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Severe period pain, persistent pelvic discomfort, pain during intercourse, or difficulty getting pregnant can sometimes be associated with a condition called endometriosis. Many people assume that painful periods are simply part of menstruation. However, when the pain affects daily activities, work, sleep, or quality of life, it deserves medical attention.
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause inflammation, pain, and scar tissue, and may affect the ovaries, fallopian tubes, and other pelvic structures. Symptoms differ from person to person, and some people may have the condition without noticeable symptoms.
Understanding the possible causes, recognising the warning signs, and seeking an appropriate medical assessment can help patients make informed decisions about their care.
The inner lining of the uterus is called the endometrium. In endometriosis, tissue similar to this lining develops in other parts of the body, most commonly within the pelvis.
These areas of tissue can respond to hormonal changes during the menstrual cycle. This may lead to inflammation, pain, adhesions (scar tissue that can cause organs to stick together), or ovarian cysts known as endometriomas.
Endometriosis can affect different areas, including:
The location and extent of the condition vary. Importantly, the severity of pain does not always correspond to the amount of endometriosis present.
According to the World Health Organization, endometriosis affects an estimated 10% of reproductive-age women worldwide. It can have physical, emotional, and reproductive effects.
The exact cause of endometriosis is not yet known. Researchers believe that several biological and hormonal factors may contribute to its development.
Possible explanations include:
This theory suggests that some menstrual blood flows backwards through the fallopian tubes into the pelvic cavity. However, retrograde menstruation alone does not explain all cases of endometriosis.
Endometriosis can run in families. Having a close relative, such as a mother or sister, with the condition may increase a person’s likelihood of developing it.
Differences in immune system activity and inflammatory processes may play a role in the development or persistence of endometriosis. Research is continuing to understand these mechanisms.
Endometriosis is influenced by hormones, particularly oestrogen, which helps regulate the menstrual cycle. Hormonal activity can contribute to the growth and symptoms of endometriosis tissue.
These are possible contributing mechanisms rather than confirmed explanations for every case. There is no single proven cause, and developing endometriosis is not a patient’s fault.
Endometriosis symptoms may occur before or during periods, but some people experience pain throughout the month. Symptoms can also change over time.
Common symptoms include:
Not everyone experiences all these symptoms. Some people have minimal symptoms despite having endometriosis, while others experience substantial pain.
Consider arranging a consultation if period pain repeatedly prevents you from attending work or school, pelvic pain continues outside menstruation, you experience pain during intercourse, or you have persistent bowel or bladder symptoms associated with your cycle.
Do not assume that severe pain is something you simply have to tolerate. A clinical assessment can help identify the cause and determine appropriate next steps.
Diagnosing endometriosis can take time because its symptoms overlap with other conditions, including uterine fibroids, adenomyosis, pelvic inflammatory disease, and some bowel disorders.
A gynaecologist may recommend the following steps, depending on your symptoms and medical history.
The doctor may ask about your menstrual cycle, pain patterns, bleeding, bowel or bladder symptoms, family history, previous treatments, and whether you are planning a pregnancy.
Keeping a menstrual and pain diary can help you explain when symptoms occur, how long they last, and how they affect daily activities.
A clinical examination may be offered when appropriate and with your consent. It can help assess pelvic tenderness or other findings, although a normal examination does not rule out endometriosis.
A pelvic ultrasound, including a transvaginal ultrasound when suitable and acceptable, can help identify ovarian endometriomas and some forms of deep endometriosis. It can also help identify other possible causes of symptoms.
However, a normal ultrasound does not exclude endometriosis, particularly superficial disease.
An MRI may be recommended in selected cases to assess suspected deep endometriosis or understand how extensively certain pelvic structures may be affected.
Laparoscopy is a surgical procedure in which a small camera is inserted through a small incision in the abdomen. It may be considered when symptoms persist, imaging is inconclusive, or surgery is otherwise appropriate. Treatment of visible endometriosis may sometimes be performed during the same procedure.
Not every patient needs surgery to begin treatment. The diagnostic approach should be guided by clinical assessment, symptoms, imaging findings, and the patient’s preferences.
Clinical reference: NICE guideline on endometriosis diagnosis and management.
