Endometriosis: The invisible pain swept under the rug

"Ever since I first got my period at age 12, I’ve experienced intense pain on both sides of my abdomen. It was so severe I thought it was kidney colic. I kept taking painkillers to numb it. Every time I complained, I was told, 'All girls go through this, you’re not the only one.'"

That’s how Amal(*), 33, recounts her long struggle with menstrual pain. What she didn’t know at the time was that this pain was a symptom of endometriosis—a condition in which tissue similar to the uterine lining grows outside the uterus, often on the ovaries or fallopian tubes.

Hormonal changes during the menstrual cycle affect this misplaced tissue, causing inflammation and pain. Because endometriosis is linked to reproductive years, it often goes undiagnosed or is dismissed as normal period pain.

However, are there symptoms that signal endometriosis?

Research shows that around 25% of endometriosis cases exhibit no symptoms. But the absence of symptoms does not correlate with the severity of the condition.

When symptoms do appear, they can significantly affect a person's ability to function day to day.

“In my second year of college, I missed a final exam because of my period. The pain on the first day is so intense, I have to stay in bed—and again, everyone told me it was normal and would go away once I got married,” Amal said.

Symptoms of endometriosis

Pelvic or lower abdominal pain is one of the most common symptoms. Pain may occur during or after menstruation. Some experience painful urination, constipation, or nausea.

Heavy menstrual bleeding is another possible symptom. You may need to change pads or tampons frequently or bleed through your clothes.

For some women, endometriosis has a profound impact on daily life and may lead to depression.

Risk factors

Several factors can increase the likelihood of developing endometriosis, including:

• Early onset of menstruation
• Late onset of menopause (typically around age 52, but anywhere between 40 and 55 is considered normal)
• Short menstrual cycles (less than 27 days)
• Heavy periods lasting more than seven days
• Family history or genetic predisposition
• Medical conditions that prevent menstrual blood from leaving the body
• Reproductive tract disorders

"I kept going to doctors, but they always downplayed it," Amal recalled. "They said I was exaggerating or being dramatic. It took years to get a proper diagnosis," she continued.

Endometriosis is one of the leading causes of infertility in women. Despite its prevalence, diagnosis can take time because its symptoms often overlap with other gynecological conditions.

It can also affect teenagers and sexually inactive women, challenging the misconception that it only affects married women and can lead to painful, disruptive symptoms that impact their emotional and social well-being.

Globally, about 10% of women of reproductive age—more than 176 million—are affected by endometriosis, making it a major women’s health issue.

Chronic complications

Complications from endometriosis can include internal scarring, severe adhesions affecting the bowel and urinary tract, ovarian cysts, and recurring abscesses. Furthermore, infertility may be linked to fallopian tube damage.

In some cases, the condition may cause intestinal blockage or raise the risk of ovarian cancer. Even when fertility isn’t a concern, managing chronic pain is often an ongoing struggle.

"I spent years not knowing I had endometriosis, until one doctor suggested we try a laparoscopy—everything changed after that," Amal recalled.

Laparoscopy remains the only reliable way to diagnose endometriosis. This minimally invasive surgery allows doctors to view the abdominal cavity and collect tissue samples for confirmation.

Treatment options

Once diagnosed, patients often have to try different treatments to find what works best.

"After I was diagnosed, I received hormone injections for a year. Then I switched to pills that stop menstruation, which caused the endometrial tissue to shrink," Amal explained.

While there is currently no cure, surgery remains the most definitive treatment to remove excess tissue. Before recommending surgery, doctors usually suggest trying non-invasive options like:

• Birth control pills
• Hormonal IUDs
• Gonadotropin-releasing hormone (Gn-RH) therapy
• Pain relievers such as NSAIDs or acetaminophen (Tylenol)
• Fertility treatments if pregnancy is desired

"When my family found out I wasn’t faking it, they were shocked. My mother cried," Amal said.

It’s crucial to take women's pain seriously. Unfortunately, it’s often dismissed—by both families and medical professionals, leading to delays in diagnosis and treatment that can sometimes result in life-threatening complications.

Today, Amal’s condition has significantly improved thanks to proper treatment. "Thank God, I’m so much better now. The pain is almost gone, and my period isn’t the worst time of the month anymore."

---

(*)Name has been changed at the source’s request.

(**)A version of this article first appeared in Arabic on 23 May, 2022.