The 5 things to know before you read on
- Endometriosis affects about 1 in 10 women of reproductive age — roughly 190 million worldwide — yet the average woman waits 4 to 12 years for a diagnosis.
- Period pain that stops you functioning is not normal. Pain that worsens year on year, resists painkillers, or comes with pain during sex or bowel movements is the classic endometriosis pattern.
- You no longer need surgery to be diagnosed. Current ESHRE and ACOG guidance supports diagnosing and treating endometriosis on symptoms and imaging alone.
- A normal ultrasound does not rule it out. Superficial disease is frequently invisible on every scan, which is why so many women are wrongly reassured.
- There is no cure, but there is good control. Hormonal treatment, and surgery when needed, return most women to a normal life.
"I've had this pain since I was fifteen. Three doctors told me it was just how my body is."
I hear a version of that sentence almost every week in my Gurugram clinic, and it still makes me angry. Because by the time a woman says it to me, she has usually lost years — to missed exams, missed work, cancelled plans, and a slow, corrosive sense that she is somehow weaker than everyone else who "just deals with" their period.
She is not weaker. She has, very often, been carrying an undiagnosed disease.
Endometriosis affects around 10% of women of reproductive age worldwide, roughly 190 million women, according to the World Health Organization. And yet the WHO also notes that the average time to diagnosis runs between four and twelve years. There are very few conditions this common that we are this slow to name.
This guide explains what endometriosis actually is, how to tell whether your pain warrants investigation, and — importantly — how much has changed recently in how it is diagnosed and treated.
Should you get this checked?
This will not tell you whether you have endometriosis — no questionnaire can, and anyone who claims otherwise is selling something. What it will tell you is whether your symptoms are the ones doctors are supposed to take seriously, and give you something concrete to bring to an appointment.
Section 1 is taken from the NICE guideline (NG73), which advises clinicians to suspect endometriosis when a woman — including girls aged 17 and under — reports one or more of these.
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What is endometriosis, exactly?
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus — most often on the ovaries, the fallopian tubes, the outer surface of the uterus, the ligaments that hold it in place, the bowel, or the lining of the pelvis.
Here is the part that explains the pain. That misplaced tissue still responds to your monthly hormones. It thickens and bleeds with every cycle, exactly as the lining inside your uterus does. But unlike a period, that blood has nowhere to go. It sits in the pelvis, causing inflammation, irritation and, over time, scar tissue and adhesions that can bind organs to one another.
That distinction matters, because it explains why the pain often is not confined to your period at all, and why it tends to get worse rather than better if nothing is done.
Is your period pain normal, or is it endometriosis?
Some cramping in the first day or two of a period is normal and expected. What is not normal is pain that controls your life. In clinic, these are the patterns that make me think seriously about endometriosis.
Does the pain stop you functioning?
Not "is it uncomfortable" — does it stop you? Missing school, college or work every month, lying down with a hot water bottle unable to do anything else, vomiting or fainting from the pain, or finding that standard painkillers barely touch it.
A useful test I ask patients: if a male colleague described this level of monthly pain, would anyone tell him it was normal?
Has it been getting worse over the years?
Endometriosis is usually progressive. Women often describe periods that were manageable in their teens and have steadily worsened through their twenties, or pain that used to last a day and now begins several days before bleeding starts.
Ordinary period pain does not usually follow that escalating trajectory.
Is there pain outside your period?
This is one of the most telling signs, and the one most often missed. Look for:
- Pain during or after sex (deep pain, not at the entrance) — medically called deep dyspareunia.
- Pain when opening your bowels or passing urine, particularly around your period.
- Chronic pelvic pain — pain that does not go away when the period ends.
- Lower back or leg pain that follows a cyclical pattern.
Many women never mention pain during sex to a doctor, because nobody has ever asked and it feels too private to volunteer. Please mention it. It is clinical information, and it changes what I look for.
Are there other symptoms travelling with it?
Endometriosis frequently comes with heavy bleeding, significant bloating (often called "endo belly"), nausea, fatigue that is out of proportion to your sleep, and bowel symptoms that get misdiagnosed as irritable bowel syndrome for years.
Difficulty conceiving is also a common way endometriosis first comes to light.
If several of those describe you, the next step is not another painkiller. It is a proper evaluation.
Why does endometriosis take so long to diagnose?
Four to twelve years, per the WHO. In the UK, Endometriosis UK puts the typical wait at eight to ten years. There is no single villain here — it is a series of small failures that compound.
Girls are taught that periods hurt. So severe pain gets filed under "unlucky" rather than "unwell", often by the woman herself, for years before she ever mentions it.
Bowel symptoms get labelled IBS. Bladder symptoms get labelled recurrent UTI. Pain gets labelled stress. Each label closes the file a little further.
Superficial peritoneal endometriosis is often invisible on ultrasound and MRI. A normal scan is regularly — and wrongly — treated as proof that nothing is there.
For decades, confirmation meant a laparoscopy. That surgical threshold delayed a great many diagnoses, and it is precisely what recent guidelines have moved away from.
The updated NICE guidance in the UK made a related point that I think about often: women are frequently not even told that endometriosis is suspected, and have the pathway of care left unexplained to them. Being kept in the dark is its own kind of delay.
How is endometriosis diagnosed now? Do you need surgery?
No — and this is the single most important change in endometriosis care in years. You can now be diagnosed and treated on the basis of your symptoms, examination and imaging, without waiting for a diagnostic laparoscopy.
The 2022 ESHRE guideline moved away from laparoscopy as the mandatory gold standard, recommending imaging and supporting clinical diagnosis from characteristic symptoms. In March 2026, ACOG published guidance in the same direction, explicitly enabling clinicians to treat endometriosis on a clinical diagnosis rather than requiring surgical confirmation first — with the stated aim of shortening the time women wait for treatment.
In practice, an assessment with me usually involves:
Please hold on to this: a normal scan does not rule out endometriosis. Guidelines say so explicitly. If your scan was clear but your symptoms fit the pattern, that is a reason to keep investigating, not to be sent home.
What treatments actually work for endometriosis?
Treatment aims at three things: controlling pain, protecting fertility where that matters to you, and slowing progression. What is right for you depends heavily on your symptoms, your age and whether you are trying to conceive now.
Hormonal treatment: the first line
ESHRE gives strong recommendations to all of the following for endometriosis-associated pain:
- Combined hormonal contraceptives — the pill, vaginal ring or patch. Often used continuously to suppress periods altogether.
- Progestogens — including dienogest, widely used for endometriosis.
- The hormonal IUD (levonorgestrel intrauterine system) or the etonogestrel implant — particularly useful where heavy bleeding travels with the pain.
I want to address something directly here, because it comes up constantly. Being offered the pill for endometriosis is not being fobbed off. Hormonal suppression is real, guideline-backed treatment that works by switching off the cycling that drives the disease. Being offered it without anyone explaining why is the actual problem — and that is a communication failure, not a treatment failure.
GnRH agonists and antagonists are a further option where first-line treatment has not worked, usually with add-back therapy to protect bone density.
Pain relief
NSAIDs such as mefenamic acid can help, though the evidence supporting them is weaker than for hormonal treatment. They work best as an adjunct rather than as the whole plan — which is precisely how they are usually misused, as a decade-long substitute for a diagnosis.
Support that is not a prescription
Pelvic floor physiotherapy, heat, exercise as tolerated, and psychological support all have a genuine place, particularly in long-standing pain where the nervous system itself has become sensitised. The WHO lists physiotherapy and cognitive behavioural therapy among management options. None of this is a substitute for treating the disease, but dismissing it is a mistake too.
When is laparoscopic surgery the right step?
Surgery is a recommended option for reducing endometriosis pain, and it becomes the right step when pain persists despite medical treatment, when there is a significant ovarian endometrioma, when deep disease is affecting the bowel or bladder, or in some situations where fertility is the priority.
Two details are worth knowing before you consent to anything:
- Excision is generally preferred to ablation. Cutting the disease out, rather than burning the surface, is what ESHRE suggests where surgery is being done.
- For an ovarian endometrioma, cystectomy beats drainage. Removing the cyst wall rather than simply draining and coagulating it reduces both recurrence and pain — a strong recommendation.
Deep endometriosis involving bowel or bladder should be managed in a centre with genuine expertise in it, not as an incidental finding dealt with mid-operation. If that is what your scan suggests, ask directly about who will be in the theatre.
Our laparoscopic (keyhole) surgery page explains what the operation itself involves, and the gynae surgery in Gurugram hub covers the full range of procedures.
A hysterectomy does not cure endometriosis
This is one of the most damaging myths in gynaecology, and women are still being told otherwise. Endometriosis lives outside the uterus, so removing the uterus does not remove the disease.
Guidelines state plainly that hysterectomy will not necessarily cure the symptoms. It can be considered for women who have completed their family and have exhausted other options — and any endometriosis present must still be removed at the same operation. If a hysterectomy has been recommended to you for endometriosis, that is a very reasonable moment to seek a second opinion.
