Endometriosis: A Long-Overlooked Disease

Painful periods (dysmenorrhea), pelvic pain outside periods, painful intercourse, painful defecation, infertility, cyclical bowel/urinary symptoms.

Diagnosis

Clinical suspicion drives investigation. Pelvic ultrasound and MRI detect deep infiltrating disease; laparoscopy remains the gold standard.

Medical treatment

• Combined hormonal contraceptives
• Progestins
• GnRH analogues for refractory disease
• NSAIDs for pain

Surgery and fertility

Excision of endometriotic lesions can relieve pain and improve fertility. Multidisciplinary care (gynaecology, pain, fertility) is increasingly the standard.

Severe period pain that disrupts school or work is never normal: it warrants evaluation.