Heavy periods are bad enough but pain is worrying

One possible cause of heavy bleeding (menorrhagia) is a hormonal imbalance. There are other causes, such as fibroids, endometriosis and pelvic inflammatory disease. Basically, anything that increases the surface area of the endometrium (the inner womb lining that sheds at menstruation) will cause menorrhagia. The possible cause of the heavy bleeding could also be linked to the problems you experience when you attempt to go to the loo.

Endometriosis is very common, affecting as many as 25 per cent of women in their reproductive years. Many do not have any symptoms and the diagnosis is only made at other operative times. In endometriosis, tissue like the inner lining of the uterus (womb) is found outside the uterus, usually within the pelvic cavity. The most common sites where this tissue is deposited are over and around the ovaries and deep in the pelvis around the lower bowel, rectum and the bladder neck.

As this tissue behaves in the same way as that of the endometrium, bleeding at the time of the menses will cause inflammation in these other sites (bladder, lower bowel, etc.) This could be why you get pain – the commonest symptom associated with the condition – in and around those areas when you have your period.

Discussions with your doctor should be arranged, and as it is not always easy to prove a diagnosis by examination a further opinion from a gynaecologist will probably be necessary. Most treatment is medical (not surgical) so life can be fairly rapidly improved for you in these circumstances.