A silent, often-missed condition that turns routine pain into a chronic battle. Dr Anshumala ShuklaKulkarni, Gynaecologist, Kokilaben Dhirubhai Ambani Hospital, helps us understand endometriosis.
What is endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. This misplaced tissue responds to hormonal changes, particularly oestrogen, just like the uterine lining — thickening, breaking down, and bleeding — but without a natural way to exit the body.
It most commonly appears in the pelvis — on or beneath the ovaries, behind the uterus (in the Pouch of Douglas), and on ligaments, the vagina, or rectum. In some cases, it may also affect the bladder, appendix, abdominal wall, or even areas higher in the abdomen. More than just a reproductive condition, endometriosis is now recognised as a systemic inflammatory disease, meaning it can affect multiple organs and systems in the body.
Why do some people develop it?
There’s no single, definitive cause. However, certain factors increase risk:
• Early onset of menstruation.
• Heavy, prolonged, or frequent periods.
• Family history of endometriosis.
It is also linked to immune system dysfunction. The body fails to clear abnormal tissue effectively, while inflammation is heightened, allowing the condition to persist and progress.
How common is delayed diagnosis?
Very. Globally, diagnosis can take four to seven years. Symptoms often begin in adolescence, but many women are only diagnosed in their mid-20s or later — frequently when facing fertility issues.
Pain is often dismissed as “normal,” or patients are labelled as overreacting. This delay can lead to severe disease progression. Cultural silence, lack of awareness, and even gaps in medical understanding contribute to this problem.
What are the warning signs?
Your menstrual history is often the first clue. Watch for:
• Increasing or severe menstrual pain that disrupts daily life.
• Pain that worsens over time (instead of improving with age).
• Pain in the lower abdomen, middle, or sides.
• Pain that doesn’t respond well to standard painkillers.
When should you seek medical advice?
Don’t wait it out if you experience:
• Pain around ovulation or before periods.
• Bowel or bladder pain during menstruation.
• Frequent urination, diarrhoea, or constipation linked to your cycle.
• Lower abdominal tenderness.
• Pain during intercourse.
• Difficulty conceiving.
If your body is consistently signalling distress, it deserves attention — not dismissal.
How is endometriosis diagnosed?
Imaging techniques like specialised ultrasound and MRI can detect many ovarian and deep lesions. However, smaller peritoneal deposits are often harder to identify.
The only definitive diagnosis is through laparoscopy, a minimally invasive surgical procedure where tissue is removed and examined.
How does it affect fertility?
Endometriosis is associated with infertility in around 30% of affected women. Sometimes, infertility is the only symptom.
It impacts fertility in several ways:
1. Physical damage: Scarring or distortion of the ovaries and fallopian tubes can disrupt egg and sperm movement.
2. Functional disruption: Even without visible damage, it can affect fertilisation, embryo development, and implantation.
Early detection significantly improves outcomes.
What are the treatment options?
Medical Therapy
Hormonal treatments such as oral contraceptive pills or GnRH agonists can help control symptoms. However, they do not cure the condition or improve fertility, and may have side effects.
Surgical Management
Modern treatment focuses on the complete excision (removal) of endometriotic tissue rather than simply burning it. The disease is often compared to an iceberg — surface treatment can leave deeper disease behind.
Excisional Surgery (laparoscopy)
This approach offers:
• 70–80% chance of significant pain relief.
• Improved fertility outcomes.
• Effectiveness even in severe cases.
Most procedures are minimally invasive, allowing faster recovery.
Can lifestyle changes help?
While not a cure, certain measures may reduce risk or help manage symptoms:
• Regular exercise.
• Hormonal regulation (such as prescribed oral contraceptives).
These should complement — not replace — medical care.
The Bigger Picture
Endometriosis isn’t just about periods — it’s about quality of life. If something feels off, don’t accept dismissal as an answer. The right diagnosis, from the right specialist, can change the trajectory of the condition entirely.
Dr Anshumala Shukla-Kulkarni is an MD (O&G), DGO, FCPS, Fellow in Minimally Invasive Surgery (Singapore & Australia). Head – Minimally Invasive Gynaecology, Gynaecology Laparoscopic and Robotic Surgery.
