Very sudden change in my periods - is it endometriosis?

[Neleh]

I want some advice from an expert about some questions I have about periods.  I am 23 years old (I’ll be 24 later this year) and since I was 20-and-a-half I have had bad cramps for at least several days before my period starts, often as much as a week or even two weeks before it starts.  What’s rather odd is that from the age of 15-20.5 years I only had cramps when my period was actually beginning, never even one day before it started.  The change was so sudden – in October 2004 I had cramps as my period was beginning but in November 2004 I had bad cramps for several days beforehand – and it’s remained like that ever since, with the cramps usually occurring up to 1 week before my period starts.  

The change in the timing of my cramps in November 2004 also marked the start of a change in the regularity of my periods.  Up until then they had been very regular.  I was very lucky and from the time I started my periods at the age of 10 they had almost always occurred exactly every 4 weeks, occasionally several days later.  Since the age of 20.5, however, their timing has been much more unpredictable.  They are hardly ever dead on 4 weeks but usually occur every 4.5 to 5 weeks.  Several times I have had a period which was 6 weeks after my last one.  Because I get bad cramps for quite a few days beforehand it has become impossible to tell when my period will start, unlike in the past when I knew for certain that it was starting when I had cramps.  

[Neleh]

Forgot to tell you that I never get any pain anywhere else except in my stomach (cramps).  I do always feel bloated on the first day of a period but I've heard this is normal and is a symptom of PMS.

[Neleh]

Thanks for your reply.  I'd like to know if Primary Dysmenorrhea can ever cause cramps for a week or two before a period starts - or are cramps occuring for this length of time before a period one of the characteristic symptoms of Endometriosis?  One site I visited said that the contractions of the uterus that cause Primary Dysmenorrhea are abnormal and are caused by a hormone inbalance, but other sites do not seem to mention this and just say it's normal.  What do you think about this?

[John Kim, M.D.]

The painful cramps that you describe could be endometriosis. I suggest that you see your doctor. They can check some hormones and thyroid test to determine why your periods have changed. They can also examine you and order an ultrasound to look for any uterine or ovarian problem like an ovarian cyst. If everything is normal, if you are not interested in getting pregnant, a trial of oral contraceptive pills can be done to see if your cramping pain improves.