For many women, period pain is an unwelcome but familiar visitor — something to be managed with painkillers, rest and the reassurance that it’s “normal.” But what if it isn’t? Imagine a young woman in her twenties, curled up on her bathroom floor every month, told time and again by doctors that her pain is simply part of being a woman. Years pass. Her pain worsens. Only after countless appointments, tests and tears does she finally learn the truth: she has endometriosis.
Endometriosis is a long-term condition in which tissue similar to the lining of the womb grows outside it, on the ovaries, fallopian tubes, bowel or other pelvic organs. It can cause severe pain, heavy bleeding, fatigue and in some cases, fertility problems. Despite being estimated to affect around one in ten women of reproductive age, it remains one of the most frequently misdiagnosed gynaecological conditions [1]. Studies show that it can take anywhere from seven to ten years for women to receive an accurate diagnosis [2].
This isn’t just a medical issue; it’s a social one. Delayed diagnosis means years of unmanaged pain, emotional strain, and disruptions to work, relationships and fertility plans. Many women are dismissed, told they are overreacting or misdiagnosed with conditions like irritable bowel syndrome or anxiety. The result is a painful mix of physical suffering and psychological frustration, a feeling of being unheard in one’s own body.
This blog explores why endometriosis continues to be misdiagnosed despite its prevalence. It delves into the medical, cultural and systemic factors behind these delays and shares real stories of women who endured years of uncertainty before finally being taken seriously. Through their experiences, we aim to understand not only why this problem persists, but also how awareness, empathy and better medical understanding can change the course for others still searching for answers.
What is Endometriosis?
Endometriosis is a chronic, often painful condition in which tissue similar to the lining of the womb, called the endometrium, grows in places where it doesn’t belong. These growths can occur on the ovaries, fallopian tubes, outer surface of the uterus or other pelvic organs. Each month, just like the uterine lining, this tissue thickens and bleeds in response to hormonal changes. However, unlike menstrual blood, it has no way to leave the body. Over time, this trapped tissue can cause inflammation, scarring and the formation of adhesions, bands of fibrous tissue that can bind organs together and cause significant pain.
According to Yale Medicine, endometriosis affects around one in ten women of reproductive age, a figure echoed by multiple studies worldwide [3]. However, experts believe the real number is likely much higher because many cases go undiagnosed or are mistaken for other conditions. Research highlights that delayed or missed diagnosis remains one of the most pressing challenges in women’s health today, with symptoms often misunderstood or minimised [4].
The symptoms of endometriosis can vary dramatically from one person to another. The most common include pelvic pain that intensifies during menstruation, chronic lower back or abdominal pain, pain during or after sexual intercourse, heavy or irregular menstrual bleeding, bloating and digestive disturbances. Some women experience severe fatigue, while others struggle with fertility; in fact, endometriosis is among the leading causes of infertility in women.
What makes the condition particularly challenging is its unpredictability. Some women with extensive endometrial growths may feel little to no discomfort, while others with minimal lesions experience crippling pain. This inconsistency often complicates diagnosis, leading to years of trial, error, and frustration before the condition is correctly identified.
Endometriosis is not simply “bad period pain,” it is a complex medical disorder that requires awareness, timely recognition, and sensitive care. Understanding its nature is the first step towards addressing the widespread delays and misconceptions that surround it.
The Diagnostic Journey of Endometriosis: Typical Delays and Misdiagnoses
The diagnostic journey for Endometriosis is one marked by frustration, missed cues and prolonged uncertainty. Studies consistently show that from the time a woman first experiences symptoms to the moment she receives an accurate diagnosis can take several years. A review found diagnostic intervals of up to seven to ten years between symptom onset and confirmed diagnosis [5]. In another major analysis, the average diagnostic delay worldwide was 6.8 years (ranging from 1.5 to 11.4 years), underscoring the global scale of the issue [6].
One of the main reasons for this delay is that endometriosis often mimics other conditions. Many women are initially treated for problems such as irritable bowel syndrome (IBS), urinary tract infections, ovarian cysts, or fibroids. In some cases, their symptoms are mistaken for pelvic inflammatory disease or even dismissed as stress-related pain.
