The pain women are told to ignore: Understanding pelvic pain beyond endometriosis

Severe pelvic pain in women is still often dismissed as stress, anxiety, or normal menstrual cramps. For many, this pain turns into a long struggle for answers. Endometriosis — a condition where tissue similar to the uterine lining grows outside the uterus — has finally brought attention to the issue. However, experts warn that not every case of pelvic pain is caused by endometriosis. In India, millions of women continue to suffer for years without the correct diagnosis or treatment, paying a heavy emotional and financial price.

When pelvic pain isn’t endometriosis

Endometriosis affects around 42 million women in India — nearly one in ten of reproductive age. It is a serious condition, but it is not the only cause of pelvic pain. Doctors say that assuming every woman with pain has endometriosis can lead to wrong treatments and more suffering.

“Endometriosis is a major reason, but not the only one,” explains gynaecologist Dr. Smeet, who treats patients with chronic pelvic pain. “If we stop investigating other causes, we fail our patients.”

Pelvic pain can also result from other medical problems such as:

• Adenomyosis, where the uterine lining grows into the muscle wall.

• Pelvic Inflammatory Disease (PID), caused by untreated infections.

• Fibroids and ovarian cysts, which create pressure and discomfort.

• Pelvic congestion syndrome, where blood flow in pelvic veins is blocked.

• Pelvic floor muscle dysfunction, leading to nerve and muscle pain.

All these conditions can mimic endometriosis, but they need different kinds of treatment. Many women, however, are prescribed hormonal pills or painkillers without further testing. When that fails, they are often told that the pain is “in their head.” This attitude leaves them unheard and untreated for years.

How delayed diagnosis changes lives

The Indian Council of Medical Research (ICMR) conducted a major study in 2023, showing that Indian women wait an average of 7.2 years before getting an accurate diagnosis of endometriosis — longer than the global average. This delay has serious effects. The pain becomes chronic, organs can be damaged, and fertility can decline quietly over time.

But the bigger tragedy is that not every woman with pelvic pain actually has endometriosis. Some may have completely different conditions that remain undiscovered for years. During this time, women go from one doctor to another, lose trust in the healthcare system, and often feel helpless.

The reasons for these delays are complex. Many stem from deep-rooted cultural attitudes that normalise women’s pain. “Period pain” is still viewed as something women should endure silently. There is also a shortage of experts. India has only one endometriosis specialist for every five million women, making early diagnosis almost impossible for many.

General doctors often lack training to differentiate between the many causes of pelvic pain, which leads to misdiagnosis and unnecessary treatments. The result is that women continue to live with pain while society tells them to simply “be strong.”

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The silent cost of ignoring women’s pain

The impact of untreated pelvic pain goes beyond health — it affects careers, finances, and mental well-being. According to the ICMR, endometriosis alone costs India between ₹38,000 and ₹50,000 crores annually in medical expenses. In addition, ₹12,000 to ₹15,000 crores are lost in productivity due to missed work, and ₹7,000 to ₹9,000 crores more are spent on fertility treatments like IVF.

These numbers represent real lives — women who leave jobs, postpone dreams, and suffer emotional breakdowns. Many of them are still told that their pain “isn’t that bad.”

What India must do next

Pelvic pain is not a diagnosis — it is a symptom that needs serious attention. Experts say India must invest in better healthcare systems for women. This means setting up multidisciplinary clinics, where gynaecologists, pain specialists, urologists, gastrointestinal doctors, pelvic floor therapists, and counsellors work together to find the real cause of pain.

Instead of quick consultations and painkillers, women need detailed examinations and empathy. They need doctors who listen.

The country must also create awareness at schools, workplaces, and communities that women’s pain is real and deserves care. More training should be given to doctors and nurses to recognise the signs of endometriosis and other pelvic conditions early.

Why this conversation matters

Endometriosis is a serious public health issue — but it should not be the only explanation for every case of pelvic pain. Focusing too narrowly on one condition can leave many women unseen and untreated.

Every woman who suffers from chronic pain without answers loses more than just health — she loses years of her life waiting to be believed. Seven years is the average delay in getting help, but for some, it lasts even longer.

This issue is not just about medicine. It’s also about gender equality, ethics, and human dignity. If women’s pain were treated with the same urgency as men’s, countless lives would already be transformed. It’s time to listen, to diagnose correctly, and to act. Every woman deserves to be heard — and healed.