Repeat hospital visits with dysmenorrhoea and an atypical pancreatitis presentation were just some of the clues that led doctors to diagnose a rare case of endometriosis-induced pancreatitis.

The 46-year-old patient attended an ED in Norfolk, Virginia in the US with epigastric pain and nausea two days after the onset of painful menses.

She had at least nine admissions in the previous year with dysmenorrhoea, a history of heart failure with mild reduced ejection fraction, hypertension and type 2 diabetes, and took hydrochlorothiazide for blood pressure control.

In her 30s she started experiencing heavy menstrual bleeding, soaking through 5-7 pads every 24 hours.