13-07-2025
From pain to prevention, endometriosis treatment is finally offering relief
For decades, endometriosis has lurked in the blind spots of medical understanding. A chronic estrogen-dependent inflammatory condition, endometriosis often got dismissed as 'just bad periods." It affects over 190 million women worldwide, yet diagnosis is routinely delayed by 7 to 10 years, leaving countless lives disrupted by pain, misdiagnosis, and invisibility.
'Despite being as common as diabetes, it lacks a single definitive test and often takes more than seven years to diagnose," says Dr Anshumala Shukla Kulkarni, head of minimally invasive gynaecology and robotic surgery at Kokilaben Dhirubhai Ambani Hospital in Mumbai. But thanks to a growing body of research, cutting-edge diagnostics, and a systemic push for recognition, endometriosis is no longer being relegated to the margins of women's health.
'Endometriosis is an estrogen-dependent inflammatory condition where endometrial-like tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, peritoneum, and, in severe cases, the bowel and bladder," explains Dr Sapna Raina, senior consultant at Narayana Health City, Bengaluru. 'Yet despite its prevalence, the average diagnostic delay remains 7–10 years."
That delay, she adds, is not just a medical failure but a cultural one: 'The hallmark symptom—chronic pelvic pain—is often dismissed as normal period pain, especially in adolescents and young women." The consequences? Women are frequently misdiagnosed with conditions like irritable bowel syndrome or urinary tract infections, while the root cause—endometriosis—goes untreated.
Dr Smeet Patel, endometriosis specialist at Mayflower Women's Hospital in Ahmedabad, agrees that this delay is emblematic of deeper systemic failings. 'There's definitely a gap in medical education where endometriosis isn't highlighted in early training," he says. 'Bias has a significant play too—women's pain is normalized or trivialized, and hence it gets delayed investigation."
A QUIET REVOLUTION IN DIAGNOSIS
New research is challenging the necessity of invasive laparoscopies for diagnosis. Among the most promising innovations are mRNA-based blood and saliva tests, which can detect molecular changes invisible to conventional imaging.
'AI-powered MRI with 3D pelvic reconstruction" is also transforming the diagnostic process, Kulkarni notes. These tools allow for 'a full extent of the disease to be understood pre-operatively," giving surgeons the ability to plan interventions with surgical precision.
Additionally, the Ultrasound-Based Endometriosis Staging System (UBESS) offers 'a real-time, less-invasive alternative to exploratory surgery," while specific biomarkers like interleukins may soon enable clinicians to diagnose the disease with a simple blood test. Even menstrual blood is being explored as a diagnostic tool. 'Menstrual blood analysis is being explored for its potential to detect endometrial cells, inflammatory markers, or altered gene expression patterns linked to the disease," says Raina.
Patel sees huge promise in these developments—if paired with accessibility. 'The potential of making a diagnosis with menstrual blood is really thrilling," he says. 'It could turn early detection on its head by providing a non-invasive, easily obtained sample—particularly for patients from resource-deprived areas or those unwilling to undergo laparoscopy."
GETTING TO THE ROOT OF IT
Perhaps the most profound shift is not in the tools, but in the way science is beginning to understand the disease itself. 'Recent studies are also exploring how the gut microbiome, immune dysfunction, and endocrine disruptors contribute to the development and persistence of endometriosis," Kulkarni explains. That means looking beyond the uterus to the whole body to understand potential triggers:
* Disrupted immune surveillance may allow endometrial-like tissue to implant and grow outside the uterus.
* Microbiome imbalances, especially in the gut and reproductive tract, appear linked to disease severity.
* Long-term exposure to environmental toxins like BPA and phthalates is under investigation for triggering hormonal imbalances that may contribute to disease onset.
If these connections hold, preventive strategies could begin early—during adolescence or earlier. 'Some researchers now believe that endometriosis may begin in utero or during early adolescence," Kulkarni adds. 'If validated, this could unlock a window for preventive care."
RETHINKING ENDOMETRIOSIS TREATMENT
While laparoscopy and hormonal suppression remain standard, 'surgical excision of lesions offers long-term symptom relief and improved fertility in select cases," says Raina. But increasingly, the approach is shifting toward less aggressive and more personalized solutions.
Among these are 'rectal wall shaving" and 'disc resection" for bowel-involved cases, which aim to minimize complications while preserving fertility. Laparoscopic microwave ablation, particularly for women with adenomyosis, 'targets abnormal tissue with precision, preserving the uterine wall and reducing post-op recovery time." Still experimental but promising are regenerative medicine and neuromodulation techniques, including stem-cell therapies and nerve-targeting treatments to manage chronic pain and promote tissue healing.
INTEGRATIVE CARE GAINS GROUND
Patients, often out of desperation, have long turned to complementary therapies. Now, science is starting to catch up. 'Dietary approaches focusing on reducing processed foods and increasing omega-3s and fiber show modest but meaningful benefits," notes Kulkarni.
Likewise, pelvic floor physiotherapy has shown particular promise for patients with deep infiltrating endometriosis (a severe condition where endometrial tissue grows deep- almost 5mm – into the pelvic tissues). And while acupuncture and stress-reduction techniques remain under-researched, early trials are hopeful. 'These approaches, when integrated with medical management, can improve quality of life and reduce flare-ups."
Patel agrees but cautions against over-reliance. 'Holistic approaches such as diet and yoga can provide adjunctive relief, but not to the detriment of systemic, evidence-based treatment," he says. 'Endometriosis is an intricate medical condition—not a lifestyle disease. The burden of care should not fall solely on the patient." If innovation is one half of the solution, systemic reform is the other. "This delay [in diagnosis] reflects systemic gaps in how women's pain is understood and managed," says Kulkarni.
She calls for improved medical training: 'There's a need to better equip general practitioners and gynecologists to recognize endometriosis early, especially in adolescents who present with chronic pelvic pain." Also urgent is the establishment of standardized diagnostic protocols, ensuring that primary care physicians follow a tiered and structured approach rather than resorting to dismissal.
Finally, public awareness is key. 'Campaigns aimed at normalizing conversations about menstrual pain and encouraging early medical help-seeking can help reduce stigma and improve early intervention."
In many ways, endometriosis is a medical paradox: common, devastating, yet long ignored. But that tide is finally turning. 'Endometriosis research is finally gaining momentum with significant progress in early diagnosis, less invasive treatments, and deeper understanding of its origins," Kulkarni says. 'While there's no cure yet, science is moving from symptom management to disease modification—and potentially, prevention."
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