There is currently no definitive cure for endometriosis, but several treatments can help manage symptoms and improve quality of life. The right approach depends on pain severity, the location and extent of disease, previous treatments, possible side effects, and whether pregnancy is a current priority.
A doctor may recommend suitable pain-relieving medicines to reduce menstrual or pelvic pain. The choice depends on the patient’s medical history, other medicines, and individual risks. Do not start or regularly use pain medicines without professional advice if you have relevant health conditions or are unsure whether they are suitable for you.
Hormonal medicines may help reduce pain by suppressing or changing hormonal activity associated with the menstrual cycle. Options may include combined hormonal contraceptives, progestogen-based treatments, and other specialist-prescribed hormonal medicines.
These treatments are not appropriate for everyone and can have side effects. Some hormonal treatments also prevent or delay attempts to conceive while being used, so fertility goals should be discussed before starting treatment.
Surgery may be considered when symptoms remain troublesome despite medical treatment, when endometriosis affects certain organs, or when the clinical team believes an operation may be beneficial.
Laparoscopic surgery may be used to remove or destroy endometriosis lesions, divide adhesions, or treat selected ovarian endometriomas. The expected benefits and risks depend on the location and extent of disease and the type of procedure.
Endometriosis can recur after surgery, and some patients may continue to experience pain. Surgery should therefore be considered through an informed discussion with the treating specialist. If surgery is advised, you can check the hospital’s cashless facility and bed categories when planning your admission.
Long-term pelvic pain may require more than one approach. Depending on individual needs, care may include pelvic health physiotherapy, pain management, psychological support, and specialist fertility advice.
These approaches can complement medical treatment, particularly when symptoms affect sleep, relationships, emotional wellbeing, or everyday functioning.
Yes. Endometriosis can be associated with difficulty getting pregnant, but a diagnosis does not mean that pregnancy is impossible.
The condition may affect fertility through inflammation, adhesions, changes in pelvic anatomy, or involvement of the ovaries. The effect varies considerably from person to person.
If you are trying to conceive, tell your gynaecologist before choosing a treatment plan. Some hormonal medicines control symptoms but are not used to help achieve pregnancy while you are taking them. Depending on your circumstances, the doctor may discuss fertility assessment, surgery in selected cases, or referral to a fertility specialist.
Treatment decisions should consider both symptom relief and reproductive goals, rather than assuming that one approach is suitable for everyone.
Alongside medical care, some practical measures may help you manage symptoms:
These measures do not cure endometriosis, but they may help you communicate your symptoms and work with your healthcare team on a management plan.
Endometriosis is a chronic condition that can significantly affect quality of life. Its impact varies, and some cases may involve the ovaries, bowel, bladder, or fertility. Persistent or worsening symptoms should be assessed by a qualified healthcare professional.
There is currently no guaranteed permanent cure. Medication and surgery can help manage symptoms, but symptoms or lesions may return. Long-term care depends on individual needs and response to treatment.
No. Symptoms vary widely, and some people have little or no noticeable pain. Conversely, severe pain can occur even when visible disease appears limited.
Ultrasound can identify some forms of endometriosis, including many ovarian endometriomas and selected cases of deep disease. However, a normal scan does not rule out the condition.
No. Treatment may begin with medication and symptom management. Surgery is considered according to symptoms, examination and imaging findings, treatment response, fertility goals, and individual preferences.
Yes. Symptoms or lesions can recur after surgery. Follow-up care and a discussion about longer-term management may be helpful.
Seek an assessment if period pain regularly disrupts your normal activities, does not improve with appropriate treatment, or occurs alongside persistent pelvic pain, painful sex, bowel or bladder symptoms, or difficulty conceiving.
If you are experiencing severe period pain, persistent pelvic discomfort, painful intercourse, or difficulty conceiving, do not ignore your symptoms. Early medical evaluation can help identify the possible cause and guide appropriate treatment.
At Smt S R Mehta & Sir K P Cardiac Institute, Mumbai, patients can enquire about available gynaecological consultation and treatment services to understand their symptoms and discuss suitable care options with a qualified specialist.
Do not let persistent menstrual pain go unaddressed. Contact us to seek medical advice and discuss the next steps for your health.
Early evaluation can help find the cause and guide the right treatment. Speak to our team about your symptoms.
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