For instance, studies have found that women with endometriosis are significantly more likely to also receive a diagnosis of IBS [7], reflecting both the overlap in symptoms and the challenges of accurate detection. Statistics show how widespread this problem is, with some reports estimating average diagnostic delays of up to nine years [8]. Healthcare reviews have described these long intervals as common even among women experiencing severe, disabling symptoms. Each year lost in uncertainty is not merely a statistic; it represents years of unmanaged pain, ineffective treatments and emotional exhaustion.
For many women, the journey to diagnosis involves countless appointments and repeated explanations of symptoms that are often minimised or misunderstood. This prolonged process not only delays relief and treatment but also allows the disease to progress, sometimes leading to more extensive complications. Understanding why these delays happen is crucial to improving early recognition and ensuring women’s pain is finally taken seriously.
Why Misdiagnosis and Delay Happen in Endometriosis: Contributing Factors
The reasons behind the frequent misdiagnosis and delayed detection of endometriosis are multifaceted, spanning personal, medical and systemic levels.
Patient-related factors
In many cultures, menstrual pain is seen as an unavoidable part of womanhood. Girls often grow up hearing that cramps and heavy periods are “normal,” which can make them less likely to seek medical help early. Even when they do, the tendency to minimise or normalise pain often leads to underreporting of symptoms. Many women delay consulting a doctor simply because they believe their experiences are typical of menstruation. Shame and cultural stigma surrounding discussions about reproductive health also play a role, discouraging open conversations and timely care.
Provider-related factors
At the primary-care level, endometriosis can be challenging to identify because its symptoms overlap with a wide range of other conditions. General practitioners often see patients presenting with pelvic pain, bloating or fatigue, signs that may initially resemble irritable bowel syndrome, urinary infections or stress-related discomfort. The variability of symptoms makes it difficult to recognise a consistent pattern and diagnostic imaging can add further complexity, as scans and ultrasounds may not always reveal smaller or deep-seated lesions. Given these challenges, and the limited training opportunities in specialist gynaecology available in some settings, healthcare providers may understandably focus on more common explanations first. This can unintentionally lead to delays in referral or diagnosis.
Systemic and methodological factors
The most common method for confirming endometriosis remains laparoscopy, a minimally invasive surgical procedure that allows direct visualisation of the lesions. Because it is surgical, it’s often reserved for advanced cases or when other explanations have been ruled out, delaying formal diagnosis. Healthcare systems with limited specialist services, long waiting times and inconsistent referral pathways add further obstacles.
Symptom overlap and variability
Endometriosis rarely presents the same way in two people. The condition can affect different organs and manifest as gastrointestinal pain, urinary symptoms or severe fatigue, depending on where the tissue grows. This diversity makes it easy to misattribute symptoms to other disorders, resulting in fragmented treatment and years of uncertainty.
Collectively, these factors form a web of delay; one reinforced by societal silence, medical uncertainty and structural limitations. Breaking this cycle requires not only medical advancement but also cultural change, where women’s pain is heard, believed and investigated with the seriousness it deserves.
Endometriosis in Singapore: Stories of Delayed Diagnosis
Statistics tell one story, but the human experience behind them reveals another, one of endurance, confusion and also strength. Over the years, Dr Ma Li has met many women whose paths to an endometriosis diagnosis were long and difficult. Each journey is unique, yet the pattern of delayed recognition and repeated misdiagnosis is all too familiar. Here are a few stories from our patients, shared anonymously, that highlight how these experiences affect daily life, work and emotional wellbeing.
A university student in her twenties
She began experiencing sharp pelvic cramps in her late teens. Each month, the pain left her unable to attend classes or social events, but she was repeatedly told that some women simply have “painful periods.” After years of medication changes and dismissals, a laparoscopy finally revealed endometriosis on her ovaries and pelvic wall. The delayed diagnosis brought both relief and frustration, relief to finally have an explanation and frustration that it had taken six years to be believed.
