“Dismissed, ignored and belittled – the long road to endometriosis diagnosis”. Endometriosis can deeply affect your health, especially making your periods difficult, and potentially affecting your sex life. Because the symptoms can vary widely, many women don’t know the pain they might be experiencing is actually endometriosis. In this article, we shine a light on endometriosis and try to understand better what it is, some of the problems, and ways of better living with it. In particular, we focus on the issue of endometriosis and tampons.
Endometriosis is a common disease, but it often isn’t spoken about or understood, and also seems to have a lot of “mystery” about it. Endometriosis is a condition where tissue similar to the lining of the womb grows outside it in other parts of the body, often starting when you become a teenager. In the UK, Endometriosis affects 1.5 million women, a similar number of women affected by diabetes. In Australia, it affects nearly 1 million women. The prevalence of endometriosis in women with infertility is about 30–50%. Endometriosis is the second most common gynaecological condition (after fibroids).
Endometriosis is where cells similar to the ones in the lining of the womb (uterus) are found elsewhere in the body. Every month these cells react in the same way to those in the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood has no way to escape. Endometriosis can affect you from puberty to menopause, although the impact may be felt for life.
Endometriosis can have a significant impact on a person's life in several ways, including:
- Painful menstrual cramps
- Pain in the lower abdomen and back
- Pain during urination or bowel movements when on period
- Heavy menstrual bleeding
- Chronic pain
- Fatigue/lack of energy
- Depression/isolation
- Problems with a couple’s sex life/relationships
- An inability to conceive
- Difficulty in fulfilling work and social commitments
- It is also possible to have endometriosis with no symptoms
However, with the right endometriosis treatment, many of these issues can be addressed, and the symptoms of endometriosis made more manageable.
It’s important to remember that:
- Endometriosis is not an infection
- Endometriosis is not contagious
- Endometriosis is not cancer
One of the problems with endometriosis is that the symptoms are variable, and this contributes to the 6.5-year delay in diagnosis. Common symptoms include pelvic pain that puts life on hold around or during a person’s period. It can impact fertility for some but not for all. Endometriosis most often affects the reproductive organs but it can also be found in and around the bowel and bladder. It has been found in every part of the body, including the skin, joints, lungs and brain.
Currently, there is no cure for endometriosis. The different treatments available for endometriosis aim to reduce the severity of symptoms and improve the quality of life for someone living with the condition. The type of treatment you receive for your endometriosis should be decided in partnership between you and your healthcare professional. Your healthcare professional will consider many different factors when working out the best endometriosis treatment method for you, such as your age, the severity of endometriosis you have and the severity of your symptoms.
Endometriosis and Tampons
Endometriosis can cause pain and inflammation, particularly around and during a period. For some people, this pain may make using a tampon feels uncomfortable or painful. People with endometriosis may experience pain when inserting or wearing a tampon.
In some cases, endometriosis adhesions can affect the tissue between the rectum and the vagina which can make it painful to insert or remove a tampon.
Additionally, if a person regularly experiences vaginal pain due to endometriosis, anxiety about the pain occurring again can cause the pelvic floor muscles to tighten. This can cause additional discomfort during intercourse or tampon use. Tampon pain associated with endometriosis may be similar to endometriosis dyspareunia. Endometriosis dyspareunia is usually described as pelvic pain with deep vaginal penetration, often related to sexual intercourse. Dyspareunia has been called the neglected symptom of endometriosis. More than half of people with endometriosis usually experience dyspareunia.
Preventing tampon pain
Quite simply, the best way to prevent tampon pain is to stop wearing tampons. A person may instead use non-insertable period products such as pads and period underwear. Frequently asked questions about endometriosis and tampons:
Does endometriosis cause pain when removing a tampon?
If endometriosis causes widespread inflammation, it may make it painful to insert or remove a tampon. In some cases, endometriosis may affect the tissue between the rectum and the vagina. Bleeding, inflammation, and scar tissue from endometriosis may cause the surrounding areas to feel painful, particularly around and during a period. This may make sexual intercourse and tampon use painful.
Do tampons aggravate endometriosis?
There is little research on tampon use and endometriosis. There appears to be no evidence to suggest that tampons aggravate endometriosis.
Can wearing tampons cause endometriosis?
No tampons do not cause endometriosis they can sometimes just make the pain a lot worse depending on where your uterus is sitting. Hence why pads and period underwear are recommended. Some people even find that because of the slanting of the uterus due to endometriosis the blood pooling and clotting results in a very uncomfortable process of having to squeeze the clots out.
Benefits of stopping using tampons
Apart from the obvious pain relief by stopping using tampons if you have endometriosis, the other benefits include:
- Maximum 8-hour use - You cannot sleep with a tampon in for more than 8 hours. The risk of toxic shock syndrome increases when you wear a tampon for 6 hours.
- Single-Use - Once you’ve used one, that’s it. It’s done. Though tampons can be made from natural and sustainable materials such as cotton, their disposable nature still carries an environmental impact. They have an afterlife of 500-800 years and contribute to 13 billion pieces of period products going into landfills globally every year.
