Understanding Endometriosis: Symptoms, Causes & Your Path to Relief

Table Of Content

Ishani's Story and the Reality of Endometriosis

Remember Ishani from our page on Period pain overview, symptoms, causes? Her story of increasingly severe and chronic menstrual pain wasn’t just “bad periods.” It was a red flag that eventually led to a diagnosis: endometriosis.

Like many women in India, Ishani initially dismissed her escalating pain, attributing it to the common belief of “period pain sabko hota hai.” However, as her pain intensified, impacting her ability to attend college and socialise with friends, she realised something was different. 

According to the Endometriosis Society of India, endometriosis affects an estimated 25 million women in India [Reference 1]. Furthermore, reports from two of India’s most recognised daily newspapers, the Times of India and the Business Standard, state that around 42 million women in India suffer from the condition and have called for a comprehensive national health policy to address it.

Endometriosis often goes undiagnosed or misdiagnosed for an average of 8 to 11 years from the onset of symptoms, a delay that can significantly impact a woman’s quality of life and fertility.

This page is dedicated to understanding endometriosis: what it is, its symptoms, potential causes, and the available treatments that can offer significant relief, just like Ishani eventually found.

Infographic titled "Endometriosis x India" showing that for 4.2 crore women in India, what seemed like "normal" period pain was actually a key symptom of endometriosis. It highlights the hidden struggle many face, as on average it takes 8 to 11 years from the first symptoms for a girl in India to be correctly diagnosed with endometriosis. This reflects the challenges related to symptoms like menstrual pain not relieved by NSAIDs, chronic pelvic pain, pelvic cramping before/during periods, and other endometriosis symptoms. The infographic underscores the need for awareness and early endometriosis treatment in India. The graphic ends with the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas.

What is Endometriosis?

Endometriosis is a condition where tissue similar to the uterine lining (the endometrium) grows outside the uterus. This misplaced tissue can be found on the ovaries, fallopian tubes, and other areas in the pelvic cavity. Just like the lining of the uterus, this endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle. However, because this blood has nowhere to exit the body, it can cause inflammation, scar tissue, adhesions (bands of fibrous tissue that can cause organs to stick together), and pain.

Endometriosis Symptoms: Recognising the Red Flags

While the primary symptom of endometriosis is often severe menstrual pain (dysmenorrhea), it’s crucial to recognise that the pain associated with endometriosis is often more intense and can differ from typical period cramps. Many women with endometriosis describe pain that significantly impacts their daily life. If you are wondering how you know if your painful periods are due to endometriosis, or if you are curious about what are the first signs of endometriosis, paying close attention to these symptoms is key.

Common Endometriosis Symptoms

Severe Period Pain

Pain that is significantly worse than normal period cramps and may not be relieved by over-the-counter pain medication. You may also notice that your pain gets progressively worse over time.

Pelvic Pain Outside of Periods

Many women with endometriosis experience chronic pelvic pain that isn’t limited to their menstrual cycle. If you are asking yourself, “Can endometriosis cause pain outside of periods?” the answer is yes.

Pain During or After Intercourse (Dyspareunia)

This is a common symptom due to the location of endometrial implants.

Painful Bowel Movements or Urination

These symptoms may occur, particularly during menstruation, if endometrial tissue is present on or near the bowel or bladder.

Heavy Bleeding (Menorrhagia) or Irregular Periods

While not always the case, endometriosis can sometimes be associated with changes in menstrual flow. If you are concerned and want to know more, you can explore whether endometriosis makes periods heavier or irregular.

Fatigue

Persistent tiredness is a common complaint among women with endometriosis.

Infertility

Endometriosis can sometimes make it difficult to conceive.

Endometriosis Causes: What We Know

The exact endometriosis causes are not fully understood, but several theories exist. The most widely accepted is retrograde menstruation, where menstrual blood containing endometrial cells flows backward through the fallopian tubes. It’s also believed that genetics, a malfunctioning immune system, and hormonal factors may play a role.

Diagnosing Endometriosis: Seeking Answers

If you suspect you might have endometriosis based on your symptoms, the first step is to consult a gynaecologist. They will listen to your detailed medical history and use common diagnostic methods to understand if you have endometriosis:

Pelvic Exam

A physical examination to check for any abnormalities.

Ultrasound

An imaging technique that can help identify cysts associated with endometriosis (endometriomas).

Laparoscopy

This is the most definitive way to diagnose endometriosis. It is a minimally invasive surgical procedure where a camera is used to visualise the pelvic organs and confirm the diagnosis.

Do you suspect your period pain could be Endometriosis?

