Understanding uterine conditions: When period pain isn’t ‘normal’

Bleeding between periods, unusually heavy flow, and pain or bleeding during sex can be signs of an underlying uterine condition—yet many people dismiss these symptoms as normal, especially when they run in the family.

“People suffer in silence with this, but whether it’s an anatomic issue or a hormone issue, we can figure it out,” said Laura France, MD, vice president of the women’s and children’s service line with M Health Fairview.

When to talk to your provider

If your periods come less than 21 days apart, return quickly after ending, or involve soaking through a pad, tampon, or menstrual cup every 30 to 60 minutes for several hours, it’s time to speak with a healthcare provider. These symptoms are not typical and may signal a treatable condition.

Uterine conditions that affect menstrual health and fertility

Many uterine conditions not only disrupt your cycle but also make it harder to get pregnant. Common conditions include:

Diagnosing uterine conditions

There’s no single test to find the cause of uterine problems. Instead, healthcare providers often rely on your symptom descriptions, paired with blood tests or ultrasounds, to make an informed diagnosis.

France recommends tracking what’s normal for you and sharing with your provider. Pay attention to:

“Some people will say they don’t want to do anything about their irregular periods, and that’s fine,” France said. “But it can still be helpful to watch for those signs in case you want to become pregnant or address issues later.”

Your menstrual cycle evolves throughout life. If your periods were easier a few years ago, hormonal changes or the development of fibroids could be the reason.

The treatment will depend on the cause. For example, thyroid issues can affect your period and are easily treated with medication. Thyroid medication might also help with issues like temperature tolerance, bowel movements, and sleep.

Birth control can also be used to regulate hormones. Non-hormonal medications like tranexamic acid can help with bleeding issues without the side effects that hormones might bring. Other issues like fibroids or polyps might need to be surgically removed. That can be done with a quick outpatient procedure that allows you to go home the same day.

PCOS: More than missed periods

PCOS is marked by elevated testosterone levels, which may cause excess facial or body hair and missed periods. Diagnosis involves hormone testing and an ultrasound, which may reveal cysts arranged like a string of pearls. They occur because ovaries are trying to ovulate but can’t. Instead, they make little cysts and never actually release an egg. In an ultrasound, those tiny follicles can be seen in a line on the outside edge of the ovary.

PCOS is often linked to a higher body weight but not always. Unfortunately, having PCOS can also make weight loss more difficult.

“You can do everything right—exercise, eat well—and still not see results. It’s frustrating,” France said.

While many people are OK with missing their monthly period and may wait to get care until they’re ready to have children, France recommends getting missed periods checked out regardless of pregnancy plans.

“PCOS does increase your risk for type 2 diabetes,” France said. “So you definitely want to know what’s going on to reduce your future risk.”

Treatment depends on pregnancy goals and may include hormonal birth control or metformin, a diabetes medication that can help with weight loss and fertility.

Endometriosis: Pain before the period

Endometriosis symptoms often begin days before menstruation, with intense cramping and heavy bleeding. Pain during sex and bowel movements is also common.

During menstruation, most blood exits through the cervix and vagina, but some flows backward through the fallopian tubes. In about 10% of menstruating people, this blood reaches pelvic organs like the ovaries, bladder, and bowel, triggering inflammation and scar tissue over time.

Treatment options include hormonal birth control, surgery to remove tissue, or medications that induce menopause.

Fibroids: New option for painful growths

About 30% of people with a uterus will have non-cancerous muscle growths called fibroids in their lifetime. Many won’t even know it. But about a quarter of people with uterine fibroids will experience pain, heavy bleeding, or anemia.

First treatment is often hormonal birth control options that are used to suppress the ovarian hormones, which helps reduce bleeding, size of fibroids, and size of uterus. M Health Fairview also offers Acessa, a minimally invasive procedure that allows people to go home the same day. Acessa uses radiofrequency from a small needle to shrink or destroy each fibroid. The treatment allows you to keep your uterus, and pregnancy may be possible after Acessa treatment.

Expert care for women is available throughout the Twin Cities area