A young professional
For nearly a decade, she battled bloating, nausea and unpredictable bowel habits. She was treated for irritable bowel syndrome, gastritis and even anxiety before imaging revealed deep endometriotic lesions on her bowel and bladder. Living with undiagnosed pain had affected her work performance and confidence, leaving her fearful of being seen as unreliable.
A mother in her thirties
Heavy, painful periods had been part of her life since adolescence, but she learned to push through them. Over time, chronic fatigue and back pain forced her to take repeated sick leave, and she was told it might be fibroids or depression. A specialist referral finally led to a diagnosis of endometriosis, nearly twenty years after her first symptoms. By then, she had lost her job and much of her confidence.
These experiences show what statistics alone cannot: that behind every delayed diagnosis lies a life interrupted. Years of uncertainty can erode not only physical health but also self-trust and emotional wellbeing. Recognising these experiences is key to improving awareness, shortening diagnostic timelines, and ensuring women’s pain is never dismissed as “just period pain.”
Consequences of Mis- and Delayed Diagnosis in Endometriosis
When endometriosis is not diagnosed early, the effects extend far beyond physical discomfort. The stories of our patients shared earlier: the student who lost years of education to unexplained pain, the professional who struggled to stay employed and the mother who endured decades before being believed reflect just how far-reaching these consequences can be.
Physical consequences
For many women, the longer endometriosis remains undiagnosed, the more advanced it becomes. In our patients’ cases, repeated delays allowed the condition to progress, leading to dense adhesions and more extensive lesions that required surgical treatment. Chronic inflammation can damage the ovaries and fallopian tubes, reducing fertility and making conception more difficult. Some of our patients only discovered the condition after facing challenges with pregnancy or undergoing fertility screening. By this stage, management becomes more complex, and treatment may involve a combination of surgery and hormonal therapy to control symptoms and preserve reproductive health.
Emotional and social consequences
The emotional toll of being dismissed or misdiagnosed for years is immense. Several of our patients shared how they began doubting their own pain after being told that their symptoms were “normal” or “stress-related.” Living with unpredictable flare-ups while trying to maintain relationships, careers or studies led to exhaustion, frustration, and in some cases, anxiety or depression. The feeling of being unheard, of having to justify one’s pain, was often described as more distressing than the physical discomfort itself. Restoring emotional wellbeing after such experiences takes time, empathy, and validation.
Economic and life impact
The economic and social costs of delayed diagnosis are also significant. As seen in the stories we shared, chronic pain and fatigue forced some patients to take extended medical leave or leave their jobs altogether. Others struggled to meet academic deadlines or manage household responsibilities. These disruptions don’t just affect individual lives; they have wider implications for productivity and quality of life. When women spend years searching for answers, they lose not only time but also opportunities for advancement, stability, and confidence.
The experiences of our patients highlight that endometriosis is not simply a gynaecological condition but a whole-person disease, one that affects physical health, emotional wellbeing and life trajectory. Early diagnosis and compassionate care can change this story, giving women the chance to live without years of uncertainty and pain.
What Can Be Done to Improve Endometriosis Diagnosis and Awareness
The stories and experiences of our patients underline one crucial truth — delayed diagnosis is not inevitable. With greater awareness, improved training, and more open conversations about women’s health, the long diagnostic journey that so many endure can be shortened. Addressing this issue requires action at every level — from individuals recognising when something isn’t right, to healthcare providers and policymakers creating systems that support early and accurate diagnosis.
For individuals
Awareness begins with listening to your body and acknowledging that severe or persistent period pain is not normal. Many of our patients delayed seeking specialist help because they believed their discomfort was something they had to endure. Recognising patterns, such as pain that interferes with work, school or daily activities is key. Women are encouraged to document their symptoms, track their cycles and advocate for further investigation when pain persists. Seeking a referral to a gynaecologist with experience in endometriosis can make a significant difference in achieving timely diagnosis and effective management.
For clinicians
Healthcare professionals play an essential role in changing the narrative around endometriosis. Greater awareness and training at the primary-care level can help doctors recognise that symptoms such as chronic pelvic pain, bowel disturbance or fatigue may indicate something more than common menstrual discomfort. Our patients’ stories show that early referral to a specialist can prevent years of unnecessary suffering. Clinicians are encouraged to take pain reports seriously, even when imaging or test results appear inconclusive, and to consider endometriosis as part of the differential diagnosis rather than a last resort.