Stop guessing, start knowing. Our Period Pain Calculator helps you determine the severity and understand the red flags you need to know for a confident conversation.
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Endometriosis Treatment: Finding Your Path to Relief

While there is currently no cure for endometriosis, effective endometriosis treatment options are available to manage symptoms and improve quality of life. The best treatment approach will depend on the severity of your symptoms and your individual circumstances.

Your gynaecologist will discuss various treatment options, which may include:

  • Pain Medication: Prescription based non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain. 
  • Hormonal Therapy: Medications like birth control pills can help slow the growth of endometrial tissue and manage symptoms.
  • Surgery: Laparoscopic surgery can be used to remove endometrial implants and scar tissue, providing pain relief and potentially improving fertility.
  • Lifestyle Changes: Many women also ask if lifestyle changes can help reduce endometriosis pain. While not a cure, incorporating gentle exercise, stress management, and an anti-inflammatory diet can provide significant relief.

Endometriosis Without Intervention: The Cost of Waiting

Endometriosis is a progressive disease. Without intervention, the misplaced tissue can continue to grow, leading to increasing severity of symptoms and long-term health complications. The normalisation of pain and the delay in diagnosis mean that many women don’t receive treatment until the disease has progressed significantly.

Here’s a look at what can happen with no intervention:

After 2-3 Years of No Intervention

The small, superficial lesions that may have initially caused minimal pain can become deeper and more numerous. This can lead to the formation of adhesions (scar tissue) that can begin to bind organs together, causing more pain and potential dysfunction.

After 5-10 Years of No Intervention

The disease can progress to moderate or severe stages. You may develop endometriomas, or “chocolate cysts,” on your ovaries. These can rupture, causing severe pain. The extensive scar tissue can distort pelvic anatomy, significantly increasing the risk of infertility. This is a common point where women, who may have been trying to conceive, finally seek a diagnosis.

The Lifetime Cost of Non-Intervention in Endometriosis

Over a woman’s lifetime, ignoring endometriosis pain can lead to chronic, debilitating pain, significant mental health challenges, and long-term damage to reproductive organs. On a global scale, the women’s health gap, driven in part by conditions like endometriosis, is estimated to cost the world 75 million years of life lost due to poor health annually, which is the equivalent of seven lost days per woman per year [Reference 2]. This highlights the immense personal and societal cost of untreated conditions.

An informational graphic titled "The Hidden Cost of Endometriosis" features a background image of a woman clutching her abdomen in pain. It explains that endometriosis is a progressive condition, and without early endometriosis treatment, the impact goes beyond just pain. The graphic outlines three stages of delayed care: Cost #1 – "2–3 Years of Waiting": small endometrial lesions grow deeper and more numerous, with pelvic adhesions forming, binding organs and causing chronic period pain. Cost #2 – "5–10 Years of Waiting": the disease may worsen into moderate or severe endometriosis, with ovarian cysts (endometriomas) potentially rupturing, leading to severe pelvic pain and increased risk of infertility. Cost #3 – "Lifetime Cost": untreated endometriosis can result in chronic pelvic pain, long-term reproductive damage, and reduced fertility. The graphic ends with the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas. and the website www.painfulperiods.in.

If you are diagnosed with endometriosis, your gynaecologist may also check for other related conditions such as Adenomyosis and PCOS, as these conditions can sometimes coexist or share similar symptoms. We also have a dedicated guide on Uterine Fibroids.

