What Is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus — on the ovaries, fallopian tubes, bladder, bowel, or the peritoneal lining of the pelvis. Like the endometrial lining inside the uterus, this displaced tissue responds to oestrogen: it swells, bleeds, and attempts to shed each month. Because there is nowhere for the blood to go, it triggers inflammation, scarring, and the formation of adhesions — fibrous bands that bind organs together.
An estimated 190 million women worldwide are affected. In India, endometriosis is significantly under-diagnosed — partly because period pain is widely normalised and partly because many women wait years before the condition is investigated properly. The average delay between the onset of symptoms and diagnosis is seven to ten years.
Recognising the Symptoms
The hallmark symptom is dysmenorrhoea — painful periods that disrupt daily life. But endometriosis can also present as:
- Chronic pelvic pain unrelated to menstruation
- Pain during or after intercourse (dyspareunia)
- Pain on urination or opening the bowels, particularly during a period
- Heavy or irregular periods
- Fatigue, bloating and low mood — sometimes dismissed as IBS or anxiety
- Difficulty conceiving
Importantly, the severity of pain does not correlate with the extent of disease. Some women with widespread endometriosis have minimal discomfort; others with small lesions are debilitated. Never use pain level as a guide to whether endometriosis is serious.
Does Endometriosis Increase Cancer Risk?
This is one of the most common questions I hear. The short answer: endometriosis is not cancer, but certain subtypes — particularly endometrioma (ovarian endometriosis) — are associated with a modestly elevated risk of clear-cell and endometrioid ovarian cancer. The absolute risk remains small. However, women with endometriosis benefit from regular gynaecological surveillance because the conditions can co-exist, and because symptoms of ovarian cancer (bloating, pelvic discomfort, early fullness) overlap significantly with endometriosis symptoms.
A 2021 large population-based study found that women with endometriosis had approximately a 1.9-fold increased relative risk of ovarian cancer compared with the general female population. This underscores the importance of imaging, CA-125 monitoring, and specialist follow-up for women with confirmed endometrioma.
When to Seek Specialist Evaluation
You should seek a specialist opinion if:
- Your periods are consistently painful enough to require strong analgesia or time off work
- You have been trying to conceive for more than 12 months without success (6 months if over 35)
- Pelvic pain is present outside your period
- You have a known ovarian cyst or endometrioma on ultrasound
- Your symptoms are worsening over time despite standard medical management
Endometriosis is diagnosed definitively only by laparoscopy with biopsy — ultrasound can detect endometriomas but misses peritoneal implants. An experienced gynaecological surgeon should assess whether surgical treatment is appropriate alongside or instead of hormonal therapy.
Dr. Nishtha Tripathi Patel is a gynaecological oncosurgeon at Sterling Hospitals, KD Hospital, and Welcare Speciality Hospital, Ahmedabad. For consultation: +91 76988 00333.