Severe menstrual pain is often dismissed as normal. But persistent pain that disrupts daily life or occurs with other symptoms may signal endometriosis, a chronic condition affecting an estimated 10 per cent of women of reproductive age. The World Health Organization (WHO) estimates that about 190 million women worldwide live with endometriosis. It occurs when tissue resembling the uterine lining grows outside the uterus, causing inflammation and sometimes scar tissue. The condition most often affects the pelvis but can also occur in the abdomen and chest. It may develop from a person’s first period through menopause.

Symptoms vary widely. WHO lists severe menstrual pain, heavy bleeding, chronic pelvic pain, infertility, bloating and nausea among the possible symptoms. Pain may also occur during sex, bowel movements or urination. Some people have severe symptoms; others have few or none. This makes diagnosis difficult based on symptoms alone. WHO estimates that diagnosis can take four to 12 years, particularly where specialist care is limited. Attitudes that minimise menstrual pain can add to the delay. Not all painful periods are caused by endometriosis, but recurring pain that interferes with work, education, relationships or daily activities should be assessed. Warning signs include unusually heavy bleeding, pelvic pain that continues after menstruation, pain during sex, and recurring pain during bowel movements or urination.Tracking symptoms and their timing can help during a medical consultation.

There is no single test for every case. Doctors may review a patient’s medical and menstrual history and use imaging such as ultrasound or magnetic resonance imaging (MRI). WHO says symptoms and imaging can sometimes support a clinical diagnosis, so surgery is not always needed before treatment begins. In some cases, laparoscopic surgery may be used to examine affected tissue or obtain samples. A normal initial assessment does not necessarily explain persistent symptoms.

Endometriosis has no definitive cure. Treatment focuses on controlling symptoms, improving quality of life and addressing fertility needs. Doctors may recommend painkillers or hormonal treatments, including combined contraceptives, progestins and other hormone-based medicines. Surgery may be considered to remove lesions, adhesions or scar tissue. The decision depends on symptoms, previous treatment, side effects, cost, availability and pregnancy plans. Treatment should therefore be individualised. WHO estimates that 25 to 50 per cent of women experiencing infertility may have endometriosis. A diagnosis does not mean pregnancy is impossible. Treatment choices may differ for someone trying to conceive and someone focused primarily on pain control. Fertility treatment, including assisted reproductive techniques, may be considered where appropriate.

Endometriosis can affect far more than menstrual health. WHO says pain, heavy bleeding, fatigue, infertility, anxiety and depression can reduce quality of life. Severe symptoms may prevent people from attending work or school and can lead to lost income. Repeated consultations, imaging, medicines and specialist care can also create financial strain, especially in low- and middle-income countries where access to specialised services is limited.

There is no known way to prevent endometriosis, and no single cause has been established. WHO says greater awareness, earlier diagnosis and appropriate treatment can reduce its impact. Not every painful period indicates endometriosis. But persistent or severe symptoms deserve medical assessment. Anyone whose menstrual pain repeatedly disrupts daily life, or who experiences chronic pelvic pain, heavy bleeding, painful sex or recurring bowel or urinary symptoms, should consult a healthcare professional. Recognising that severe, persistent menstrual pain should not automatically be ignored is an important step towards earlier diagnosis and better care.