Illustration depicting adenomyosis, a condition where the uterine lining abnormally grows into the muscle wall of the uterus, leading to severe menstrual pain and other adenomyosis symptoms. The background features a soft pink watercolor texture. At the top, the word "Adenomyosis" appears in bold pink text, followed by a description in black italicized font that reads, "Uterine lining abnormally grows into the muscle wall of the uterus." The central cartoon-style image shows a pink uterus with a sad facial expression, tears near the fallopian tubes, and red spots on the upper right side representing abnormal tissue growth. Wavy red and black lines around the uterus symbolize cramps and pelvic pain, common in painful periods caused by adenomyosis. The uterus has arms that are holding the ovaries, which also appear distressed. At the bottom left is the website "www.painfulperiods.in," and in the bottom right corner, a pink speech bubble appears next to the phrase "Stop the Period Pain" in bold pink text, highlighting a call to action for those suffering from chronic period pain and seeking help for their uterine health. The graphic portrays the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas.
A pink, cartoon-style illustration of a uterus with PCOS showing a sad facial expression and teardrops under its eyes, symbolizing discomfort. Both ovaries are depicted with multiple small ovarian cysts, representing Polycystic Ovary Syndrome. The right ovary (on the left side of the image) has 5 visible cysts, and the left ovary (on the right side) has 6 cysts. Wavy lines and lightning bolt symbols near the lower part of the uterus suggest pelvic pain or cramping, common symptoms of PCOS in women. The background features a soft pink watercolor texture. At the top, bold text reads: “PCOS (Polycystic Ovary Syndrome)”. Below, in smaller text: “Cysts on ovaries prevent them from regularly releasing eggs,” indicating irregular periods and potential fertility issues due to PCOS. At the bottom right corner, a logo says “Stop the Period Pain” with a pink speech bubble icon. The website “**www.painfulperiods.in**” is written in pink in the bottom left corner. The graphic portrays the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas.
An illustrated educational graphic about uterine fibroids, a common cause of painful periods. The background is pink with a soft watercolor texture. At the top, bold pink text reads "Uterine Fibroids", followed by black italic text saying, "Non-cancerous growths in the uterus that develop within or on the uterine walls." Below the text is a cartoon-style illustration of a uterus with a sad face, eyes shut tight, and tears coming from both eyes, indicating severe menstrual cramps and pelvic pain. The uterus is depicted in pink with fallopian tubes and ovaries on each side. Multiple yellowish, bumpy fibroid tumors in uterus are shown growing on various parts of the uterus, including inside and on its outer wall. Zigzag lines around the uterus represent period pain and discomfort. In the bottom right corner, pink text says, "Stop the Period Pain" next to a speech bubble icon. In the bottom left corner, the website "www.painfulperiods.in" is displayed, suggesting a resource for information on uterine fibroids treatment and relief from painful menstruation. The graphic portrays the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas.
Illustration highlighting endometriosis symptoms and painful periods. The central image is a cartoon-style female reproductive system showing the uterus, ovaries, and fallopian tubes, with a sad facial expression, teary eyes, and red marks indicating pelvic pain. Dark red patches representing endometrial tissue growth outside the uterus are visible on the uterus, fallopian tubes, and ovaries—depicting a classic case of endometriosis disease. Pain indicators like squiggly lines and "Zzz" marks surround the uterus to emphasize chronic period pain. At the top, the text reads: “Endometriosis” in bold pink letters, followed by a description in black italics: “Tissue similar to the uterine lining abnormally grows outside the uterus.” At the bottom right, there's a pink speech bubble with the words “Stop the Period Pain,” supporting awareness for severe menstrual cramps and period pain treatment. Bottom left includes the website link: www.painfulperiods.in. The background is a soft pink watercolor texture, maintaining a gentle and supportive tone. The graphic portrays the campaign message "STOP The Period Pain." Which is a knowledge initiative campaign by Blue Cross Laboratories the makers of meftal spas.

Hope and Support: Tackling Endometriosis In India

Just like Ishani, who found relief and a renewed sense of well-being after her diagnosis and treatment, there is hope for managing your endometriosis and living a full and active life. The pain of endometriosis is often dismissed as “just a part of being a woman,” leading to years of suffering, misdiagnosis, and a significant toll on a girl’s physical and mental well-being. But it doesn’t have to be this way. By empowering our girls with knowledge and creating supportive systems, we can change the narrative around period pain and ensure early intervention for those who need it most. Here’s what schools in India must do:

Expand Period Education Beyond Hygiene

School curricula should move beyond basic menstrual hygiene to include comprehensive Period Pain Workshops. These workshops should educate girls on the signs of common disorders like period pain & endometriosis, empowering them to recognise and seek help for abnormal symptoms.

Establish Accessible Period Health Points

Schools and colleges should have designated “Period Health” counselors or nurses. This creates a safe, non-judgmental space where girls can discuss their symptoms and get professional advice without fear of stigma.

Role of Govt. Policy

As the article in The Times of India points out, initiatives under “Beti Bachao, Beti Padhao” can increase awareness, promote early diagnosis, and ensure access to comprehensive care for women suffering from endometriosis.

Living with endometriosis can be challenging, but remember that you are not alone. Seeking support from healthcare professionals, family, friends, and support groups can make a significant difference in your journey.

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The Answers You've Been Looking For

Get clear, concise answers to your most pressing questions about endometriosis.

Your Journey to #StopThePeriodPain Starts Here

Every month, millions of Indian girls & women suffer in silence, told that their severe period pain (dysmenorrhea) is “normal.” Our mission is to break that silence. #StopThePeriodPain campaign is here to empower you with 3 simple truths:

References:

  1. Endometriosis Society of India: Endometriosis: A Clinical Experience of 500 Patients from India
  2. McKinsey Health Institute: Closing the women’s health gap
  3. The Times of India – Endometriosis Awareness: Need for comprehensive health policy in India
  4. The New Indian Express – Women with endometriosis don’t get proper care worldwide, says Lancet
  5. Business Standard – Endometriosis: The missed disease affecting 42 million Indian women
  6. Motherhood Women & Children’s Hospital