For anyone who has been told their periods are just painful, their pain is just stress, or that what they’re feeling is normal, and known, somewhere, that it wasn’t.
One of the patients I think about most came to our clinic at 34, already a decade into a journey that should have taken one year.
She was 16 the first time she missed school because of her period.
By 22, she had been to the emergency room twice with pain so severe she couldn’t stand. Both times she was given painkillers and sent home. By 26, she had been told by three different doctors that some women just have difficult periods. By 28, she was struggling with infertility and nobody had yet considered that the pain and the fertility problem might have the same cause.
She was finally diagnosed with endometriosis at 29. Stage III. After thirteen years of symptoms.
Her story is not an outlier. Studies report diagnostic delays ranging from five to over ten years, and that gap has not meaningfully improved despite growing awareness [1]. In some countries the delay stretches beyond a decade. The disease progresses during those years. The pain worsens. Fertility becomes more complicated. The psychological toll of not being believed compounds into something that takes years of its own to recover from.
One detail that surprises many people, including those already managing a gynecological diagnosis: endometriosis is found in approximately 30 to 50% of women with infertility. If you have been trying to conceive without success and nobody has mentioned endometriosis, that is a conversation worth having with your doctor.
This is the opening of a longer article.
The full piece — the mechanisms, the labs to ask for, and what to do about it — is free to read on our newsletter.
Sources & Research
Every claim in this article is grounded in peer-reviewed research. DOI links open the original studies.
De Corte P, Klinghardt M, von Stockum S, Heinemann K. Time to diagnose endometriosis: current status, challenges and regional characteristics — a systematic literature review. BJOG. 2025;132(2):118–130. doi:10.1111/1471-0528.17973
Fryer J, Mason-Jones AJ, Woodward A. Understanding diagnostic delay for endometriosis: a scoping review using the social-ecological framework. Health Care Women Int. 2025;46(3):335–351. doi:10.1080/07399332.2024.2413056
Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction. 2010;25(6):1528–1535. doi:10.1093/humrep/deq044
National Institute for Health and Care Excellence. Endometriosis: diagnosis and management. NICE guideline NG73. Updated November 2024. Available at: https://www.nice.org.uk/guidance/ng73
Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception. 2010;81(3):185–196. doi:10.1016/j.contraception.2009.09.014
Anastasi E, Scaramuzzino S, Viscardi MF, et al. Efficacy of N-acetylcysteine on endometriosis-related pain, size reduction of ovarian endometriomas, and fertility outcomes. International Journal of Environmental Research and Public Health. 2023;20(6):4686. doi:10.3390/ijerph20064686
Mariani M, Viganò P, Gentilini D, et al. The selective vitamin D receptor agonist, elocalcitol, reduces endometriosis development in a mouse model by inhibiting peritoneal inflammation. Human Reproduction. 2012;27(7):2010–2019. doi:10.1093/humrep/des136