For systems and policy
Broader systemic improvements are needed to close the diagnostic gap. Endometriosis remains underfunded and underrepresented in research, despite affecting millions worldwide. Investment in non-invasive diagnostic tools, such as advanced imaging and biomarker testing, could reduce reliance on surgical confirmation through laparoscopy. Clearer clinical guidelines, streamlined referral pathways and multidisciplinary women’s health services would also ensure patients receive faster, more coordinated care. At the policy level, nationwide awareness campaigns and education initiatives can help normalise open discussion about menstrual and reproductive health, reducing stigma and encouraging earlier consultation.
Early diagnosis changes lives. Each step, whether a woman trusting her instincts, a doctor asking one more question or a health system improving its support structures brings us closer to a future where endometriosis is recognised promptly, treated effectively and no longer allowed to silence the women it affects.
Conclusion: The Path Ahead and Hope for Women with Endometriosis
Endometriosis is far more common than most people realise, yet it continues to be one of the most misdiagnosed and misunderstood conditions in women’s health. The stories shared by our patients reflect what research consistently shows: that delayed diagnosis can affect every aspect of life, from physical health and fertility to emotional wellbeing and work. Too often, women spend years being told their pain is “normal,” when in truth it signals something far more serious.
Yet there is hope. Awareness of endometriosis is growing, and more women are being encouraged to speak openly about their symptoms. Medical understanding has advanced in recent years and specialists now have better tools and treatment options than ever before. Each patient who finds the courage to seek help and each clinician who listens without dismissal, moves us closer to breaking the silence that has surrounded this condition for too long. The resilience of those living with endometriosis serves as a reminder that progress is possible. With earlier recognition and compassionate care, women can regain control of their health and quality of life.
If you are experiencing ongoing pelvic pain, heavy periods or symptoms that disrupt your daily activities, do not ignore them. Schedule a consultation with Dr Ma Li’s clinic to discuss your concerns, receive a thorough assessment and explore the most appropriate treatment options for you. Early diagnosis and the right care can make all the difference.
References
- Endometriosis. Retrieved October 31, 2025, from https://www.who.int/news-room/fact-sheets/detail/endometriosis
- De Corte, P., Klinghardt, M., von Stockum, S., & Heinemann, K. (2025). Time to diagnose endometriosis: Current status, challenges and regional characteristics—a systematic literature review. Bjog, 132(2), 118–130. https://doi.org/10.1111/1471-0528.17973
- Endometriosis. Yale Medicine. Retrieved October 31, 2025, from https://www.yalemedicine.org/conditions/endometriosis
- Hudson, N. (2021). The missed disease? Endometriosis as an example of ‘undone science.’ Reproductive Biomedicine & Society Online, 14, 20–27. https://doi.org/10.1016/j.rbms.2021.07.003
- De Corte, P., Klinghardt, M., von Stockum, S., & Heinemann, K. (2025). Time to diagnose endometriosis: Current status, challenges and regional characteristics—a systematic literature review. Bjog, 132(2), 118–130. https://doi.org/10.1111/1471-0528.17973
- Fryer, J., Mason-Jones, A. J., & Woodward, A. (2025). Understanding diagnostic delay for endometriosis: A scoping review using the social-ecological framework. Health Care for Women International, 46(3), 335–351. https://doi.org/10.1080/07399332.2024.2413056
- Chiaffarino, F., Cipriani, S., Ricci, E., Mauri, P. A., Esposito, G., Barretta, M., Vercellini, P., & Parazzini, F. (2021). Endometriosis and irritable bowel syndrome: A systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 303(1), 17–25. https://doi.org/10.1007/s00404-020-05797-8
- Ellis, K., & Wood, R. (2024). A decade to wait: Update on the average delay to diagnosis for endometriosis in Aotearoa New Zealand. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 64(5), 524–529. https://doi.org/10.1111/ajo.13836