1 in 10
Women affected by endometriosis worldwide
7 years
Average time from symptom onset to diagnosis
30–50%
Of women with endometriosis experience infertility

What Is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus — on the ovaries, fallopian tubes, bladder, bowel, and sometimes further afield. Like the uterine lining, this tissue responds to hormonal cycles — thickening and then bleeding each month. But unlike period blood, which exits through the cervix, this blood has nowhere to go. It causes inflammation, scarring, adhesions, and — in time — significant damage to the reproductive organs.

The Symptoms — And Why They Are Dismissed

The most common reason endometriosis takes so long to diagnose is that its primary symptom — painful periods — is routinely dismissed as normal. It is not. Symptoms that should prompt specialist evaluation include:

  • Severe period pain — pain that disrupts daily life, causes vomiting, or requires strong pain medication every cycle
  • Chronic pelvic pain — not just during periods, but throughout the month
  • Pain during or after intercourse (dyspareunia)
  • Painful bowel movements or urination during menstruation
  • Heavy periods or bleeding between periods
  • Bloating — sometimes called "endo belly," severe bloating particularly around menstruation
  • Difficulty conceiving — endometriosis is found in 30–50% of women investigated for infertility
  • Fatigue — often severe and underappreciated as a symptom
Dr. Juneja's Message

I have seen women who have been told for 8–10 years that their pain is normal, who have been given the pill to "manage" symptoms without any investigation, and who come to me with Stage III or IV endometriosis affecting their fertility. This is avoidable. If your pain is significant, it deserves investigation — not reassurance.

How Is Endometriosis Diagnosed?

This is one of the most misunderstood aspects of the condition. Endometriosis cannot be definitively diagnosed by ultrasound alone, though a skilled sonographer can detect ovarian endometriomas (chocolate cysts). A normal ultrasound does not rule out endometriosis.

The gold standard for diagnosis is laparoscopy — a minimally invasive surgical procedure where a camera is inserted through the abdomen to directly visualise and biopsy endometrial deposits. However, many specialists — including Dr. Juneja — take a clinical diagnosis approach when symptoms are clear, treating empirically before proceeding to surgery.

  • Specialist consultation — detailed symptom history is the most important diagnostic tool
  • Transvaginal ultrasound — can detect ovarian endometriomas and deep infiltrating disease
  • MRI — for mapping more complex or deep disease before surgery
  • Laparoscopy — definitive diagnosis and simultaneous treatment of lesions

Endometriosis and Fertility

30–50% of women with endometriosis face some degree of fertility challenge. The mechanisms are multiple — distorted anatomy from adhesions, toxic effects of endometrioma fluid on eggs, impaired embryo implantation, and reduced ovarian reserve (particularly in women with ovarian endometriomas, which can damage surrounding follicles).

Importantly, early-stage endometriosis can still cause significant fertility problems, and late-stage disease does not always mean infertility is inevitable. The relationship is complex and highly individual.

If You Have Endometriosis and Want to Conceive

Do not delay. The condition is progressive, and ovarian reserve can decline with each cycle. If you have been diagnosed with endometriosis and are considering pregnancy — even in the next 1–2 years — speak to a fertility specialist now. Egg freezing before further ovarian damage occurs is also worth discussing.

Treatment Options

  • Medical management — hormonal therapies (GnRH analogues, progesterone, OCP) can suppress the disease and reduce pain, but do not treat underlying infertility
  • Laparoscopic surgery — removal of endometriotic deposits and endometriomas; can improve fertility significantly in the right cases
  • IVF — often the most effective route to pregnancy for women with moderate to severe endometriosis, particularly those with reduced ovarian reserve
  • Pain management — multidisciplinary approach including physiotherapy, diet, and psychological support alongside medical treatment
"Painful periods are not a rite of passage. They are a signal worth listening to. The earlier endometriosis is identified, the more options a woman has."

How to Get a Faster Diagnosis

  • Do not accept "it's normal" from anyone if your pain significantly disrupts your life
  • Keep a symptom diary — noting pain severity, timing, and associated symptoms helps build a picture
  • Ask specifically for an endometriosis evaluation, not just a routine gynaecology check
  • See a gynaecologist who specialises in endometriosis and has experience with laparoscopic treatment
  • If you are also trying to conceive, see a fertility specialist simultaneously