40% of Endometriosis cases show no symptoms and are diagnosed via routine imaging
Hyderabad: Endometriosis, a debilitating condition affecting one in 10 women worldwide, continues to be widely misunderstood and often dismissed disease. Despite impacting over 4.2 crore women in India alone, awareness remains alarmingly low, leading to delayed diagnoses and prolonged suffering.
Ahead of the Endometriosis Awareness Month in March, medical experts emphasise the importance of recognising symptoms early to prevent severe complications, such as infertility and kidney failure.
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, affecting not just the ovaries but also the rectum, ureters, bowels, bladder, and even the lungs and diaphragm in severe cases. "The disease can be silent, with nearly 40 per cent of patients showing no symptoms and only being diagnosed through routine imaging," said Dr Vimee Bindra, an endometriosis specialist.
Among the most common symptoms are painful periods, chronic pelvic pain, infertility, painful bowel movements, painful urination, recurrent urinary tract infections (UTIs), nausea, vomiting, and severe fatigue. Unfortunately, menstrual pain is often dismissed as normal, with many women advised that marriage or childbirth will resolve their discomfort. "If period pain interferes with your daily life and does not subside with over-the-counter medication, it is not normal and requires medical attention," Dr Bindra emphasised.
Early diagnosis is crucial in preventing organ damage, but many patients struggle for years before receiving proper medical attention. Diagnosis begins with symptom evaluation, followed by a pelvic examination and imaging techniques such as transvaginal ultrasound or MRI. However, imaging alone may not always detect the disease, especially if interpreted by non-specialists. "Many women are declared healthy due to normal ultrasound or MRI reports, even when they have endometriosis. Proper training for doctors is essential," said Dr Bindra.
The treatment approach varies depending on the severity of symptoms. While some patients can manage with medication, others require surgery. Laparoscopic or robotic surgery is preferred over open surgery, as it allows for better visibility and precision. "If endometriosis is deeply infiltrating organs like the bladder or rectum, a multidisciplinary team involving gynaecologists, colorectal surgeons, and urologists is essential," said Dr Bindra. However, incomplete or poorly executed surgeries can lead to residual disease, which is often mistaken for recurrence.
Beyond physical suffering, endometriosis significantly impacts personal and professional lives. Many women experience painful intercourse, leading to marital issues, while the chronic pain and fatigue contribute to anxiety and depression. "Endometriosis is not just a reproductive disease; it affects every aspect of a woman's life," Dr Bindra remarked.
Financially, treatment remains a major hurdle. Complex surgeries can be costly, particularly when multiple specialists are involved. Additionally, many insurance companies do not cover endometriosis-related surgeries, often classifying them as infertility treatments. "We are fighting to ensure insurance companies recognise endometriosis as a serious condition requiring coverage," said the founder of Endometriosis Foundation of India.
Stronger government initiatives are necessary to bridge the knowledge gap and improve patient care. Teaching teenagers, both boys and girls, about painful periods and abnormal symptoms to promote early awareness can be one of the interventions at the school level.
Moreover, ensuring that endometriosis surgeries are covered under health insurance policies without long waiting periods is crucial to make treatment accessible to women. Third, updating curricula in medical colleges to emphasise the latest diagnostic and treatment approaches for endometriosis is required at this level of prevalence.
"Make it a separate super specialty in colleges that students can opt for in their post-graduate years," Dr Bindra suggested.
To further raise awareness, the Endometriosis Foundation of India is organising the Yellow Ribbon Run on March 2, at Jalavihar, Hyderabad. "Like the pink ribbon symbolises breast cancer awareness, the yellow ribbon represents endometriosis. We need to start talking about menstrual health and stop dismissing women’s pain," she said.
