When the pain isn’t “normal”

Many of us heard “it’s normal for it to hurt” with our very first period. Sometimes that’s true. But sometimes the pain has a name – one that affects millions of women, and that on average waits years for someone to say it.

What endometriosis is

In endometriosis, tissue similar to the lining of the uterus grows outside it. There it causes inflammation and scar tissue.¹

The cause is still unknown. The World Health Organization notes that the condition is associated with a dysregulated immune system, and that the risk is higher when there is a family history of endometriosis.¹ There is currently no cure – but there are ways to manage the symptoms.¹

Symptoms you shouldn’t ignore

Endometriosis doesn’t look the same for everyone. The symptoms are variable and broad – which is why health workers don’t always recognise it easily.¹ The most common signs are:

• severe period pain that stops you from doing your normal activities;²
• heavy bleeding – for example needing to change your pad or tampon every 1 to 2 hours;²
• pain in the lower tummy and back, including outside your period;^1,2
• pain during or after sex, or when you pee or poo;^1,2
• extreme tiredness, bloating and nausea;^1,2
• difficulty getting pregnant.¹

Pain that stops you from doing your normal activities is not “just your period”.

Why diagnosis takes so long

On average it takes between 4 and 12 years for endometriosis to be diagnosed.¹ One reason is that the symptoms vary so much. Another is harder to hear: in many countries the people around a woman – her family, and often health workers too – don’t know that the chronic pelvic pain of endometriosis is not normal.¹

The WHO adds that normalising the pain and the stigma around it harms the mental health of the people affected – and that attitudes which play down period pain make all of this worse.¹

How it is diagnosed

A doctor starts from the symptoms. An ultrasound or other imaging is often done. Laparoscopy – a small operation with a camera – can confirm the diagnosis, but according to the WHO it isn’t always needed as a first step: a diagnosis can also be made from symptoms and imaging.¹ New methods are being developed too, such as symptom questionnaires and tests of blood, saliva or menstrual blood.¹

What can be done

Endometriosis can’t be cured, but the symptoms can be eased. According to the WHO the options include:¹

• pain relief and anti-inflammatory medicines, such as ibuprofen and naproxen;
• hormonal treatment – for example the pill, the patch or the ring, or a hormonal IUD;
• surgery to remove the lesions;
• support for women who want to become pregnant;
• physiotherapy and cognitive behavioural therapy alongside.

What suits you depends on your symptoms, age and plans – which is why the decision is made together with a doctor.

Before your appointment

An appointment goes more easily when you have something to start from. For a few cycles beforehand, you could note down:

1. when the pain starts and how long it lasts;
2. how strong it is, on a scale of 0 to 10;
3. how often you change your pad or tampon on your heaviest days;
4. whether the pain keeps you from school, work or training;
5. what helps and what doesn’t – including medicines.

You’re not exaggerating

If the pain makes you cancel plans, miss days, or simply doesn’t seem normal to you – you have every right to say so and be heard. The NHS advises seeing a doctor if you think you might have endometriosis, or if your symptoms are affecting your everyday life, work and relationships.²

Sources

1. World Health Organization. Endometriosis – fact sheet, 15 October 2025.
2. NHS (UK National Health Service). Endometriosis.