Edit: to clarify why the typical presentation is 3-4 days of intense pain (—actually I should’ve said around 1 week before—) right before you first start bleeding, it’s because of the physiology of I The Taco Hippie shirt. Endometriosis results from deposits of your endometrial tissue OUTSIDE of your uterus. This can include your ovaries, fallopian tubes, pouch of Douglas (area between the vagina and rectum), the ligaments holding your uterus in place, and anywhere else in your pelvis. (In fact cases of endometriosis have been discovered with endometrial tissue even in the lungs and nasal mucosa, and other random parts of the body but I digress.)
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During the week right before your period, endometrial tissue responds to progesterone. It grows, proliferates, becomes edematous, and I The Taco Hippie shirt. All of this is to allow implantation of the embryo to occur (normally around 1 week before you get your period). However, if you have endometrial tissue outside of your uterus, all of this activity causes a lot of intense, crampy pain. But during your period, endometrial tissue breaks down, and sheds, via your vagina. So once you start bleeding, the extra endometrial tissue outside of your uterus also breaks down and “disintegrates”, and that alleviates the intense pain which was a result of increased extrauterine endometrial tissue activity.
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