Painful Periods: Normal Discomfort or a Sign of Disease? How to Recognize Endometriosis

Pain that women have grown used to over the years may be a sign of a serious disease.

Many women regard painful periods as a natural part of life. Severe cramps, constant discomfort, the need to take painkillers, and even missing work or classes are often considered normal. But should menstruation really be accompanied by such intense pain?

According to the World Health Organization (WHO), around 190 million women worldwide have endometriosis — approximately 10% of women of reproductive age. Despite its prevalence, the condition often remains undiagnosed for many years.

Endometriosis can significantly reduce quality of life, cause chronic pelvic pain, and affect reproductive health. Its symptoms may resemble those of other gynecological conditions, making timely diagnosis difficult.

How can you tell when menstrual pain is no longer normal? Which symptoms should not be ignored? Is it possible to detect endometriosis at an early stage and preserve reproductive health?

We asked Rozikul Anarkulovich Fozilbekov — Head of the Gynecology Department, a surgeon with 26 years of professional experience — to answer these and other important questions.

1. Rozikul Anarkulovich, many women have grown accustomed to enduring painful periods since adolescence. Where is the line between ordinary menstrual discomfort and pain that may indicate a serious illness?

Pain that makes you cancel your plans is not normal. Mild discomfort on the first or second day of the cycle is acceptable. But if an ordinary pill does not help, you have to miss work or classes, and things only get worse over the years, that is a warning sign, not a “feature of your body.”

2. What is endometriosis, why does it develop, and what happens in a woman’s body when she has this condition?

Imagine that the tissue lining the inside of the uterus has “moved” to the ovaries, peritoneum, or bowel. And every month it bleeds where it should not. Inflammation develops around it, followed by adhesions and scars — hence the pain. There is no single cause: heredity, immunity, and hormones all play a role. About one in ten women has the disease.

3. Which early signs of endometriosis are most often overlooked? Can the condition develop without noticeable symptoms?

The most insidious symptom is the one you have grown used to. This includes pain during periods and intimacy, bloating and painful bowel movements on menstrual days, spotting, and constant fatigue. Sometimes the disease remains silent for years and is discovered only when a woman cannot get pregnant.

4. Why do some women live with endometriosis for years without knowing they have it? What usually delays diagnosis?

On average, the road to a diagnosis takes 7–10 years. Women are told, “Put up with it; everyone has pain.” The symptoms masquerade as cystitis, bowel problems, or back pain. And an ordinary ultrasound done “just to tick a box” may miss small lesions.

5. Can endometriosis affect young girls, including teenagers? When should parents be concerned about their daughter’s painful periods?

Yes, and more often than people think. Mothers, take notice if your daughter misses school because of her periods, takes painkillers by the handful, complains of nausea, or faints on those days. The advice “Have a baby and it will go away” does not work here.

6. Apart from painful periods, what other symptoms may indicate endometriosis? Can pain occur between periods or spread to the lower back, bowel, or other areas?

It can. Pain may occur in the middle of the cycle, in the lower back and sacrum, and radiate down a leg. If the bowel is affected, going to the toilet is painful; if the bladder is affected, urination is frequent and painful. Add heavy periods, anemia, and chronic fatigue, and the picture becomes clear.

7. Is it true that endometriosis can cause infertility? How can it affect natural conception and pregnancy?

It is not a sentence, but it is a serious risk: endometriosis is found in 30–50% of women who cannot become pregnant. It causes adhesions in the fallopian tubes, reduces the egg reserve, and interferes with conception. The good news is that many patients become pregnant naturally or with IVF; such pregnancies simply need closer monitoring.

8. How is endometriosis diagnosed today? Is ultrasound enough, or are other tests needed to confirm the diagnosis?

Surgery just to make a diagnosis is no longer mandatory. Most often, a careful examination and expert transvaginal ultrasound are enough; if deep disease is suspected, an MRI is performed. Laparoscopy is needed when there is no clear answer or treatment is required.

9. Some women rely on painkillers every month to manage severe menstrual pain. What are the risks of suppressing symptoms without finding the underlying cause?

A pill switches off the alarm, but not the fire. While the pain is suppressed, the disease may spread, forming cysts and adhesions and affecting neighboring organs. Years of taking painkillers also take a toll on the stomach and kidneys. If you cannot get through a single cycle without a pill, look for the cause rather than increasing the dose.

10. What modern treatments are available for endometriosis? When is medication sufficient, and when might surgery be needed?

We start with hormonal therapy: it “puts the lesions to sleep” and completely relieves pain for many women. Surgery, usually laparoscopic, is needed for large cysts, involvement of the bowel or urinary tract, when pills do not work, and for infertility. Important: the surgeon must have experience specifically in endometriosis. The first operation is the most important.

11. Can endometriosis be cured completely, or does it require long-term management? Can it return after treatment?

I will be frank: this is a chronic disease. After surgery, without maintenance treatment, it returns in about one in five patients within five years. But it can be kept under control: you can live without pain, work, and have children. The main thing is regular follow-up.

12. Finally, what is your most important advice for women who have endured painful periods for years and keep postponing a gynecological appointment? Which symptoms mean they should seek medical advice?

Stop putting up with it. Pain is not a personality trait or “a woman’s lot”; it is a symptom. See a gynecologist if:

• painkillers do not help;

• your periods disrupt your life;

• intimacy or going to the toilet during your period is painful;

• your periods are very heavy;

• you have not become pregnant for more than a year (or more than six months if you are over 35).

Early diagnosis means simpler treatment and a better chance of preserving the possibility of becoming a mother.