Menstruation, or a period, is the bleeding that occurs about monthly in healthy people born with a uterus, from puberty to menopause. This happens when the endometrium, the tissue that lines the inside of the uterus, is shed.

Endometriosis is a condition that occurs when endometrium-like tissue is found outside the uterus, usually within the pelvic cavity. It is often considered a major cause of pelvic pain.

Pelvic pain significantly impacts quality of life. But how can you tell the difference between period pain and endometriosis?

Periods and period pain

Periods involve shedding the 4-6 millimetre-thick endometrial lining from the inside of the uterus.

As the lining detaches from the wall of the uterus, the blood vessels which previously supplied the lining bleed. The uterine muscles contract, expelling the blood and crumbled endometrium.

The crumbled endometrium and blood mostly pass through the cervix and vagina. But almost everyone back-bleeds via their fallopian tubes into their pelvic cavity. This is known as “retrograde menstruation”.

The process of menstrual shedding is caused by inflammatory substances, which also cause nausea, vomiting, diarrhoea, headaches, aches, pains, dizziness, feeling faint, as well as stimulating pain receptors.

These inflammatory substances are responsible for the pain and symptoms in the week before a period and the first few days.

For women with heavy periods, their worst days of pain are usually the heaviest days of their period, coinciding with more cramps to expel clots and more retrograde bleeding.

Many women also have pain when they are releasing an egg from their ovary at the time of ovulation. Ovulation or mid-cycle pain can be worse in those who bleed more, as those women are more likely to bleed into the ovulation follicle.

Around 90% of adolescents experience period pain. Among these adolescents, 20% will experience such severe period pain they need time off from school and miss activities. These symptoms are too often normalised, without validation or acknowledgement.

What about endometriosis?

Many symptoms have been attributed to endometriosis, including painful periods, pain with sex, bladder and bowel-related pain, low back pain and thigh pain.

Other pain-related conditions such migraines and chronic fatigue have also been linked to endometriosis. But these other pain-related symptoms occur equally often in people with pelvic pain who don’t have endometriosis.

Repeated, significant period and ovulation pain can eventually lead some people to develop persistent or chronic pelvic pain, which lasts longer than six months. This appears to occur through a process known as central sensitisation, where the brain becomes more sensitive to pain and other sensory stimuli.

Central sensitisation can occur in people with persistent pain, independent of the presence or absence of endometriosis.

Eventually, many people with period and/or persistent pelvic pain will have an operation called a laparoscopy, which allows surgeons to examine organs in the pelvis and abdomen, and diagnose and treat endometriosis.

Yet only 50% of those with identical pain symptoms who undergo a laparoscopy will end up having endometriosis.

Endometriosis is also found in pain-free women. So we cannot predict who does and doesn’t have endometriosis from symptoms alone.

How is this pain managed?

Endometriosis surgery usually involves removing lesions and adhesions. But at least 30% of people return to pre-surgery pain levels within six months or have more pain than before.

After surgery, emergency department presentations for pain are unchanged and 50% have repeat surgery within a few years.

Suppressing periods using hormonal therapies (such as continuous oral contraceptive pills or progesterone-only approaches) can suppress endometriosis and reduce or eliminate pain, independent of the presence or absence of endometriosis.

Not every type or dose of hormonal medications suits everyone, so medications need to be individualised.

The current gold-standard approach to manage persistent pelvic pain involves a multidisciplinary team approach, with the aim of achieving sustained remission and improving quality of life. This may include:

• physiotherapy for pelvic floor and other musculoskeletal problems
• management of bladder and bowel symptoms
• support for self-managing pain
• lifestyle changes including diet and exercise
• psychological or group therapy, as our moods, stress levels and childhood events can affect how we feel and experience pain.

Whether you have period pain, chronic pelvic pain or pain you think is associated with endometriosis, if you feel pain, it’s real. If it’s disrupting your life, you deserve to be taken seriously and treated as the whole person you are.

Sonia R. Grover, Senior Research Fellow, Murdoch Children’s Research Institute; Clinical Professor of Gynaecology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

With around one in 50 adults diagnosed with cancer each year, many people are faced with the difficult task of sharing the news of their diagnosis with their loved ones. Parents with cancer may be most worried about telling their children.