- Cannot be recycled - Tampons and their packaging contain single-use plastics, and as they absorb bodily fluid which is considered hazardous waste they are not recyclable.
- Vaginal transmission of chemicals – It’s 15 times higher and more likely to enter directly into your bloodstream than orally. Given this, the likelihood of our bodies absorbing toxic plastic vaginally while we use pads or tampons to manage our period is very high.
- You’ll have to buy new tampons each month - As a result, tampons may not be the most cost-effective form of period care that they initially seem.
- Microplastics - Considering the median number of particles found in the tested products, it can be estimated that a woman using tampons could be exposed to 86 trillion fragmented synthetic polymers over a lifetime of product use. The effects of microplastics can consist of oxidative disorder, immune response, neurotoxicity, as well as reproductive and developmental toxicity.
- Dangerous chemicals – tampons usually contain dangerous chemicals, like pesticide residues, bleach, and phthalates that can harm the body.
- Toxic Shock Syndrome (TTS) Risk – As mentioned previously using tampons for longer than 8 hours can increase your risk of TSS.
- Potential allergens - The plastics, synthetic fibres, wool pulp, chlorine, synthetic chemicals, artificial fragrances and pesticides, and herbicide-ridden cotton used in disposable tampons can lead to allergic reactions, hormone disruption, and even reproductive disorders.
Pads and Period Underwear – the Pros and Cons
Pads
Pros
- Easy for heavy periods - Women who have heavy periods should change their hygiene products more often than others. Regular pad change is an easier process than changing a tampon.
- Easy to use - They are easier to use than tampons (no insertion) and are also ideal for use at night. You can use them all night without worrying.
- Worn for longer - more than tampons 8 hours. You can also buy wider, more absorbent pads designed for overnight use to minimise your risks of leakage.
- Almost no risk of Toxic Shock Syndrome (TTS) - Studies show that using pads has a lower risk of developing TSS compared to tampons.
- Know when to change - It can be hard to tell when you might need to change your tampon. But it’ll be obvious when it’s time to change your pad.
Cons
- Swimming is not possible - Sanitary pads can be worn during most activities, but you cannot swim with them. They soak up the water and can detach from your underwear, which can be a very uncomfortable and embarrassing experience.
- Less discreet - Certain types of clothing may be visible, but this is not something that should cause feelings of shame, as it is a completely normal fact. For women who want a discreet choice, the solution lies in the use of tampons.
- Bacteria build-up - This can cause your vagina to have a pH imbalance if you keep your sanitary product on for too long and bacteria build up on your pad.
- Can move - The pad may move out of place, becoming uncomfortable and leaking on your clothes.
- Irritation - They can also itch and scratch with general movement, e.g. walking
- Messy - Some people describe pads as messy. This is the whole combination of them potentially moving in your underwear and the issue of removing them and wrapping them for disposal.
- Single-use - Once you’ve used one, that’s it. It’s done. Though pads can be made from natural and sustainable materials such as cotton, their disposable nature still carries an environmental impact. They have an after-life of 500-800 years.
- Increased waste - Pads come individually wrapped which also increases the waste.
- You’ll have to buy pads each month - As a result, pads may not be the most cost-effective form of period care that they initially seem.
- Potential allergens - The plastics, synthetic fibres, wool pulp, chlorine, synthetic chemicals, artificial fragrances and pesticides, and herbicide-ridden cotton used in disposable pads can lead to allergic reactions, hormone disruption, and even reproductive disorders.
Period Underwear
Pros
- Reusable - made of washable materials, they can be worn multiple times. Can at least 2-3 years.
- Comfortable – they look and feel like normal undies. They don’t bunch up and move like pads.
- Movement freedom - won’t shift like a pad.
- Wear them to bed for a full night’s sleep without having to change or there’s no worry about leakage.
- Eco-friendly materials - you can get period underwear that is made from organic materials.
- Save money - they are initially more expensive than disposable alternatives but will save you money after a year of use.
- Stress-free - you can wear them for 8-12 hours depending on the absorbency you buy and your flow. But they are leak-proof.
- Swimming - you can buy period swimwear which absorbs the blood while you’re swimming and is 100% leakproof, in and out of the water.
- Never need to worry about changing and disposing of tampons or pads again, particularly in a public bathroom.
- Prevention for toxic shock syndrome (TSS) – as there is no insertion of product and no loose product pieces that can get stuck in the vagina.
Cons
- Take a while to dry – to prevent tearing of period underwear, it’s recommended that they are air dried and not tumble dried. They can take 4-12 hours to dry.
- You'll need several pairs - because you might want to limit your washing and they take a while to dry you might need to buy a few pairs.
- Changing in public may be a hassle - depending on your flow you may need to change during the day. However, heavy flow period undies should last most for 8-12 hours and absorb 3 tampons worth.
If you think you want more information about endometriosis, please speak with your GP. You may also like to visit Endometriosis UK or Endometriosis Australia at: https://www.endometriosis-uk.org or https://endometriosisaustralia.org/
Some of the information for this article was sourced from Endometriosis UK, Endometriosis Australia and “Dyspareunia in Their Own Words: A Qualitative Description of Endometriosis-Associated Sexual Pain” from the National Library of Medicine: