Q. I have painful periods. What should I do to relieve the pain?  
A. Taking painkillers or analgesics would be the obvious answer. Most of the pain during periods in the teenage period, gradually decrease with age. Before painkillers, for mild pains a hot water bath or hot fomentation may give considerable relief. 

Q. Why is there pain during periods? Does it get better with age? 
A. Pain during periods is possibly due to the release of prostaglandins. Often painful periods are transient in nature and settle with age. Occasionally due to various diseases like endometriosis and infections, the pain may get progressively worse. What starts initially around the time of periods may last the entire month causing considerable discomfort.

Q. Severe pain starts before my periods and lasts beyond the bleeding. My doctor says it can be worrisome. Can you explain?
A. There are roughly two types of pain during periods. One type occurs during the bleeding phase, which is common and usually not associated with disease. In the second type where pain starts well before the period begins and ends later, could be associated with diseases like pelvic inflammatory disease and endometriosis.

Q. I used to take two painkillers for my periods. Now I need more than six. Is there a reason to worry?
A. Increasing need for painkillers could possibly but not necessarily be suggestive of a gynecologic disorder. It would be wise to check with your doctor.

Q. What are ‘chocolate cysts’?  My friend has two of them.
A. Chocolate cysts get the name for the altered blood retained in the cysts, which looks like chocolate when the cysts rupture. These cysts are associated with a disease called endometriosis. Though the cysts may be an incidental finding, often it is associated with painful periods and lower tummy heaviness persisting throughout the cycle.

Q. I have severe cramping pain throughout the month. It worsens during my period. Could I have endometriosis?
A. Yes it is indeed a possibility. A chronic infection or a non-gynaecological problem may be present. You need to be evaluated by a doctor.

Q. When is it necessary to have an operation for painful periods?
A. Only when conventional analgesics are not able to control pain or the need of medicines becomes prohibitively high with possible harm, is an operation considered. Also abnormalities diagnosed during pelvic examination or in the course of an ultrasound could warrant a surgery for further evaluation.

Q. What effect can endometriosis have on future fertility? 
A. It all depends on the degree of the disease. In severe cases it can adversely affect the chances of fertility. Surgery combined with medical therapy and use of artificial reproductive techniques is usually necessary for women with endometriosis finding it difficult to conceive.

Q. Why does endometriosis need long-term treatment? 
A. Unfortunately endometriosis has a high recurrence rate, sometimes years after the original disease was first detected. Besides this the pain may warrant long-term treatment in women with endometriosis.

Q. Can I have endometriosis even when my ultrasound is okay?  
A. Only some features of the disease like chocolate cysts are visible on ultrasound. Other features like adhesions cannot be seen. It also needs to be understood that mild disease inside the body can present with severe symptoms and it is always not always proportional.