Endometriosis: Why Painful Periods Should Never Be Ignored
Endometriosis affects millions of women worldwide, yet most wait years before receiving a correct diagnosis. Learn the warning signs and available treatments.
By Dr. Amrendra Prasad Kushwaha
"Period pain is normal — just bear with it." This is advice many women with endometriosis have heard from family, friends, and sometimes even doctors. The reality is that severe, debilitating period pain is not normal, and endometriosis is one of the most important reasons to take it seriously.
What Is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus — on the ovaries, fallopian tubes, the outer surface of the uterus, the bowel, or the bladder. This tissue responds to hormonal changes during the menstrual cycle, causing inflammation, internal bleeding, and the formation of scar tissue (adhesions).
It affects approximately 10% of women of reproductive age worldwide.
Warning Signs
The hallmark symptom is dysmenorrhoea — painful periods that interfere with daily life. Other warning signs include:
- Pelvic pain that starts before and continues after menstruation
- Pain during or after sexual intercourse (dyspareunia)
- Pain during bowel movements or urination, especially during periods
- Heavy menstrual bleeding or bleeding between periods
- Bloating ("endo belly") around the time of menstruation
- Fatigue, particularly during periods
- Difficulty getting pregnant — endometriosis is found in 30–50% of infertile women
How Is Endometriosis Diagnosed?
Endometriosis is notoriously difficult to diagnose. The average delay between first symptoms and diagnosis is 7–10 years — largely because symptoms are dismissed or attributed to normal period pain.
- Clinical history and symptom pattern are the first step
- Pelvic ultrasound can detect ovarian endometriomas (chocolate cysts)
- MRI provides more detailed mapping of deep endometriosis
- Laparoscopy is the gold standard — it allows direct visualisation and biopsy of endometrial lesions
Stages of Endometriosis
Endometriosis is classified into four stages (I–IV) based on the extent and location of the implants:
| Stage | Description |
|---|---|
| Stage I (Minimal) | A few small implants, no significant adhesions |
| Stage II (Mild) | More implants, slightly deeper |
| Stage III (Moderate) | Many deep implants, small cysts on one or both ovaries |
| Stage IV (Severe) | Many deep implants, large cysts, dense adhesions |
Stage does not always correlate with symptom severity — some women with Stage I have severe pain, while others with Stage IV have few symptoms.
Treatment Options
There is currently no cure for endometriosis, but effective treatment can control symptoms and improve quality of life.
Medical Management
- NSAIDs (e.g., ibuprofen) for pain relief during periods
- Combined oral contraceptive pill — suppresses the cycle and reduces lesion activity
- Progestins — thin the endometrial lining and reduce pain
- GnRH analogues — induce a temporary menopause-like state to shrink lesions
Surgical Management
Laparoscopic surgery is the treatment of choice for moderate-to-severe endometriosis. I perform:
- Excision of endometrial implants (preferred over ablation — removes tissue rather than burning the surface)
- Cystectomy — removal of ovarian endometriomas (chocolate cysts)
- Adhesiolysis — freeing pelvic organs stuck together by scar tissue
Surgery significantly reduces pain and improves fertility outcomes in most women.
Fertility Considerations
Women with endometriosis who wish to conceive should not delay. Options include:
- Laparoscopic surgery to improve the pelvic environment
- Ovulation induction with IUI (intrauterine insemination)
- IVF — particularly effective for Stage III–IV endometriosis
Living with Endometriosis
Endometriosis is a chronic condition that requires long-term management. Regular follow-up, a healthy anti-inflammatory diet, stress reduction, and open communication with your specialist are key to maintaining quality of life.
You deserve to be heard. Severe period pain is not something you must simply endure.
If you experience any of the symptoms described above, please do not wait. Early intervention leads to better outcomes — both for pain and for fertility.
Contact: 984-3504431 | Hope Hospital, Kathmandu