Endometriosis is a word that many women are familiar with but only a few truly understand it, until it affects them personally. It is often brushed off as “just bad period pain,” however it can be a chronic, debilitating condition that not only affects a woman’s reproductive health but also her mental well-being, relationships, fertility, and quality of life.

Menstruation is still a taboo subject in India, where many women are trained to put up with their discomfort in silence. Long periods of pain and delayed diagnoses are caused by culturally embedded shame and ignorance. We need to normalise discussions about female reproductive issues, persistent pelvic pain, and period health.

What is Endometriosis?

Endometriosis is a condition where tissue that resembles the lining of the uterus grows outside of it. It can lead to excruciating pelvic pain and difficulty in conceiving. It can develop from the time of first menstruation until menopause.

Endometriosis causes endometrium, tissue similar to uterine lining to proliferate outside of the uterus. These tissues behave like uterine lining, thicken, break down, and bleed each month but since there’s nowhere for the blood to go, it causes inflammation, scar tissue, adhesions, and chronic pain.

Types of Endometriosis Lesions

Endometriosis can present in different forms based on where the tissue is found and how deeply it grows:

• Endometrioma: Also known as ovarian endometriosis, this type forms fluid-filled cysts on the ovaries. These are commonly referred to as “chocolate cysts” due to the thick, dark blood they contain. Endometriomas can cause pelvic pain and may affect fertility.
• Superficial Endometriosis: This form affects the outer layer of the pelvic organs, such as the uterus, ovaries, and the pelvic lining (peritoneum). It is called “superficial” because the tissue stays on the surface and doesn’t grow deep into the organs.
• Deep Infiltrating Endometriosis (DIE): In more severe or less common cases, endometrial-like tissue grows deep into pelvic organs. It can affect areas like the recto-vaginal septum (the space between the uterus and rectum), bladder, or intestines. This type often causes more intense symptoms and may require surgical treatment.

What are the symptoms?

There are some people with endometriosis who have no symptoms at all. For those who do, lower abdominal (pelvic) pain is a typical symptom. Pain might be most obvious:

• when having sex or right after
• during urinating or bowel movements.

Some individuals also encounter:

• persistent pelvic discomfort
• problems getting pregnant,
• bloating or nausea,
• exhaustion, depression, anxiety,
• excessive bleeding during or between periods
• After menopause, symptoms frequently get better but not always

What are the identifiable Red flags 🚩

Endometriosis often goes undiagnosed because its symptoms are normalized, especially menstrual pain. However, period pain that disrupts daily life is not normal. The earlier the condition is identified, the better the chances of managing it effectively and preserving fertility.

Here are some clinically recognized warning signs that should not be ignored:

• Severe Menstrual Pain Unresponsive to Medication

• Pain During or After Intercourse (Dyspareunia)

• Painful Bowel Movements or Urination—Especially During Periods

• Heavy or Irregular Menstrual Bleeding

• Difficulty Conceiving (Infertility)

• Chronic Pelvic or Lower Back Pain

• Family History of Endometriosis

• Frequent Bloating and Digestive Issues

Identifiable causes of Endometriosis

Some of the possible causes of endometriosis are as follows:

1. Retrograde Menstruation (Backflow of Menstrual Blood)

During a normal period, menstrual blood flows out of the uterus through the cervix and vagina. In retrograde menstruation, some of this blood flows backward through the fallopian tubes into the pelvic cavity. This blood may contain endometrial cells, which can stick to surfaces like the ovaries, bladder, or intestines. Once attached, these cells can grow and behave like the lining of the uterus—bleeding and shedding during each menstrual cycle.

2. Cellular Metaplasia (Change of Cell Type)

In some cases, cells outside the uterus may transform into endometrial-like cells through a process called metaplasia. This theory suggests that certain body tissues—especially those in the pelvis—can change their structure under specific conditions and begin to function like endometrial tissue, leading to the formation of endometriosis lesions.

