Daijiworld Media Network - New Delhi

New Delhi, Sep 13: Severe or persistent menstrual pain should not be dismissed as a normal part of menstruation as it could be a sign of endometriosis, a chronic condition that can affect fertility and significantly impact quality of life, doctors said.

Experts said growing evidence indicates that genetic and epigenetic factors may influence a woman's susceptibility to endometriosis, underlining the importance of awareness and early diagnosis.

“Symptoms of period pain are often dismissed as ‘normal’ because many of us lack awareness of a condition called endometriosis. It is a painful condition where tissue like the womb lining grows outside the uterus. It affects 1 in 10 women and girls, often causing severe period pain, pelvic pain, and infertility,” said Dr Priti Arora Dhamija, senior consultant, Obstetrics and Gynecology and fertility expert at Sitaram Bhartia Institute of Science and Research.

She said women in India often wait seven to 10 years for a diagnosis, partly because doctors may lack simple tools to identify the condition at an early stage.

Such delays can result in worsening pain, missed school or work and a decline in quality of life, she added.

Over the past decade, epigenetics has emerged as an important mechanism in the development of endometriosis, Dr Dhamija said. Epigenetic modifications, including DNA methylation, histone modifications and chromatin remodelling, can alter gene expression without changing the underlying DNA sequence.

She also pointed to gaps in India's pluralistic healthcare system and the lack of effective referral mechanisms, which can force women to consult multiple providers, including traditional healers and alternative practitioners. This, she said, can increase both the complexity and financial burden of seeking care.

Dr Jyotsna Suri, head of the Department of Gynaecology and Obstetrics at Safdarjung Hospital, Delhi, said endometriosis should not be viewed simply as a genetic disorder, but as a complex disease involving interactions between genetic, hormonal, immune and environmental factors.

“Women with a close family member affected by endometriosis may have a higher risk, but genes are only one piece of the puzzle. Increasing evidence suggests that genetic susceptibility interacts with hormonal and inflammatory pathways as well as environmental factors to influence whether the disease develops and how severely it manifests,” she said.

Epigenetic changes may also influence the condition by altering gene expression without changing the DNA sequence, Dr Suri added.

She stressed that severe period pain should never be considered something women simply have to endure. Pain that interferes with daily activities, pain during intercourse, persistent pelvic pain or difficulty conceiving warrants medical evaluation.

“Recognising the symptoms early can shorten the diagnostic journey, reduce years of unnecessary suffering and help preserve reproductive health,” she said.

Dr Bindu Bajaj, consultant in the Department of Gynaecology and Obstetrics at Safdarjung Hospital, highlighted the importance of raising awareness among adolescents and families, noting that painful periods can begin at an early age and symptoms may progressively worsen.

“Endometriosis should be considered when menstrual pain is severe, recurrent or progressively worsening, particularly when routine painkillers provide little relief or the pain affects school, work, sleep or social activities,” Dr Bajaj said.

The condition may also cause pain during bowel movements or urination around menstruation and can later result in fertility problems.

“There is no single simple test that can identify every case, and diagnosis often requires a detailed menstrual and medical history, clinical examination and appropriate imaging. A family history should prompt greater vigilance, but the absence of such a history does not rule out the disease,” she said.

“The message for women is simple: disabling period pain deserves medical attention and should not be normalised,” Dr Bajaj added.

Experts said continued research into genetic and epigenetic mechanisms could eventually help identify women at greater risk, allowing closer monitoring and more personalised approaches to treatment.