Severe period pain not normal, could signal endometriosis, warn doctors

Doctors have warned that severe or persistent period pain may indicate endometriosis. They said earlier diagnosis can reduce suffering and help protect fertility.

In Short

• Diagnosis delay in India averages 7-10 years, worsening symptoms
• Genetic and epigenetic factors influence susceptibility to endometriosis
• Epigenetic changes affect gene expression without altering DNA sequence

Doctors have said that severe or persistent period pain should not be dismissed as a normal part of menstruation, warning that it could be a sign of endometriosis, a chronic condition that can affect fertility and significantly reduce a woman’s quality of life.

They said growing evidence points to the role of genetic and epigenetic factors in shaping a woman’s susceptibility to the condition, underlining the need for greater awareness, earlier diagnosis and timely medical evaluation.

“Symptoms of period pain are often dismissed as ‘normal’ because many of us lack awareness of a condition called endometriosis. It is a painful condition where tissue like the womb lining grows outside the uterus. It affects 1 in 10 women and girls, often causing severe period pain, pelvic pain, and infertility,” said Dr Priti Arora Dhamija, senior consultant, Obstetrics and Gynaecology and fertility expert at Sitaram Bhartia Institute of Science and Research.

In India, most women wait 7-10 years for a diagnosis because doctors often lack simple tools to identify it early, she said, adding that the delay leads to worsening pain, missed school or work and decreased quality of life.

Dr Dhamija said epigenetics has emerged over the past decade as a central mechanism in the pathogenesis of endometriosis.

“Epigenetic modifications, including DNA methylation, histone modifications and chromatin remodelling, can alter gene expression without changing the underlying DNA sequence. India’s pluralistic health system and lack of referral systems creates a gap that forces women to navigate multiple providers, including traditional healers and alternative practitioners, increasing complexity and financial burden,” she said.

Dr Jyotsna Suri, Head of the Department of Gynaecology and Obstetrics at Safdarjung Hospital, Delhi, said endometriosis is not simply a genetic disorder but a complex disease resulting from the interaction of genetic, hormonal, immune and environmental factors.

“Women with a close family member affected by endometriosis may have a higher risk, but genes are only one piece of the puzzle. Increasing evidence suggests that genetic susceptibility interacts with hormonal and inflammatory pathways as well as environmental factors to influence whether the disease develops and how severely it manifests,” she said.

She added that epigenetic changes may also play an important role by altering how genes are expressed without changing the underlying DNA sequence.

“Importantly, severe period pain should never be dismissed as something a woman simply has to live with. Pain that disrupts daily life, pain during intercourse, persistent pelvic pain or difficulty conceiving warrants medical evaluation. Recognising the symptoms early can shorten the diagnostic journey, reduce years of unnecessary suffering and help preserve reproductive health,” Dr Suri said.

Dr Bindu Bajaj, consultant in the Department of Gynaecology and Obstetrics at Safdarjung Hospital, said awareness among adolescents and families is equally important, as painful periods can begin early and symptoms may progressively worsen.

“Endometriosis should be considered when menstrual pain is severe, recurrent or progressively worsening, particularly when routine painkillers provide little relief or the pain affects school, work, sleep or social activities,” she said. The condition can also present with pain during bowel movements or urination around menstruation and, later, fertility problems.

“There is no single simple test that can identify every case, and diagnosis often requires a detailed menstrual and medical history, clinical examination and appropriate imaging. A family history should prompt greater vigilance, but the absence of such a history does not rule out the disease.

The message for women is simple: disabling period pain deserves medical attention and should not be normalised,” Dr Bajaj said. Experts added that greater research into genetic and epigenetic mechanisms could help identify women who need closer monitoring and support more personalised treatment approaches.

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