Dr Ramya Raj, Specialist Obstetrician and Gynaecologist at International Modern Hospital Dubai, warns that endometriosis is frequently overlooked or mistaken for other medical conditions, potentially delaying diagnosis and treatment. Medical reviews estimate that 25–50% of women experiencing infertility may have endometriosis.

Dubai: For many women, severe menstrual cramps, persistent pelvic pain and discomfort during everyday activities are often dismissed as a normal part of being a woman. However, a Dubai-based gynaecologist is warning that these symptoms could indicate endometriosis, a chronic condition that may affect reproductive health and quality of life.

Dr Ramya Raj, Specialist Obstetrician and Gynaecologist at International Modern Hospital Dubai, said endometriosis remains under-recognised, with some women experiencing symptoms for years before receiving an accurate diagnosis.

Medical reviews have estimated that approximately 25–50 per cent of women experiencing infertility may have endometriosis, although estimates vary according to the population studied and diagnostic methods used.

The condition occurs when tissue similar to the lining of the uterus grows outside the uterus, triggering inflammation, pain and, in some cases, difficulties with conception.

When period pain is more than just cramps

According to Dr Raj, one of the greatest challenges in diagnosing endometriosis is the widespread belief that severe menstrual pain is normal.

Young women may be reassured that painful periods are simply part of menstruation, particularly when symptoms begin during adolescence.

However, pain that repeatedly interferes with school attendance, employment, sleep or everyday activities deserves medical evaluation.

“Importantly, persistent pelvic pain that affects education, work, daily activities, or quality of life should never be considered a normal part of menstruation,” Dr Raj stressed.

She explained that while mild menstrual discomfort is common, persistent or debilitating pain may indicate an underlying gynaecological condition requiring further investigation.

Why endometriosis is frequently misdiagnosed

Dr Raj highlighted that endometriosis can produce symptoms resembling several other medical conditions, making diagnosis challenging.

These include adenomyosis, uterine fibroids, pelvic inflammatory disease, irritable bowel syndrome and interstitial cystitis, a condition associated with chronic bladder discomfort.

Because symptoms overlap, patients may initially seek treatment for gastrointestinal, urinary or other pelvic problems before endometriosis is considered.

Some women experience painful periods, while others develop persistent pelvic discomfort, pain during intercourse, bowel symptoms or difficulty becoming pregnant.

The severity of symptoms does not always reflect the extent of the disease, meaning even women with relatively limited endometriosis may experience significant pain.

Can an ultrasound miss endometriosis?

One of the most important concerns raised by Dr Raj is that routine imaging does not always detect the condition.

“Ultrasound may appear normal in women with superficial endometriosis, creating false reassurance if clinical suspicion is low,” she explained.

Ultrasound can identify certain forms of endometriosis, including ovarian endometriomas and some deep lesions, but superficial disease may remain undetected.

A normal scan therefore does not necessarily rule out endometriosis, particularly when symptoms strongly suggest the condition.

Dr Raj emphasised the importance of considering a patient’s medical history, symptom patterns and clinical findings rather than relying solely on imaging results.

Could endometriosis affect fertility?

Endometriosis is associated with infertility in some women, although many patients with the condition can conceive naturally.

The disease may affect fertility through inflammation, changes in pelvic anatomy, adhesions or involvement of the ovaries and fallopian tubes.

Medical literature suggests that endometriosis is relatively common among women undergoing fertility investigations, reinforcing the importance of considering the condition when conception is delayed.

However, Dr Raj’s clinical observations also highlight the need to avoid assuming that every woman with endometriosis will experience infertility.

Early assessment allows patients to understand their reproductive health and discuss appropriate treatment options based on their symptoms, age and pregnancy plans.

Why treatment may begin before a definitive diagnosis

Dr Raj noted that young women experiencing menstrual pain are sometimes prescribed pain-relieving medication or hormonal treatment without further investigation.

These treatments can be appropriate for managing suspected endometriosis, and medical guidelines do not require every patient to undergo surgery before treatment begins.

However, persistent symptoms, worsening pain or inadequate response to treatment should prompt reassessment.

A clinical evaluation may include a detailed symptom history, pelvic examination where appropriate, ultrasound or specialist referral.

In selected cases, further imaging or laparoscopy may be considered.

The emotional and everyday impact of delayed diagnosis

Beyond physical discomfort, endometriosis can significantly affect emotional wellbeing, relationships, productivity and daily life.

Women experiencing repeated episodes of severe pain may miss classes, take time off work or avoid social activities.

For those attempting to conceive, uncertainty about the cause of fertility difficulties can create additional emotional distress.

Dr Raj stressed that patients should feel comfortable discussing menstrual symptoms openly and seeking further medical advice when their concerns remain unresolved.

Early recognition can change the patient journey

Dr Raj urged women not to normalise recurring pelvic pain simply because it occurs around menstruation.

Recognising symptoms early and seeking appropriate medical evaluation can help identify the condition, guide symptom management and support informed reproductive decisions.

Treatment may involve pain management, hormonal therapy, surgery in selected cases or fertility-focused care, depending on individual circumstances.

The key message, she emphasised, is that menstrual pain should not routinely disrupt a woman’s education, career or quality of life.

“Persistent pelvic pain that affects education, work, daily activities, or quality of life should never be considered a normal part of menstruation,” Dr Raj reiterated.