Endometriosis occurs when tissue similar to the lining of the uterus grows outside it — on the ovaries, fallopian tubes, bowel or the pelvic lining. That tissue still responds to the monthly hormonal cycle, thickening and bleeding, but it has no way to leave the body. The result is inflammation, scarring and adhesions.

It affects roughly one in ten women of reproductive age, and takes an average of seven years to diagnose — largely because severe period pain is so often dismissed as normal.

Symptoms of endometriosis

• Period pain severe enough to interrupt work, study or sleep, often starting before the bleeding does
• Pain during or after intercourse
• Heavy or prolonged bleeding, or bleeding between periods
• Pain when passing urine or opening the bowels, typically worse during a period
• Persistent pelvic pain outside of periods
• Fatigue, bloating and nausea around the cycle
• Difficulty conceiving

Symptom severity does not track with disease extent. Mild endometriosis can be intensely painful; extensive disease is sometimes found only during fertility investigation.

Why it is so often missed

Painful periods are widely normalised, so many women do not raise them. Symptoms also overlap with irritable bowel syndrome, bladder conditions and uterine fibroids. Endometriosis is not visible on a routine scan unless cysts have formed, so a normal ultrasound does not rule it out. If your periods are changing in pattern or flow, that is worth discussing — see also our note on reduced period flow.

How endometriosis is diagnosed

Diagnosis starts with a detailed symptom and cycle history, followed by a pelvic examination. A transvaginal ultrasound can identify endometriomas (ovarian cysts) and deep infiltrating disease. MRI maps extent before surgery. Laparoscopy — keyhole surgery allowing direct visualisation and biopsy — remains the definitive test, and treatment can often be carried out in the same procedure.

Endometriosis and fertility

Between 30 and 50 per cent of women with endometriosis experience difficulty conceiving, through adhesions distorting pelvic anatomy, inflammation affecting egg quality, or blocked fallopian tubes. Many conceive naturally; others benefit from surgical treatment or assisted reproduction.

Getting assessed

You do not need to prove your pain is severe enough to be taken seriously. If periods are disrupting your life, that is reason enough for assessment. Our endometriosis treatment service covers diagnosis through to medical and surgical management, including fertility-preserving approaches.

Book a consultation with Dr. Asavari Karani at Tulsi Clinic, Matunga, Mumbai.