Endometriosis — The Silent Condition Millions of Women Have Without Knowing | Dr. Chetna Jain, Gurgaon

She has had painful periods since she was a teenager. She has been told it is normal. She has been told all women go through it. She has been given painkillers, sent home, and told to manage. Years pass. The pain gets worse. She starts missing work, cancelling plans, dreading every month. Then one day — sometimes after a decade of suffering — she finally gets a diagnosis: endometriosis.

This story is heartbreakingly common. I am Dr. Chetna Jain, a gynaecologist in Gurgaon, and I want to talk about endometriosis today — openly, honestly, and with the urgency it deserves. Because this condition affects an estimated 1 in 10 women of reproductive age, and the average time from symptom onset to diagnosis in India is still several years too long.

What Is Endometriosis?

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus — the endometrium — grows outside the uterus, where it does not belong. This tissue commonly implants on the ovaries, fallopian tubes, the outer surface of the uterus, the bladder, and the bowel. Like the uterine lining, this misplaced tissue responds to monthly hormonal changes — it thickens, breaks down, and bleeds with every cycle. But unlike normal menstrual blood, this bleeding has nowhere to go. It becomes trapped, causing inflammation, scar tissue (adhesions), and the formation of cysts — particularly on the ovaries, where they are called endometriomas or chocolate cysts, named for their dark brown fluid content.

Over time, this chronic inflammation causes the structures of the pelvis to stick together, disrupts normal anatomy, and can cause significant — sometimes irreversible — damage to reproductive organs. And yet many women with endometriosis are walking around completely undiagnosed, their pain normalised by family, dismissed by doctors, or buried under the cultural expectation that periods are supposed to hurt.

The Symptoms — And Why They Are So Often Missed

The hallmark symptom of endometriosis is pain — but the type, location, and timing of that pain varies widely between women, which is one reason it is so frequently misdiagnosed or dismissed. Here is what to watch for:

• Severe period pain (dysmenorrhoea) that is significantly worse than "normal" cramps and does not respond well to over-the-counter painkillers

• Chronic pelvic pain that persists throughout the cycle — not just during menstruation

• Pain during or after sexual intercourse (dyspareunia) — particularly with deep penetration

• Painful bowel movements or urination during menstruation

• Heavy or irregular periods, or spotting between periods

• Bloating — sometimes called "endo belly" — significant abdominal swelling that often worsens during menstruation

• Fatigue — a deep, persistent exhaustion that is disproportionate to activity levels and worsens around menstruation

• Difficulty conceiving — endometriosis is found in approximately 30 to 50 percent of women who are struggling with infertility

Critically, the severity of symptoms does not always reflect the extent of disease. Some women with minimal endometriosis have debilitating pain; others with extensive disease have very few symptoms. This variability makes clinical assessment by an experienced gynaecologist absolutely essential.

How Is Endometriosis Diagnosed?

This is where I want to be very honest with you: endometriosis is notoriously difficult to diagnose, and delays are common. The gold standard for definitive diagnosis is laparoscopy — a minimally invasive surgical procedure in which a camera is inserted through a small incision in the abdomen to directly visualise and biopsy endometriotic lesions. However, laparoscopy is not always necessary as a first step.

At my clinic in Gurgaon, I begin with a detailed clinical history — paying close attention to the pattern, severity, and impact of your symptoms — followed by a pelvic examination and a transvaginal ultrasound. While ultrasound cannot detect all forms of endometriosis, it can identify endometriomas (chocolate cysts) and, in experienced hands, suggest deep infiltrating disease. An MRI may be recommended for a more detailed assessment before surgery. A blood marker called CA-125 is sometimes measured but is not specific enough to diagnose endometriosis on its own.

If you have been told your ultrasound is normal and therefore you cannot have endometriosis — please come for a second opinion. A normal ultrasound does not rule out endometriosis.

Treatment — There Is Help Available

Endometriosis has no cure, but it is very manageable — and the right treatment plan can dramatically improve quality of life, reduce pain, and protect fertility. Management is individualised based on symptom severity, the woman's age, her fertility goals, and the extent of disease.

• Pain management: NSAIDs such as ibuprofen or naproxen, taken correctly and consistently around menstruation, can significantly reduce endometriosis-related pain. These are most effective when started 1 to 2 days before the period begins.

• Hormonal therapy: Combined oral contraceptive pills, progesterone-only therapies, hormonal IUDs, and GnRH agonists all work by suppressing the hormonal cycle that drives endometriosis growth. They reduce pain effectively in most women and are a mainstay of medical management, particularly for those not trying to conceive.

• Laparoscopic surgery: For women with significant disease, failed medical management, or fertility concerns — surgical removal of endometriotic deposits and adhesions by an experienced laparoscopic surgeon offers meaningful pain relief and, in many cases, improved fertility outcomes. When endometriomas are present, careful surgical removal is important to preserve ovarian reserve.

• Fertility support: Women with endometriosis-related infertility are not without options. Depending on the extent of disease and ovarian reserve, I guide patients through options ranging from ovulation induction and IUI to IVF — and where appropriate, I discuss egg freezing as a fertility preservation measure.

Your Pain Is Real. And You Deserve Answers.

If there is one message I want every woman reading this to take away, it is this: painful periods that disrupt your life are not normal. You should not have to miss school, miss work, or cancel plans every single month. You should not have to simply endure. And you should never feel dismissed when you describe your pain to a doctor.

If you recognise yourself in these symptoms — whether you are 19 or 42 — please come in. My clinic in Gurgaon serves women from Palam Vihar, DLF, South City, Sector 22, Sector 23, and all of NCR. I will listen carefully, investigate thoroughly, and work with you on a plan that puts your wellbeing first.

You have waited long enough. Book your appointment today.

— Dr. Chetna Jain | Senior Gynaecologist & Obstetrician | Gurgaon, Haryana