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Then he proceeded to do a back and abdominal exam, palpating the area for tenderness. He also performed a pelvic ultrasound and drew some blood.

I'd never had someone be so thorough before.

When he finally seemed to be done, he looked up at me calmly.

"Well, Scarlet. I have a few theories."

"Okay," I said, my brow furrowing.

"It could be PMOS."

It was, I wanted to tell him. That's what I'd been told my whole life.

Because what else could it be?

“You have the pain and the irregular bleeding. But what is odd to me is the severity of your pain and the absence of cysts.”

“My other doctors said I don’t have to have cysts to still have PMOS.”

He nodded. “They're right. In fact, many don't. So the absence of cysts doesn't rule it out.”

I frowned.

“Then what's concerning you?”

“PMOS can certainly cause irregular cycles, but it usually doesn't cause this degree of pain by itself. Your pain is severe, it's been getting progressively worse, it's interfering with your training, and it's closely tied to when you bleed.”

My eyes widened. “So if it's not PMOS, what could it be?”

He rested his tablet on his knee.

“I can't diagnose what I'm about to mention here,” he said. “That's something a gynecologist would have to confirm. But I've referred enough athletes with symptoms like yours to recognize when it needs to be ruled out. Have you ever heard of endometriosis?”

I nodded. "I've heard of it, but I don’t really know anything about it.”

“The lining of your uterus is called the endometrium. Every month, that tissue builds up and then sheds during your period.”

He paused before continuing.

“With endometriosis, tissue that's very similar to that lining starts growing outside the uterus. It can grow on the ovaries, fallopian tubes, the tissue around the uterus, even the bladder or bowel.”

I frowned. “How does it get there?”

“That's one of the biggest questions we still don't have a complete answer to. We know it happens. We just don't fully understand why.”

“Okay...”

“The problem is that tissue still responds to your hormones every month, just like the lining inside your uterus does. It becomes inflamed and bleeds, but unlike your period, that blood has nowhere to go.”

He brought up a diagram on his tablet.

"That can cause inflammation, scarring, organs sticking together, and sometimes cysts on the ovaries."

My stomach sank. That sounded way more severe than PMOS.

"That's why the pain can become so severe."

“So I've been misdiagnosed?”