3. Stem Cell Involvement and Immune Spread

Stem cells, which have the ability to turn into many different types of cells, may also play a role. These cells might migrate through blood or lymphatic vessels and implant in other parts of the body, forming endometrial-like tissue. This could explain why, in rare cases, endometriosis is found in distant organs such as the lungs or even the brain.

4. Role of Female Hormones

Hormones especially estrogen play a critical role in the growth and maintenance of endometrial tissue. In people with endometriosis, high levels of estrogen can stimulate the abnormal tissue outside the uterus to grow, thicken, and bleed during each cycle just like the normal uterine lining. This repeated bleeding can cause inflammation, scarring, and chronic pain. The hormonal influence also explains why symptoms often improve after menopause or during hormone-suppressing treatments.

What should be done next?

Managing endometriosis involves more than just taking medication; it also involves making tiny, regular decisions each day. Studies reveal that sleep, stress reduction, exercise, and nutrition all have significant effects on lowering inflammation, regulating hormones, and alleviating long-term endometriosis symptoms.
The goal of this daily check list is to provide your body with comprehensive assistance. You can feel more in control over your health, energy, and fertility with these easy, evidence-based techniques, regardless of how long you’ve had endometriosis.

Category	Do Daily (✔)	Do Weekly (✓)	Avoid/Minimize (✖)	Notes
Morning Routine	Warm water with lemon + soaked flaxseeds	Herbal tea (like chamomile, turmeric)	Coffee on empty stomach ✖	Kickstarts digestion & reduces inflammation
Diet	✔ High-fiber meals: vegetables, fruits, whole grains✔ Omega-3 sources: flaxseed, walnuts✔ Cruciferous veggies: broccoli, cauliflower	✓ Include turmeric/curcumin 3–4x/week✓ Try gluten/dairy-free trial for 2–4 weeks	✖ Red meat, processed food, sugar, trans fats	Supports hormone metabolism, reduces estrogen load
Hydration	✔ 2.5–3 liters of water daily	—	✖ Sugary drinks, excessive caffeine	Keeps bowels moving & reduces bloating
Exercise	✔ 30 mins walking, light yoga, or stretches✔ Breathing exercises (diaphragmatic or alternate nostril)	✓ 2x/week: Clinical Pilates or resistance band work✓ 1–2x/week: Swimming or cycling	✖ HIIT or high-impact workouts during flare-ups	Movement reduces pelvic congestion & pain
Pelvic Health	✔ Pelvic floor relaxation: child’s pose, butterfly pose✔ Belly breathing 5–10 mins	✓ Pelvic physiotherapy session if needed	✖ Ignoring pain during intercourse or urination	Helps manage pain, spasms, and posture issues
Mental Health	✔ 10 mins journaling or meditation✔ Digital detox post 9 PM	✓ Support group check-in or therapy	✖ Self-criticism or dismissing your symptoms	Stress worsens hormonal imbalances & pain perception
Sleep Routine	✔ Sleep by 10:30 PM✔ Use hot water bag before bed if needed	✓ Magnesium-rich foods (banana, almonds) for sleep	✖ Screen exposure till late night	Sleep aids hormonal repair & immune reset
Supplements (Consult doctor first)	✔ Omega-3, Vitamin D, Magnesium Citrate	✓ Curcumin or NAC (N-acetylcysteine) as advised	✖ Overuse of painkillers without supervision	Supplements can aid inflammation control

Despite being a complicated and frequently misunderstood ailment, endometriosis is treatable. Early diagnosis, evidence-based treatment, and mindful lifestyle modifications can greatly lessen discomfort, increase fertility, and improve general quality of life—even though there is currently no proven cure.

You can take control of your health by recognising your body’s warning signs, getting the help you need from a doctor, and adopting healthy habits like anti-inflammatory eating and gentle, restorative exercise.

Keep in mind that you are not alone. Even with endometriosis, it is completely possible to lead a normal and fulfilling life with the correct information, support, and treatment.