If there is one phrase I wish we could retire from women’s health, it’s:
“Some women just have bad periods.”
Periods can be uncomfortable.
But being unable to stand upright from pain, vomiting every month, regularly missing school or work, or organizing your entire life around your menstrual cycle deserves more curiosity than that.
Endometriosis is one reason why.
The World Health Organization estimates that endometriosis affects approximately 10% of reproductive-age women and girls worldwide—around 190 million people. It is a chronic disease involving tissue similar to the uterine lining growing outside the uterus.
And yet the way we talk about it is still often reduced to:
“Really painful periods.”
That description barely scratches the surface.
Endometriosis isn't simply “the uterine lining growing outside the uterus”
This is an important scientific distinction.
Endometriosis involves tissue similar to the endometrium, the tissue lining the uterus. These lesions can occur elsewhere in the pelvis and sometimes beyond it.
The disease involves interactions between hormones, inflammation, immune processes, nerves, and surrounding tissues.
That complexity helps explain why two women with endometriosis may experience completely different symptoms.
One may have debilitating pain.
Another may have fertility difficulties but relatively mild pain.
Another may think she has gastrointestinal or bladder problems for years before anyone connects those symptoms to her menstrual cycle.
Severe menstrual pain is a major symptom—but severity matters
Painful periods are common.
Debilitating periods are different.
Endometriosis may cause severe menstrual pain that interferes with daily activities. WHO identifies severe menstrual pain as one of the disease’s common symptoms.
This distinction matters culturally.
Women are often taught that pain is simply the price of having a period.
So instead of asking whether someone has cramps, we should be asking:
What do those cramps prevent you from doing?
Are you missing school?
Calling out of work?
Unable to sleep?
Vomiting?
Unable to function without significant medication?
Quality of life matters.
Endometriosis pain doesn't have to stop when your period does
Another misconception is that endometriosis should only hurt during menstruation.
It can cause chronic pelvic pain outside the menstrual period as well.
Some women experience pain around ovulation. Others experience persistent aching, pelvic pressure, back pain, or intermittent sharp pain throughout the month.
This is important because women may dismiss pain occurring outside menstruation as unrelated.
The body doesn't always divide symptoms into neat textbook categories.
Painful bowel movements can be a clue
This symptom isn't talked about nearly enough.
Endometriosis can affect bowel movements and contribute to gastrointestinal symptoms. WHO specifically notes that the disease may affect bowel function and may cause bloating and nausea.
Some women experience severe pain while having a bowel movement, particularly around menstruation.
Others report constipation, diarrhea, bloating, or abdominal pain that becomes predictably worse during certain phases of their cycle.
Does every person with menstrual bloating have endometriosis?
Of course not.
But cyclical gastrointestinal symptoms deserve to be considered in the broader clinical picture.
Bladder symptoms can happen, too
The urinary tract can also be affected.
WHO includes painful urination among possible symptoms of endometriosis.
For someone like me, who has personally dealt with recurrent urinary symptoms, this overlap is particularly interesting.
Imagine repeatedly feeling urinary pain and automatically assuming you have another UTI.
Sometimes that's exactly what is happening.
But if symptoms repeatedly track with your menstrual cycle or cultures aren't explaining them, it may be worth broadening the conversation.
Bladder symptoms don't automatically mean endometriosis, but endometriosis belongs on the larger differential diagnosis for certain cyclical pelvic complaints.
Pain during sex deserves to be taken seriously
Painful sex is another symptom women are frequently taught to tolerate.
Maybe you're told you need more lubricant.
Maybe you're told you're tense.
Maybe you're told it's psychological.
Those things may sometimes contribute to discomfort, but persistent or deep pelvic pain during intercourse is a recognized endometriosis symptom.
Pain is information.
It doesn't automatically tell us the diagnosis, but it deserves investigation.
Fatigue is part of the story
Chronic pain is exhausting.
Poor sleep is exhausting.
Managing a chronic inflammatory disease is exhausting.
Fatigue is commonly reported by people living with endometriosis, and the disease can significantly affect quality of life, mental health, work, school, and relationships.
One challenge with fatigue is that it is nonspecific.
