Menstrual cramps are common; disabling pain is not. Discomfort managed with a hot pack and an occasional painkiller is normal physiology. Pain that keeps a girl out of school, sends a woman to the emergency room, causes vomiting or fainting, or does not respond to over-the-counter painkillers is a symptom of disease until proven otherwise. In an interview with HT Lifestyle, Dr Abhishek Mangeshikar, director of the Indian Centre for Endometriosis, Mumbai, shared when period pain needs a closer look.
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Reason behind severe period pain
Dr Abhishek Mangeshikar said the commonest cause is endometriosis, affecting roughly one in ten women of reproductive age — around 42 million in India. Adenomyosis, fibroids, pelvic infection and, in adolescents, obstructive uterine anomalies account for much of the rest.
“The global delay from first symptom to diagnosis is seven to ten years, and in India, it is often longer. That delay is not caused by a shortage of scanners or surgeons. It is caused by the pain being dismissed — first at home, then by teachers, then too often by doctors,” said Dr Abhishek. Meanwhile, the disease progresses. Superficial deposits become deep infiltrating disease involving bowel, bladder and ureters. The ovarian reserve is lost to endometriomas. Years of untreated pain rewire the nervous system, so pain persists even after the disease is removed.
Signs to watch out for
Pain requiring absence from school or work
Pain not controlled by standard painkillers
Pain during intercourse; pain on passing stool or urine during periods
Cyclical bloating
Diarrhoea or blood in urine or stool
Cyclical chest or shoulder-tip pain
Difficulty conceiving
And a normal ultrasound does not rule out endometriosis. Superficial disease is invisible on imaging. Dr Abhishek suggests not accepting severe pain as it’s normal if pain is controlling your life. Pain that stops you from living is not a rite of passage. It is a symptom.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
