Period pain isn't always normal: Could your genes be putting you at risk of endometriosis?
New Delhi: Period pain is often dismissed as a normal part of menstruation, but severe or persistent pain could be a sign of endometriosis, a chronic condition that can affect fertility and significantly impact a woman's quality of life, according to doctors.
Experts said growing evidence suggests that genetic and epigenetic factors may influence a woman's susceptibility to the condition, highlighting the need for greater awareness and earlier 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.
In India, most women wait 7-10 years for a diagnosis because often doctors lack simple tools to identify it early, she pointed out.
This delay leads to worsening pain, missed school or work and decreased quality of life.
Over the past decade, epigenetics has emerged as a central mechanism in the pathogenesis 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.
Dr Jyotsna Suri, Head of the Department of Gynaecology and Obstetrics at Safdarjung Hospital, Delhi, said that endometriosis is not simply a genetic disorder but a complex disease resulting from the interaction of 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 play an important role by altering how genes are expressed without changing the underlying DNA sequence, she said.
"Importantly, severe period pain should never be dismissed as something a woman simply has to live with. Pain that disrupts daily life, 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," Dr Suri highlighted.
Dr Bindu Bajaj consultant in the Department of Gynaecology and Obstetrics at Safdarjung hospital, stressed that awareness among adolescents and families is equally important, as painful periods can begin early 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 can also present with pain during bowel movements or urination around menstruation and, later, 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.
"The message for women is simple: disabling period pain deserves medical attention and should not be normalised," she said.
With greater research into genetic and epigenetic mechanisms, experts said a better understanding of individual risk could eventually help identify women who need closer monitoring and enable more personalised approaches to treatment.