think deserve our most attention. But focusing on the adolescent is first to know that the disease exists, try things over-the-counter like Advil or Aleve, not Tylenol. But Advil or Aleve and if that doesn’t help, then they need to see their pediatrician or family doc to let them know how bad their pain is. What often happens with the adolescent then is they’ll get tried on birth control pills in addition to things like Advil and Aleve. And if the birth control pills help, that’s great. And you can stay on those and it may actually lessen the progression over time of the disease.
But what’s really important is that if a young adolescent has tried things like Advil, Aleve, has tried six months of birth control pills, and they are still not better; then they need to seek out someone like a gynecologist who has a special interest in endometriosis. Because there’s a lot more that can and should be done to alleviate suffering.
Host: And let’s talk about that. First of all, how do you diagnose it?
Dr. Fromuth: Well right now, the general thought is that the way you diagnose it is through surgery, but that concept is changing a bit as we get better and better with imaging, with ultrasound and MRI. So, that you don’t always have to have surgery to diagnose endometriosis. And neither do you need to have a surgical diagnosis to begin treatment for endometriosis. The point here is to help to minimize suffering for our women and not get them to surgery in all cases.
Host: And what about if you don’t catch it early, and you are older and – is it more serious then because it’s more advanced?
Dr. Fromuth: The things that’s also frustrating is that women of mature age, 30 or even 40s who have had their kids, they often get lost and it’s not even considered that they may have endometriosis because they’ve had children. And heh, everybody knows if you’ve had kids, it means you are not infertile so you can’t have endometriosis. So, our women who have had babies, also need to think about this as a disease. To answer your question about can it get more severe? Absolutely it can get more severe. Endometriosis can involve the ovaries; it can involve the bowel and bladder significant enough to actually grow deeply into those tissues. And then it becomes a lot more complex and risky surgery to manage that.
So, that’s why early diagnosis is really important.
Host: And can we assume that if an older woman is diagnosed with it, that she’s had it as a teenager and just missed it or can you develop it later in life also?
Dr. Fromuth: Yeah, I would say that question is really hard to answer. Because we don’t fully understand the progression of disease. I think it’s likely that it can occur anywhere along that line. It doesn’t necessarily have to be present from adolescence and that’s simply probably has to do with the different ways that endometriosis develops. So, if you seem to have nothing as a young woman, it does not mean that you can’t get it later.
Host: What are we talking about in terms of how many people get this? Is there a large percentage of women dealing with endometriosis?
Dr. Fromuth: Surprisingly, it’s probably ten to fifteen percent of our reproductive aged women that can have endometriosis. So, it’s a lot of people out there who are suffering needlessly because they don’t even know about the disease.
Host: But the good news is that quite a bit can be done about it.
Dr. Fromuth: That’s the take home message that there’s a lot of hope for women with endometriosis because there’s a lot of people working on the problem, finding out why it starts, finding out what’s the best way to treat it, finding new medications to treat it. So, absolutely, there’s a lot of hope. But you have to get diagnosed. Unfortunately, right now, it takes about seven years on average until a woman is diagnosed with endometriosis. And sometimes, upwards of nine or ten years before they get diagnosed with some of the really severe types of endometriosis.
Host: And that’s because they didn’t recognize the symptoms in the beginning?
Dr. Fromuth: There’s faults all along the system from our primary care docs to our patients not knowing to even our gynecologists not being fully aware of the disease. So, I think there’s a lot of places where we can improve our care for women with endometriosis. It’s definitely not the patient’s fault.
Host: Thanks Doctor for your time and information on endometriosis. Dr. Thomas Fromuth is a Board-Certified Physician with UPMC OBGYN of Lancaster. If you or someone you know has these symptoms, please tell your OBGYN or your primary care provider. If you need an OBGYN, please visit www.upmcpinnacle.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Alyne Ellis. Thanks for listening.
Alyne Ellis (Host): Are you dreading that time of the month again? If you really hurt when you menstruate; you might have endometriosis. What are some of the other symptoms? And what are your treatment options? Here to tell us more is Dr. Thomas Fromuth, a Board-Certified Physician with UPMC OBGYN of Lancaster. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Alyne Ellis. So, Dr. Fromuth, let’s start with this. What is endometriosis?
Thomas Fromuth, MD (Guest): Endometriosis is actually a very common disease that not enough people know about. It’s a disease that’s unique to women. And in very general terms, it means that cells that are normally on the inside of the uterus, have gotten out of the uterus and started growing on other organs, generally in the pelvis and almost anywhere in the body.
Host: And not to scare people, this is not related to cancer?
Dr. Fromuth: No, not at all. It’s a disease of women young and old and is more of a chronic disease. Certainly not a cancer.
Host: What are some of the most common symptoms of endometriosis?
Dr. Fromuth: The most common symptom is extremely severe menstrual cramps. Not the cramps that bother you but the ones that incapacitate you, where you are missing school and you are missing work and you literally can’t move because you are on the floor in the fetal position because it hurts so much.
Host: And there are other symptoms too, like pain during sexual activity for example?
Dr. Fromuth: Endometriosis is a disease that can progress over time and get you more symptoms to include yes, you’re right, pain with intercourse, pain between your periods, pain when you empty your bladder or bowel. All of them can be really life altering.
