Endometriosis : When period pain is more than ‘ just cramps’

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By Dr. Anuradha Narayanan, Consultant Obstetrician & Gynaecologist

For many women, painful periods are considered a normal part of life. However, when menstrual pain becomes severe enough to interfere with work, studies, relationships, or daily activities, it should never be ignored. One of the most common causes of severe pelvic pain is endometriosis, a condition that affects nearly 1 in 10 women of reproductive age.

Despite being common, endometriosis is often diagnosed years after symptoms begin because many women are told that their pain is “normal.” Early diagnosis and appropriate treatment can significantly improve quality of life and preserve fertility.

What is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus. These growths may be found on the ovaries, fallopian tubes, pelvic lining, bowel, bladder, and, in rare cases, other organs.

Like the uterine lining, these implants respond to monthly hormonal changes. They thicken, break down, and bleed during each menstrual cycle. Since the blood has no way to leave the body, it causes inflammation, irritation, scarring, and adhesions, leading to pain and sometimes infertility.

Common Symptoms of Endometriosis

Symptoms vary from woman to woman. Some may have extensive disease with few symptoms, while others experience severe pain despite minimal disease.

Common symptoms include:

• Severe menstrual cramps that worsen over time

• Chronic pelvic pain

• Pain during or after sexual intercourse

• Pain while passing urine or stools, especially during periods

• Heavy menstrual bleeding or spotting between periods

• Painful bowel movements during menstruation

• Difficulty conceiving

• Fatigue

• Bloating, often called “Endo Belly”

• Lower back pain

  
  

Who Is at Risk?

You may have a higher chance of developing endometriosis if you:

• Started menstruating at an early age

• Have short menstrual cycles

• Experience heavy or prolonged periods

• Have a family history of endometriosis

• Have never been pregnant

• Have certain uterine abnormalities

  
  

Can Endometriosis Affect Fertility?

Yes. Endometriosis is one of the leading causes of infertility.

It may affect fertility by:

• Damaging the ovaries or fallopian tubes

• Causing pelvic adhesions

• Reducing egg quality

• Creating an inflammatory environment that interferes with fertilization and implantation

  
  

The good news is that many women with endometriosis conceive naturally, while others achieve successful pregnancies with appropriate treatment or assisted reproductive techniques.

How Is Endometriosis Diagnosed?

Diagnosis begins with a detailed history and pelvic examination.

Your doctor may recommend:

• Pelvic ultrasound (especially useful for ovarian endometriomas)

• MRI scan in selected cases

• Blood tests (limited role)

• Diagnostic laparoscopy, which remains the gold standard for confirming endometriosis and can also be used to treat it.

Treatment Options

Treatment depends on your age, symptoms, severity of disease, and future pregnancy plans.

1. Pain Relief

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Lifestyle modifications

• Heat therapy

2. Hormonal Treatment

Hormonal medications help suppress the growth of endometriosis tissue.

Options include:

• Combined oral contraceptive pills

• Progesterone-only tablets

• Levonorgestrel intrauterine system (LNG-IUS)

• GnRH agonists or antagonists

• Other hormonal therapies when appropriate

3. Laparoscopic Surgery

Minimally invasive surgery may be recommended to:

• Remove endometriosis implants

• Remove ovarian cysts (endometriomas)

• Release adhesions

• Improve fertility in selected women

• Relieve severe pain

4. Fertility Treatment

Women struggling to conceive may benefit from:

• Ovulation induction

• Intrauterine insemination (IUI)

• In-vitro fertilization (IVF)

The treatment plan is individualized based on age, ovarian reserve, and severity of disease.

Can Lifestyle Changes Help?

Although lifestyle changes cannot cure endometriosis, they may help reduce symptoms.

Helpful measures include:

• Regular physical activity

• Adequate sleep

• Stress management

• Maintaining a healthy weight

• An anti-inflammatory diet rich in fruits, vegetables, omega-3 fatty acids, whole grains, and lean proteins

• Limiting processed foods and excessive alcohol

Some women also benefit from pelvic floor physiotherapy and psychological support as part of a multidisciplinary approach.

When Should You See a Gynaecologist?

Seek medical advice if you experience:

• Severe period pain that disrupts your daily life

• Pain during intercourse

• Persistent pelvic pain

• Difficulty getting pregnant after trying for a year (or six months if over 35 years)

• Heavy periods associated with severe pain

• Pain during bowel movements or urination during menstruation

Early diagnosis can prevent progression and improve long-term outcomes.

Myths About Endometriosis

Myth: Painful periods are always normal.

Fact: Severe pain that limits daily activities should always be evaluated.

Myth: Pregnancy cures endometriosis.

Fact: Pregnancy may temporarily improve symptoms, but it is not a cure.

Myth: Hysterectomy always cures endometriosis.

Fact: Endometriosis can persist even after hysterectomy if disease remains outside the uterus.

Myth: Teenagers cannot have endometriosis.

Fact: Endometriosis can begin during adolescence and should be considered in young girls with severe menstrual pain.

Endometriosis is a chronic but treatable condition. Living with severe pain is not something women should simply accept. Timely diagnosis, individualized treatment, and ongoing care can significantly improve quality of life, protect fertility, and help women lead healthy, active lives.

If you have persistent pelvic pain, painful periods, or are struggling to conceive, consult a qualified gynaecologist. Early intervention can make a meaningful difference.

At Anurag Women Health Care, we believe every woman deserves to live without unnecessary pain. If your periods are affecting your daily life, don’t ignore the symptoms—help is available.

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