Dr Gauri Rupesh Gauns
Every month, many women quietly endure severe pain during their periods, often believing it to be a normal part of womanhood. As a gynaecologist, I frequently meet women who have spent years living with debilitating menstrual pain before learning that what they have been experiencing is not normal at all -it is a medical condition called endometriosis.
March is observed globally as World Endometriosis Awareness Month-an important reminder to bring attention to a disease that affects millions of women worldwide, yet remains widely underdiagnosed, misunderstood, and frequently dismissed. Endometriosis is not merely ‘bad period pain’- it is a chronic inflammatory disease that can disrupt education, careers, relationships, fertility and mental well-being. Despite its prevalence, it continues to live in the shadows of stigma and silence.
Endometriosis occurs when tissue similar to the lining of the uterus called the endometrium, grows outside the uterine cavity. These misplaced implants may be found on the ovaries, fallopian tubes, pelvic peritoneum, intestines, urinary bladder and rarely in distant locations like lungs and skin. Like the uterine lining, this tissue responds to cyclical hormonal changes-thickening, breaking down and bleeding. But unlike menstrual blood, which exits the body, this blood has nowhere to go. The result is inflammation, scarring, adhesions. These adhesions are abnormal fibrous bands that can cause pelvic organs to stick to one another, contributing to pain and infertility.
One in ten women in reproductive age group (the time between onset of first menses until menopause) lives with endometriosis. Yet the average delay in diagnosis worldwide is 7 to 10 years.
Another challenge is that endometriosis does not present the same way in every woman. Some experience excruciating pain, while others may have subtle symptoms but significant internal disease. Some struggle with infertility, while others conceive without difficulty. This diversity can make recognition challenging.
Understanding the Disease- More Than Just Period Pain.
Endometriosis can manifest through a spectrum of symptoms, many of which extend beyond painful periods. Common symptoms include:
Severe period cramps, often worsening over time
Chronic pelvic pain
Pain during or after intercourse
Pain during passing motions/urine, especially during periods
Diarrhoea or constipation (during periods)
Bloating (endo belly), nausea, fatigue, back and thigh pain during premenstrual phase
Difficulty conceiving
30- 40% of women with endometriosis may face difficulty conceiving. The disease can distort pelvic anatomy, affect ovarian function, trigger inflammation and create an environment that interferes with fertilisation or implantation.
What causes endometriosis?
The precise cause remains complex and multi factorial. Several theories attempt to explain its development:
Retrograde menstruation: the menstrual blood flows backward through the fallopian tubes into the pelvis allowing endometrial cells to implant. However, not all women with retrograde flow develop endometriosis, suggesting additional factors.
Immune dysfunction:Â altered immune function may allow abnormal cells to grow and implant.
Genetic susceptibility: women with first degree relatives (mother/ sister) with endometriosis have a higher risk
The possible role of EDCs:
A growing area of investigation suggests the role of endocrine disrupting chemicals (EDCs) being implicated in causing endometriosis and a host of other gynaecological conditions.
How is endometriosis diagnosed?
Diagnosis begins with listening- a detailed history remains the most powerful tool.
For decades laparoscopy – a surgical procedure to visualise pelvic organs- was considered the definitive diagnostic tool. While valuable, it is invasive, costly and not always readily accessible. Modern guidelines increasingly recognise that careful assessment and imaging can justify early treatment without mandatory surgery in selected patients.
Treatment for endometriosis
Management of endometriosis is tailored to the individual patient and often involves one or more of the following approaches:
- Medical therapy
Hormonal treatments including oral contraceptives, progestins and GnRH
analogues aim to suppress ovulation and reduce disease activity. These therapies can significantly alleviate pain but do not cure the disease.
- Pain management
Non-steroidal anti-inflammatory drugs, neuropathic pain medications, physiotherapy and integrative therapies may help
- Surgical treatment
Laparoscopic (keyhole surgery) excision or ablation of endometriotic lesion improves pain and fertility outcomes
- Fertility treatment
For women with infertility, options range from ovulation induction to assisted reproductive techniques like IUI or IVF.
- Role of lifestyle and diet
While lifestyle changes do not replace medical care, regular exercise, balanced nutrition, stress reduction, and adequate sleep can support overall well-being.
How can awareness change outcomes?
School and college menstrual health programmes.
Workplace sensitivity
Community engagement
Environmental awareness
Endometriosis is chronic, but suffering in silence need not be! With timely diagnosis and comprehensive management, women can reclaim quality of life. During this World Endometriosis Awareness Month, it is time we move away from minimising women’s pain to recognising it, to replace stigma with genuine support and to encourage open conversations over silence. Because, when a woman’s pain is acknowledged, diagnosis happens earlier. And when diagnosis happens earlier, suffering is reduced, and when suffering is reduced, lives are transformed!
(The author is an Obstetrician-Gynaecologist (M.D.) and Fertility Specialist, practicing in Mapusa Goa)
