For millions of women, pain is not a monthly inconvenience but a lifelong companion. Endometriosis, a chronic condition affecting around one in ten women, is routinely dismissed, misunderstood, and diagnosed years too late, leaving many to suffer in silence.
In the NHS, women can wait up to eight years for answers, often told their symptoms are “normal” or imagined. To rectify the situation, women’s health will be a key focus of the NHS’s planned online hospital, due to launch in 2027. Menopause and menstrual problems, which can signal conditions such as endometriosis or fibroids, are among nine common conditions set to be prioritised for treatment through the NHS Online Service.
To help readers understand what to look out for, Dr Nitu Bajekal, a senior consultant obstetrician and gynaecologist with 40 years of experience, offers practical advice.
Why is the NHS struggling to meet women’s health needs, and what must change to improve outcomes?
First and most important priority is raising awareness and improving education, not just for the public but also for healthcare professionals. On average, it takes seven to eight years for women to receive a diagnosis for conditions such as endometriosis, polycystic ovarian syndrome, or even painful periods caused by other factors which are often dismissed or left undiagnosed for years. Education should begin at school and extend to children, young women and men, parents, and, crucially, doctors and other health professionals. Clinicians need to understand how serious these conditions are and the profound impact they have on quality of life. This, in turn, affects earning capacity, productivity, and sick leave, meaning the government has a clear responsibility to make women’s health a priority.
Endometriosis, in particular, is one of the most significant concerns. Around one in ten women are affected, and among women who struggle to conceive, up to 50 per cent may have the condition. It is frequently overlooked despite affecting women from the onset of menstruation through menopause and beyond. The second priority must be improving diagnosis. Currently, diagnosis relies on highly specialised imaging or invasive keyhole surgery, both of which require expert clinicians and are not widely accessible. There is hope that less invasive tests, such as blood tests, could enable earlier and more widespread diagnosis, preventing many women from being left undiagnosed for years.
What signs should people look out for that indicate they should seek a diagnosis?
First and foremost, painful, heavy, irregular periods, or bleeding between periods should not be accepted as normal. They are not. At most, period pain should be limited to mild cramps that respond to simple pain relief, such as a single dose of ibuprofen. Anything beyond that, pain that affects quality of life, causes someone to miss school or work, or interferes with daily activities, should never be normalised.
Painful periods are often a sign of an underlying condition. Initial investigations should include checking for anaemia, as heavy bleeding frequently accompanies pain. Using double protection, bleeding for more than seven days, flooding, leaking, or passing clots are all warning signs that require medical attention. Bleeding after sex, bleeding between periods, missed periods, or very irregular cycles should also never be ignored.
Crucially, women should not be told to wait until they want to conceive before seeking help. There is a full life to live both before and after pregnancy, and symptoms deserve attention at every stage.
Does endometriosis affect British Asian women differently?
Endometriosis diagnosis is often significantly delayed for women of colour. There is a long history of discrimination in healthcare, and many women are still told that nothing is wrong, that they are being “hysterical”, or that the pain is “all in their head”. This is a major issue. Language barriers and cultural taboos around discussing periods also play a role. In many families, menstruation and reproductive health are not openly talked about, which means crucial family history, such as early menopause, endometriosis, or PCOS, may never be shared. Without that context, symptoms are often normalised and dismissed internally as well. For many Asian women, lack of knowledge, dismissal by health professionals, and repeated negative experiences create lasting trauma.
What common myths about endometriosis would you like to debunk?
One common myth is that everyone with endometriosis or PCOS will be infertile or unable to conceive. That is not necessarily true. While these conditions can make conception more difficult for some, seeking medical advice early can make a significant difference. Many women with endometriosis or PCOS go on to become pregnant, some naturally and others with the help of assisted reproductive techniques such as IVF. A diagnosis does not mean there is no hope, and it certainly does not mean pregnancy is impossible.
Another widespread myth is that having one condition rules out having another. This is incorrect. Conditions such as endometriosis, PCOS, fibroids, or adenomyosis can coexist, and their symptoms often overlap. Another important factor is the fear of hormonal contraception. In many Asian families, there is resistance to medications that could significantly improve symptoms, driven by myths around fertility, promiscuity, or long-term harm. While it’s essential to provide accurate information before prescribing, relying solely on “natural” approaches is not realistic for everyone.
Diet and lifestyle changes can help reduce inflammation and improve symptoms. However, many people will still require surgery or hormonal treatment. Doing everything “right” does not guarantee symptom-free living.