Almost anything can make someone tired.
But when fatigue exists alongside severe menstrual pain, pelvic symptoms, painful bowel movements, or fertility challenges, it adds another piece to the overall picture.
Endometriosis and fertility
Endometriosis can also contribute to infertility, although having endometriosis absolutely does not mean that you cannot become pregnant.
WHO identifies infertility as one of the major possible impacts of the disease.
Some women are actually diagnosed only after seeking fertility evaluation because their earlier symptoms were mild, ignored, or normalized.
This is another reason earlier awareness matters.
A woman shouldn’t have to wait until she is trying to conceive before someone takes years of pelvic symptoms seriously.
You can have significant disease without extreme symptoms
One of the most confusing aspects of endometriosis is that symptom burden does not always create a simple picture of disease extent.
Some people experience severe pain.
Others may have relatively few symptoms.
That makes relying on pain alone inadequate.
It also reinforces an important point:
You don't have to look sick enough or hurt enough to deserve investigation.
Why does diagnosis still take so long?
WHO currently reports that the average time to an endometriosis diagnosis can range from approximately 4 to 12 years.
Part of that delay reflects the complexity of the disease.
But I also think we have to acknowledge the culture surrounding women's pain.
If girls are taught from their very first period that severe pain is normal, why would they report it as a medical symptom?
If doctors are trained to hear “bad cramps” before hearing “chronic pelvic disease,” how quickly will the right questions get asked?
Better endometriosis care requires better tools.
But it also requires better conversations.
Do you need surgery to be diagnosed?
This is another area where the conversation is evolving.
Historically, laparoscopy has played a major role in definitively confirming endometriosis.
Today, clinicians may also use symptoms, physical examination, ultrasound, MRI, and other clinical information to evaluate suspected disease, depending on the circumstances.
WHO notes that early diagnosis remains challenging, and in 2026 the organization began developing a new evidence-based guideline specifically aimed at improving timely diagnosis and management of endometriosis.
The important takeaway is that women shouldn't automatically interpret a normal basic examination or imaging result as proof that their symptoms don't matter.
There still isn't a cure—and that matters
As of current WHO guidance, there is no cure for endometriosis. Treatment is aimed at managing symptoms and limiting the condition’s long-term impact.
Treatment may involve pain management, hormonal therapy, surgery, fertility treatment, pelvic-floor care, and other individualized strategies.
There is no universal treatment plan because there is no universal endometriosis patient.
That may sound frustrating, but it also reflects a broader shift in medicine toward individualized care.
New medical advancements give me hope
One part of endometriosis research that I find particularly exciting as a biomedical engineer is the push toward earlier and less invasive diagnosis.
Researchers are studying biomarkers, improved imaging technologies, and other diagnostic approaches that could eventually reduce the time women spend searching for answers.
WHO's decision to develop its first dedicated endometriosis guideline in 2026 is itself significant—it reflects growing recognition that timely diagnosis and standardized, evidence-based care need to improve globally.
We're not where we need to be yet.
But the fact that this disease is receiving greater research attention matters.
The questions I wish more women were asked
Instead of:
“Do you get cramps?”
Ask:
“Does your period pain interfere with your ability to live normally?”
Instead of:
“Do you have stomach issues?”
Ask:
“Do your bowel symptoms predictably change around your menstrual cycle?”
Instead of:
“Does sex hurt?”
Ask:
“Where does it hurt, how often, and does the pain change throughout your cycle?”
Those questions give clinicians—and women themselves—more useful information.
The bottom line
Endometriosis is not simply a painful period.
It is a chronic disease that can affect pelvic pain, menstruation, bowel and bladder symptoms, sexual health, fertility, fatigue, mental health, and overall quality of life.
Not every painful period is endometriosis.
Not every bowel symptom is endometriosis.
Not every urinary symptom is endometriosis.
But recurring symptoms that remove you from your life deserve more than:
“That's just part of being a woman.”
One of my biggest goals as a women's-health educator is to give women the language to better describe what they're experiencing.
Sometimes the beginning of getting answers is simply being able to walk into an appointment and say:
“This is affecting my quality of life, and I want to understand why.”
That is a conversation worth having.