It’s best to give children factual and age-appropriate information, so children don’t create their own explanations or blame themselves. Over time, supportive family relationships and open communication help children adjust to their parent’s diagnosis and treatment.

It’s natural to feel you don’t have the skills or knowledge to talk with your children about cancer. But preparing for the conversation can improve your confidence.

Preparing for the conversation

Choose a suitable time and location in a place where your children feel comfortable. Turn off distractions such as screens and phones.

For teenagers, who can find face-to-face conversations confronting, think about talking while you are going for a walk.

Consider if you will tell all children at once or separately. Will you be the only adult present, or will having another adult close to your child be helpful? Another adult might give your children a person they can talk to later, especially to answer questions they might be worried about asking you.

Finally, plan what to do after the conversation, like doing an activity with them that they enjoy. Older children and teenagers might want some time alone to digest the news, but you can suggest things you know they like to do to relax.

Also consider what you might need to support yourself.

Preparing the words

Parents might be worried about the best words or language to use to make sure the explanations are at a level their child understands. Make a plan for what you will say and take notes to stay on track.

The toughest part is likely to be saying to your children that you have cancer. It can help to practise saying those words out aloud.

Ask family and friends for their feedback on what you want to say. Make use of guides by the Cancer Council, which provide age-appropriate wording for explaining medical terms like “cancer”, “chemotherapy” and “tumour”.

Having the conversation

Being open, honest and factual is important. Consider the balance between being too vague, and providing too much information. The amount and type of information you give will be based on their age and previous experiences with illness.

Remember, if things don’t go as planned, you can always try again later.

Start by telling your children the news in a few short sentences, describing what you know about the diagnosis in language suitable for their age. Generally, this information will include the name of the cancer, the area of the body affected and what will be involved in treatment.

Let them know what to expect in the coming weeks and months. Balance hope with reality. For example:

The doctors will do everything they can to help me get well. But, it is going to be a long road and the treatments will make me quite sick.

Check what your child knows about cancer. Young children may not know much about cancer, while primary school-aged children are starting to understand that it is a serious illness. Young children may worry about becoming unwell themselves, or other loved ones becoming sick.

Older children and teenagers may have experiences with cancer through other family members, friends at school or social media.

This process allows you to correct any misconceptions and provides opportunities for them to ask questions. Regardless of their level of knowledge, it is important to reassure them that the cancer is not their fault.

Ask them if there is anything they want to know or say. Talk to them about what will stay the same as well as what may change. For example:

You can still do gymnastics, but sometimes Kate’s mum will have to pick you up if I am having treatment.

If you can’t answer their questions, be OK with saying “I’m not sure”, or “I will try to find out”.

Finally, tell children you love them and offer them comfort.

How might they respond?

Be prepared for a range of different responses. Some might be distressed and cry, others might be angry, and some might not seem upset at all. This might be due to shock, or a sign they need time to process the news. It also might mean they are trying to be brave because they don’t want to upset you.

Children’s reactions will change over time as they come to terms with the news and process the information. They might seem like they are happy and coping well, then be teary and clingy, or angry and irritable.

Older children and teenagers may ask if they can tell their friends and family about what is happening. It may be useful to come together as a family to discuss how to inform friends and family.

What’s next?

Consider the conversation the first of many ongoing discussions. Let children know they can talk to you and ask questions.

Resources might also help; for example, The Cancer Council’s app for children and teenagers and Redkite’s library of free books for families affected by cancer.

If you or other adults involved in the children’s lives are concerned about how they are coping, speak to your GP or treating specialist about options for psychological support.

Cassy Dittman, Senior Lecturer/Head of Course (Undergraduate Psychology), Research Fellow, Manna Institute, CQUniversity Australia; Govind Krishnamoorthy, Senior Lecturer, School of Psychology and Wellbeing, Post Doctoral Fellow, Manna Institute, University of Southern Queensland, and Marg Rogers, Senior Lecturer, Early Childhood Education; Post Doctoral Fellow, Manna Institute, University of New England

This article is republished from The Conversation under a Creative Commons license. Read the original article.