Although endometriosis has been studied for decades, the exact cause is still unclear. Many theories exist, including retrograde menstruation (when menstrual blood flows backward through the fallopian tubes instead of out the body) and immune system dysfunction. However, none of these explain fully why only some develop the condition. What researchers do know is that endometriosis is estrogen-dependent, meaning that symptoms often get worse around the time of menstruation and improve when estrogen levels are reduced (Bulun et al., 2019).

Even though endometriosis impacts about 10% of reproductive-age individuals worldwide, it is often mischaracterized as “normal” menstrual pain, which has contributed to an average diagnostic delay of seven to ten years (World Health Organization, 2023).

This delay is not due to a lack of severity, as the disorder can be debilitating for many. Rather, the combination of gender bias and symptom normalization within healthcare settings has contributed to this (Ballard et al., 2006). Unfortunately, because of this, many patients spend years navigating these symptoms without treatment or validation. 

Menstrual pain is often normalized within both cultural and clinical contexts, leading patients to delay seeking care and providers to dismiss reported symptoms. Research has also shown the impact of gender bias in pain assessment, as women’s pain is more likely to be attributed to psychological causes rather than investigated as an actual physical condition (Hoffmann & Tarzian, 2001).

 Endometriosis is also notoriously difficult due to a multitude of factors. One of the main challenges is that its symptoms often overlap with other conditions. Pelvic pain, dysmenorrhea, gastrointestinal discomfort, and fatigue are highly variable. These symptoms can also be signs of irritable bowel syndrome, pelvic inflammatory disease, and even anxiety-related disorders (Zondervan et al., 2020). Due to this variability, symptom severity does not always correlate with the extent of this disease. This makes clinical assessment based solely on pain unreliable. 

Furthermore, there is currently no noninvasive diagnostic test that can absolutely confirm endometriosis. Although imaging techniques such as MRI and ultrasound can detect ovarian endometriomas (ovarian cysts filled with old blood and tissue), they frequently fail to identify more superficial lesions. These are common and still capable of causing significant pain. As a result, a laparoscopy has remained the gold standard for diagnosis, creating a high threshold for confirmation and delaying diagnosis for many patients.

There is currently no cure for endometriosis, so treatment usually focuses on managing symptoms and improving quality of life. For many patients, this starts with pain relief and hormone therapies like birth control pills or progestins, which work by suppressing ovulation and reducing estrogen-related inflammation (Dunselman et al., 2014). While these treatments may be effective for some, they do not work universally.

For those whose symptoms do not improve with first-line treatments, more aggressive estrogen-reducing medications may be prescribed. Although these drugs can improve pain, they have many side effects and should not be used long-term. In severe cases, surgery may be recommended to remove endometriosis lesions, providing significant symptom relief but not guaranteeing a permanent resolution, as recurrence is common. 

Because endometriosis affects each person differently, management often requires a personalized approach. Many patients rely on a combination of medical treatment, symptom monitoring, and long-term care to manage the condition effectively.

Endometriosis is not just “a bad period,” nor is it something that can be willed away with pain tolerance or lifestyle changes alone. It is a complex, chronic condition that has long been underrecognized, despite affecting millions of people worldwide. The difficulty in diagnosing and treating endometriosis is not a reflection of its legitimacy, but of gaps in medical understanding and how menstrual pain has historically been dismissed. Increasing awareness and research are essential to ensure that those living with endometriosis are believed, supported, and given the care they deserve.