Does endometriosis affect your chances of getting pregnant?
It can, but a diagnosis is not a verdict. Plenty of women with endometriosis conceive naturally and without difficulty. Endometriosis is associated with reduced fertility, particularly where it distorts pelvic anatomy or involves the ovaries, but the relationship is far from absolute.
What matters most is that you tell your gynaecologist early if you are trying to conceive, because it changes the plan considerably:
- Hormonal suppression should not be used to improve fertility. ESHRE is emphatic on this — ovarian suppression does not improve pregnancy rates, and prescribing it for that purpose simply costs you time.
- Surgery may help in early-stage disease. Operative laparoscopy can be offered in stage I/II endometriosis to improve ongoing pregnancy rates.
- Assisted reproduction has a clear role, particularly where tubal function is affected, there is a male factor, or other treatment has not worked.
There is also a point here that surprises people: endometriosis can be entirely silent. In an Indian study of 502 infertile women who underwent diagnostic laparoscopy, endometriosis was found in around 55%, and more than half of those women had no symptoms at all. That is a highly selected group — women already being investigated for infertility, not the general population — but it is a useful reminder that pain and disease do not track together neatly.
If you are planning a pregnancy, our preconception care page covers what is worth doing before you start trying.
Endometriosis or adenomyosis: what is the difference?
These two get confused constantly, including in clinic, and they can occur together. The simplest way to hold the distinction:
Lining-like tissue grows outside the uterus — ovaries, pelvis, bowel. Classic picture: severe period pain, pain with sex, chronic pelvic pain, sometimes difficulty conceiving.
Lining tissue grows into the muscle wall of the uterus itself. Classic picture: heavy bleeding with severe cramping, often in women in their late thirties and forties, with a bulky tender uterus.
The treatment overlaps considerably, but the surgical decisions differ, which is why the distinction is worth making properly. If heavy bleeding is your dominant symptom rather than pain, our guides on when heavy or irregular periods need surgery and when fibroids need surgery may be the more useful read, and your menstrual cycle explained week by week covers what a normal cycle actually looks like.
Getting care for endometriosis in Gurugram
Our two clinics — Sector 51 (Mayfield Garden) and Sector 56 — serve patients across Gurugram, Golf Course Road, Golf Course Extension, Sohna Road, the DLF Phases, South Delhi and nearby NCR. Consultations run 7 days a week including Sundays.
For a first endometriosis consultation, it genuinely helps to come prepared. Bring a note of when the pain started, how it has changed, where exactly it sits, what you have already tried, and any previous scans. If you have tracked your cycle on an app, bring that too. The history is the diagnosis in this condition more than any single test.
Where surgery is needed, it is done laparoscopically at NABH-accredited hospitals in Gurugram.
Where to see us
Dr. Anam's Women Health Clinic
1st Floor, Block K, Mayfield Garden, Sector 51, Samaspur, Gurugram 122018
Phone: +91 84472 59265
Dr. Anam Ghani — Sector 56 Clinic
Plot No. 132, Opposite Devender Vihar, Sector 56, Gurugram 122011
Phone: +91 88823 93368
You can also book on WhatsApp here or through our contact form. For the wider range of gynaecological care, see our women's health and gynaecology hub.
The bottom line
If you have been managing pain like this for years, I want to say two things plainly.
The first: you were not imagining it, and you were not being dramatic. The delay in diagnosing endometriosis is a documented, worldwide failure of medicine, not a failure of yours.
The second: you do not need to prove anything to be taken seriously now. You no longer need surgery to get a diagnosis, or a decade of history to justify an appointment. What you need is one consultation where somebody asks the right questions and actually listens to the answers.
There is no cure for endometriosis. But there is control, and there is relief, and for most women there is a return to a normal life. That is a very different thing from being told to live with it.
Dr. Anam Ghani, MBBS, MS (OBGY)
Obstetrician & Gynaecologist in Gurugram with 12+ years of clinical experience and 8000+ deliveries. Trained at Lady Hardinge Medical College with senior residencies at GTB, Kasturba and DDU Hospitals. Practises at Sector 51 (Mayfield Garden) and Sector 56, Gurugram, with a special focus on high-risk pregnancy, laparoscopic gynae surgery, endometriosis, fibroids, adenomyosis and PCOS management.
To book a consultation, contact us here, WhatsApp +91 84472 59265, or call either clinic directly.
This article is for educational purposes only and does not replace a personal consultation with a qualified doctor. Every woman's situation is different. Please book an appointment for individualised advice, evaluation and treatment planning.