By Dr. Sudeshna Saha Consultant – Gynaecology, RG Stone Urology & Laparoscopy Hospital, Kolkata
Kolkata, Aug 18: Painful periods are often dismissed as a part and parcel of being a woman, something to be managed with a painkiller and pushed through. Health experts, however, are flagging that severe, worsening, or disruptive period pain can be an early sign of endometriosis. It is a chronic gynaecological condition in which tissue similar to the uterine lining grows outside the uterus, causing inflammation, pain, and, in some women, fertility difficulties. A study estimated that 247 million women of reproductive age globally, of which 42 million in India, are affected by endometriosis. Despite this number, awareness remains significantly low in India.
Dr. Sudeshna Saha, Consultant – Gynaecology, said, “One of the biggest misconceptions is that period pain is something every woman simply has to tolerate. In reality, when pain is severe, recurs every cycle, or gradually worsens, it deserves proper evaluation. Early recognition can help women understand what is happening in their bodies and make informed decisions about treatment, fertility, and long-term health.”
Causes and Risk Factors
● Retrograde menstruation, where menstrual blood containing endometrial cells flows back into the pelvic cavity instead of leaving the body.
● Genetic predisposition, with higher risk in women who have a mother or sister with endometriosis.
● Hormonal factors, particularly prolonged exposure to estrogen.
● Immune system irregularities that may prevent the body from clearing misplaced endometrial tissue.
● Delayed childbearing and later age at first pregnancy, which extend lifetime menstrual cycles.
Why Routine Approach Often Misses It
● Painful periods are widely normalised, with many girls raised to believe cramps are simply part of menstruation and something to “adjust” to.
● Symptoms vary considerably between women, and the severity of pain does not always match the extent of disease.
● Standard check-ups and general physician visits rarely probe menstrual symptoms in detail unless a woman specifically raises concerns.
● Limited awareness and hesitation around discussing menstrual or pelvic symptoms, especially in India, further delays consultation.
● Many women only seek help once pain begins affecting health, work, education, or plans for pregnancy.
Who Should Consider Evaluation
● Women whose period pain is severe enough to interfere with work, college, exercise, or social activities.
● Those who need frequent pain medication to manage menstrual pain.
● Women whose pain has progressively worsened over time.
● Those experiencing pain during intercourse, bowel movements, or urination, particularly around menstruation.
● Women with heavy or irregular periods, persistent pelvic pain, or abdominal bloating.
● Women experiencing difficulty in conceiving.
Prevention and Care Tips
● Do not dismiss period pain that repeatedly disrupts daily life. Talk to your gynaecologist rather than managing it silently for years.
● Keep a menstrual symptom diary noting pain intensity and duration, bleeding pattern, bowel or urinary symptoms, and impact on daily activities.
● Seek a clinical examination and appropriate imaging if symptoms persist, rather than relying on painkillers alone.
● If planning a pregnancy and experiencing persistent symptoms, discuss reproductive goals with a gynaecologist early rather than delaying evaluation.
● Remember that many women with endometriosis do conceive naturally — fertility difficulty is possible but not inevitable, and should not be assumed.
● Understand that management is individualised and may include medication, hormonal treatment, pain management, or, in selected cases, surgery.
Endometriosis is often under-recognised but highly manageable when identified in time. Paying attention to persistent or worsening period pain, rather than normalising it, can help women get timely diagnosis, appropriate treatment, and better long-term reproductive and overall health outcomes.