What Exactly is Endometriosis?

Period pain is so normalised in India that most women are told to push through it. A hot water bag, a painkiller, a day off if you are lucky. But for some women, the pain is not normal period pain. It is something far more relentless, far more disruptive, and far more deserving of a name. That name is endometriosis.

Around 190 million women worldwide have it, yet the average time between first experiencing symptoms and getting diagnosed is seven to ten years. Many women spend years being told their pain is in their heads, that they are exaggerating, or that it is just part of being a woman. It is none of those things.

What is Endometriosis?

Endometriosis is a chronic condition where tissue similar to your uterine lining, called the endometrium, grows outside the uterus. This tissue can show up on your fallopian tubes, ovaries, the outer surface of your uterus, your bowel, your bladder, and sometimes even organs further away.

Every month, when your hormones shift during your cycle, this misplaced tissue behaves exactly like the lining inside your uterus. It thickens, breaks down, and tries to bleed. But unlike menstrual blood, this blood cannot go anywhere. It gets trapped, causing inflammation, scarring, and adhesions, bands of fibrous tissue that glue organs together.

Over time, this leads to pain, structural damage, and often fertility problems that blindside women who had no idea this was happening inside them.

Endometriosis Symptoms: What Does it Actually Feel Like?

Endometriosis symptoms vary massively from woman to woman. Some women have widespread endometriosis and barely any symptoms. Others have small patches of tissue and pain that derail their entire life. The condition does not always announce itself loudly, which is part of why it goes undiagnosed for so long, and why so many women end up doubting themselves before anyone believes them. The most common symptoms are:

Painful Periods: Pain that starts before your period, continues through it, and does not respond to standard painkillers is one of the hallmark endometriosis symptoms. This is not ordinary cramping. It is the kind of pain that has you curled up on the bathroom floor, missing work, cancelling plans, and quietly wondering if this is just what your life will look like every month.
Chronic Pelvic Pain: Many women with endometriosis have pain throughout the month, not just during periods. It can be a dull, constant ache or sharp and sudden. It tends to get worse over time if left untreated.
Pain During or After Sex: Deep pain during intercourse, especially in certain positions, is common and often goes unspoken. It happens because endometrial deposits can form behind the uterus and around the vaginal walls. Many women stay silent about this for years, not realising it is a medical symptom worth mentioning.
Painful Bowel Movements or Urination: Around your period, bowel and bladder symptoms such as pain, urgency, and bloating are common. Endometrial tissue can attach to your bowel or bladder, making what should be normal bodily functions genuinely painful.
Heavy Menstrual Bleeding: Extremely heavy flow during periods with large clots could indicate endometriosis.
Infertility: Endometriosis affects about 30-50% of women who struggle to conceive. The scars and adhesions can damage the fallopian tubes and ovaries, affecting fertilisation.
Fatigue: A high level of exhaustion that exceeds the normal tiredness and does not get better with sleep. This is more frequent around the time of menstruation.

Causes of Endometriosis: Why Does It Happen?

Despite years of research, the exact causes of endometriosis remain unknown. The most widely researched theory is retrograde menstruation, in which menstrual blood flows back into the pelvic cavity rather than leaving the body. This blood may contain endometrial cells, which can attach to surrounding tissues. But while retrograde menstruation is common, not all women who have it develop endometriosis, which suggests immune system differences play a big role in who gets affected. Other contributing factors are:

Genetics: Women with a close female relative, especially a mother or sister, who has endometriosis are much more likely to develop it. If your mother suffered through painful periods that were never properly investigated, her experience and yours may be more connected than anyone told you.
Immune System Dysfunction: In women with endometriosis, the immune system may not be able to spot and destroy misplaced endometrial tissue. This allows the tissue to survive and grow where it shouldn't.
Hormonal Factors: Endometriosis is an estrogen-dependent condition. Higher estrogen levels seem to encourage the growth of endometrial deposits. This is why symptoms often ease during pregnancy and after menopause.
Environmental Factors: Exposure to certain chemicals, like dioxins found in some pesticides and industrial pollutants, has been linked to endometriosis in some research, though this connection is still being studied.

Stages of Endometriosis

There are four stages in endometriosis:

Stage 1: This is the first stage of endometriosis and indicates small, superficial implants that have little or no scar tissue.

Stage 2: The second stage in endometriosis is when there are more implants than in Stage 1, with some scar tissue too.

Stage 3: This stage is identified as a moderate stage where small cysts are seen on either one or both ovaries, and the adhesions are prominent.

Stage 4: Noted as a severe stage, this is the stage of deep implants, large cysts on the ovaries and dense adhesions from multiple organs. Fertility issues arise when women enter this stage.

Endometriosis Diagnosis

The reason why many women silently suffer from endometriosis is that the diagnosis is not a simple blood test or an ultrasound.

The initial diagnosis is done by your gynaecologist, who may perform a pelvic examination to confirm tenderness or nodules.
A transvaginal ultrasound can confirm ovarian cysts and any deep infiltration, but it can miss superficial deposits.
A laparoscopy, where a camera is sent into a small incision in the abdomen to look at the pelvic organs.
An MRI can confirm the extent of the disease. This is mostly done before surgery.

Conclusion

Endometriosis is not a rare condition. It is a common one that is simply under-recognised, under-investigated, and for too long, under-believed. If your periods have been taking more from you than they should, if pain has become a constant presence in your daily life, or if you have spent years being told everything is normal when it does not feel normal, that experience deserves to be taken seriously.

You are not being dramatic. You are not imagining it. And you deserve answers. A diagnosis changes nothing about what you have already been through, but it changes everything about what comes next.

Book an online appointment with Dr. G Rohini Kanniga for Fertility related issues.

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Frequently Asked Questions

What is endometriosis and how does it affect the body?

Endometriosis is a chronic condition where tissue similar to your uterine lining grows outside the uterus, on organs like the ovaries, fallopian tubes, bowel, and bladder. Each month, this tissue responds to hormonal changes, thickens, and bleeds, and it cannot go anywhere.

What are the common symptoms of endometriosis?

The most common endometriosis symptoms are awful period pain that does not respond to standard painkillers, chronic pelvic pain throughout the month, pain during sex, painful bowel movements or urination around menstruation, unusually heavy periods, persistent tiredness, and trouble conceiving. Symptoms vary widely between women, and some with widespread disease have relatively mild symptoms, which is a key reason why diagnosis gets delayed so often.

What causes endometriosis in women?

The exact causes of endometriosis are not fully known. The leading theory is retrograde menstruation, in which menstrual blood flows back into the pelvic cavity rather than leaving the body. Genetics, immune system dysfunction, hormonal factors, and possibly environmental exposures are also thought to play a role.

How is endometriosis diagnosed?

Diagnosis starts with a detailed symptom history, pelvic exam, and imaging, such as a transvaginal ultrasound or MRI. However, the only definitive confirmation comes through laparoscopy, a minimally invasive surgery where a camera is used to directly view the pelvic organs.