Tierra Price got her first period in sixth grade. A year later, she was experiencing intense cramping and heavy bleeding during her periods. When she asked other girls at school about their periods, they shared their own stories — some had mild cramps, and others had more severe pain.
“We don’t all feel the same level of pain,” Tierra explains. “Everyone’s period is different. So, I thought my experience was my own version of normal.”
But as Tierra got older, her menstrual symptoms worsened. In addition to the painful cramps and heavy bleeding, she started to vomit during her period. She also had diarrhea, constipation and pain during bowel movements.
Tierra’s symptoms started to disrupt her daily life, affecting her sleep and appetite.
“I would wake up in the middle of the night with pain, and I was worried I would bleed through my sheets,” says Tierra. “I felt nauseous and lost my appetite. Although I thought these symptoms might still be considered normal, it felt like something was wrong.”
Listening to the signs
For years, Tierra sought routine gynecologic care, but her symptoms persisted and often went unrecognized. It wasn’t until her early 30s that a provider took a closer look and suspected endometriosis — a condition where tissue similar to the uterine lining grows outside the uterus, often causing pain and other complications.
The only way to confirm an endometriosis diagnosis is through minimally invasive surgery. Her provider performed the procedure and removed a significant amount of endometriosis-related scar tissue and lesions. While Tierra noticed some relief from the procedure, she still had substantial pain during her periods.
Considering her persistent symptoms, Tierra was doubtful she could physically progress to natural menopause. At age 35 , she decided to have a hysterectomy to remove her uterus and help alleviate her pain. Tierra’s doctor referred her to Dr. Janelle Moulder, minimally invasive gynecologic surgeon with Atrium Health Wake Forest Baptist Center for Fertility and Reproductive Surgery.
What’s normal and what’s not
According to Moulder, guidelines for normal period symptoms:
- A period should last two to seven days.
- Some cramping is typical, but it shouldn’t leave you bedridden.
- Period symptoms shouldn’t be so severe that they disrupt your daily activities.
“Painful periods are frequently normalized or dismissed,” notes Moulder. “However, they are often the first sign of endometriosis.”
Endometriosis can take up to 10 years to diagnose. During that time, many patients experience chronic pain and reduced quality of life.
“When symptoms begin at 14 but diagnosis doesn’t come until 24, that’s a decade of lost education, career opportunities and social connections during critical developmental years,” Moulder explains.
Problems with prolonged pain
Years of living with endometriosis can cause patients like Tierra to develop additional symptoms as their bodies respond to prolonged pain.
“Severe nausea and vomiting can sometimes be triggered by intense pain,” explains Moulder.
Endometriosis symptoms, especially pelvic pain, can occur with the menstrual cycle or independently of it. For some patients, there’s a baseline level of pain that never fully goes away. This pain can also be connected to other conditions related to endometriosis, such as severe musculoskeletal pain.
“If you are experiencing pain every month for years, your body may try to protect you from this painful experience,” says Moulder. “Over time, this protective response can lead to chronic pain conditions that persist even in the absence of menstrual pain. The body becomes primed, developing a heightened sensitivity to pain signals. Without proper treatment, this cycle can intensify, causing the pain to spread beyond menstruation and disrupt daily life.”
Aligning treatment plans with patient goals
“Dr. Moulder is my hero,” Tierra explains. “She listened, respected my choices and truly helped me.” Endometriosis patients often have one of two goals: preserving fertility or managing pain. While fertility is usually a medical focus, severe pain can prompt patients to prioritize restoring daily well‑being instead.
“By the time I met Tierra, her goals had shifted from trying to get pregnant to relieving her pain and improving her quality of life,” Moulder says. “Many patients reach me after years of suffering. At that point, they just want to feel better, rebuild their relationships and live the life they’ve been missing.”
Improving quality of life involves more than treating physical symptoms. Honest conversations about the broader impact of endometriosis are essential. The condition can affect relationships, emotional well-being and daily functioning. When care focuses only on surgical outcomes and overlooks these areas, it fails to treat the whole patient.
A holistic approach is also vital when planning endometriosis surgery.
Deeply infiltrating endometriosis can affect other organ systems beyond the reproductive system. For example, when lesions grow into the bowel, patients may require bowel resection to remove the disease. The surgical team collaborates with colorectal surgeons to ensure safe, comprehensive care.
In addition, endometriosis can affect the ureters, the tubes that carry urine to the bladder, by compressing or infiltrating them. This may lead to irreversible kidney damage if left untreated.
That’s why Moulder emphasizes reviewing all symptoms before surgery.
“It’s important to recognize all the symptoms ahead of time so we can prepare for the operating room,” explains Moulder. “That way, the outcome aligns with the patient’s goals — both in terms of what the surgery allows and what the patient expects.”
Tierra’s path to parenthood
Before her hysterectomy, Tierra explored fertility options and began hormone treatments in hopes of starting a family. Although those efforts didn’t lead to pregnancy, she and her husband remained committed to growing their family.
“Given how severe my endometriosis was, I started to worry about my ability to carry a baby to term,” Tierra says. “After a lot of thought and heartfelt conversations, my husband and I decided to pursue adoption. We are currently exploring our options.”
Freedom to move, power to be herself
For Tierra, endometriosis was incredibly debilitating, affecting her physically and emotionally. With symptoms so severe, planning her day or sticking to a routine felt nearly impossible. But now, everything has changed.
“I feel like myself again,” says Tierra. “Dr. Moulder gave me freedom and agency over my body, something no other doctor was able to do. Now, I can get up and go wherever I want. I’m very active in the gym, and I love being able to move my body on my own terms.”
Moulder noticed an immediate change in Tierra.
“I remember seeing her the day after surgery,” Moulder recalls. “She felt so much better — more like herself. At that moment, I realized I had only known one part of her. Some patients return after treatment and reveal a deeper truth that was masked by their symptoms. It’s powerful to see their personality return.”
Learn more about exceptional care at Atrium Health Wake Forest Baptist Center for Fertility and Reproductive Surgery.