I pass clots, sometimes quite large, during my period. Although my periods are regular, they are often painful. Is this a symptom of endometriosis, or is this normal? I am 28.

--Kay

This may be endometriosis, or possibly adenomyosis, fibroids or polyps -- or it may even be normal for you. In any case, yours is a common and fairly easily treated problem.

Adenomyosis is a "cousin" to endometriosis. In endometriosis, the uterine lining tissue gets outside the uterus and attaches to other internal organs and structures. In adenomyosis, this tissue penetrates into the wall of the uterus an abnormal amount. Heavy, crampy periods are the hallmark of adenomyosis.

Fibroids are benign growths of the uterine wall muscle, and polyps are fleshy stalks that protrude from the uterine lining, again benign in the vast majority of cases. Both can increase bleeding by increasing the surface area of the uterine cavity -- if there is more surface, then there is more to slough off every month.

A visit to your gynecologist is in order if you are having very heavy and painful periods. Based on a physical exam and perhaps an ultrasound, your doctor may be able to give you a specific diagnosis and treatment. Often non-steroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin), may help with both cramps and bleeding. Birth control pills are another frequently used treatment. Occasionally surgery is an option as well.