Host: I was fascinated by the fact that you could also have for example, allergies that develop over time with this.
Dr. Fromuth: Certainly allergies or let’s say the immune response is in some way related to the progression of the disease. Though someone who has seasonal allergies isn’t thought to be at any more risk than anybody else for endometriosis.
Host: But you could also have something like a yeast infection or asthma possibly develop with this and maybe even later in life, infertility. Is that correct?
Dr. Fromuth: Certainly infertility. But again asthma, allergies; not typically something that’s started with endometriosis. But definitely infertility though I have to say, there’s a lot of misinformation about infertility and endometriosis. And I think it’s important that people know that endometriosis does not equal infertility, 60% of women who have endometriosis will go on and have pregnancy without a problem.
Host: But now this is a progressive disease so, does it show up first in teenagers for example, when they are first developing into women and having menstrual periods?
Dr. Fromuth: You are right, it is progressive we think. And you’re also right that the very first people that develop this are our adolescents but unfortunately, it’s just not known in the general population that this disease can occur in an adolescent. It’s unfortunately, thought that this is something that happens later on. But a young woman, a girl, who is just beginning her periods can have endometriosis from the very beginning.
Host: And what do you about it if you start to get these symptoms, what do you recommend?
Dr. Fromuth: Well focusing just on the adolescent, because I think that’s our population of women that think deserve our most attention. But focusing on the adolescent is first to know that the disease exists, try things over-the-counter like Advil or Aleve, not Tylenol. But Advil or Aleve and if that doesn’t help, then they need to see their pediatrician or family doc to let them know how bad their pain is. What often happens with the adolescent then is they’ll get tried on birth control pills in addition to things like Advil and Aleve. And if the birth control pills help, that’s great. And you can stay on those and it may actually lessen the progression over time of the disease.
But what’s really important is that if a young adolescent has tried things like Advil, Aleve, has tried six months of birth control pills, and they are still not better; then they need to seek out someone like a gynecologist who has a special interest in endometriosis. Because there’s a lot more that can and should be done to alleviate suffering.
Host: And let’s talk about that. First of all, how do you diagnose it?
Dr. Fromuth: Well right now, the general thought is that the way you diagnose it is through surgery, but that concept is changing a bit as we get better and better with imaging, with ultrasound and MRI. So, that you don’t always have to have surgery to diagnose endometriosis. And neither do you need to have a surgical diagnosis to begin treatment for endometriosis. The point here is to help to minimize suffering for our women and not get them to surgery in all cases.
Host: And what about if you don’t catch it early, and you are older and – is it more serious then because it’s more advanced?
Dr. Fromuth: The things that’s also frustrating is that women of mature age, 30 or even 40s who have had their kids, they often get lost and it’s not even considered that they may have endometriosis because they’ve had children. And heh, everybody knows if you’ve had kids, it means you are not infertile so you can’t have endometriosis. So, our women who have had babies, also need to think about this as a disease. To answer your question about can it get more severe? Absolutely it can get more severe. Endometriosis can involve the ovaries; it can involve the bowel and bladder significant enough to actually grow deeply into those tissues. And then it becomes a lot more complex and risky surgery to manage that.
So, that’s why early diagnosis is really important.
Host: And can we assume that if an older woman is diagnosed with it, that she’s had it as a teenager and just missed it or can you develop it later in life also?
Dr. Fromuth: Yeah, I would say that question is really hard to answer. Because we don’t fully understand the progression of disease. I think it’s likely that it can occur anywhere along that line. It doesn’t necessarily have to be present from adolescence and that’s simply probably has to do with the different ways that endometriosis develops. So, if you seem to have nothing as a young woman, it does not mean that you can’t get it later.
Host: What are we talking about in terms of how many people get this? Is there a large percentage of women dealing with endometriosis?
Dr. Fromuth: Surprisingly, it’s probably ten to fifteen percent of our reproductive aged women that can have endometriosis. So, it’s a lot of people out there who are suffering needlessly because they don’t even know about the disease.
Host: But the good news is that quite a bit can be done about it.
Dr. Fromuth: That’s the take home message that there’s a lot of hope for women with endometriosis because there’s a lot of people working on the problem, finding out why it starts, finding out what’s the best way to treat it, finding new medications to treat it. So, absolutely, there’s a lot of hope. But you have to get diagnosed. Unfortunately, right now, it takes about seven years on average until a woman is diagnosed with endometriosis. And sometimes, upwards of nine or ten years before they get diagnosed with some of the really severe types of endometriosis.
Host: And that’s because they didn’t recognize the symptoms in the beginning?
Dr. Fromuth: There’s faults all along the system from our primary care docs to our patients not knowing to even our gynecologists not being fully aware of the disease. So, I think there’s a lot of places where we can improve our care for women with endometriosis. It’s definitely not the patient’s fault.
Host: Thanks Doctor for your time and information on endometriosis. Dr. Thomas Fromuth is a Board-Certified Physician with UPMC OBGYN of Lancaster. If you or someone you know has these symptoms, please tell your OBGYN or your primary care provider. If you need an OBGYN, please visit www.upmcpinnacle.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Alyne Ellis. Thanks for listening.