SEVERE PERIOD PAIN MAY SIGNAL ENDOMETRIOSIS, EXPERTS WARN

For many women, menstrual pain is often dismissed as a routine discomfort; something to endure quietly with the help of painkillers.

But health experts caution that severe or persistent period pain should never be normalised, as it may signal a serious underlying condition: endometriosis.

For Salimah Abdullah, 34, what began as intense cramps during her university years turned into a debilitating monthly ordeal.

At 24, she experienced severe abdominal pain and heavy menstrual flow, often forcing her to take medical leave.

“Every month, when the pain became unbearable, I would go to a nearby clinic for painkillers after consulting a doctor,” she recalled.

Despite trying various treatments, including traditional remedies and multiple medical consultations, the pain persisted for three years.

Her turning point came four years ago after attending a health talk on endometriosis at a private hospital.

“Following a thorough examination, I was diagnosed with stage four endometriosis,” she said.

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Although newly married at the time and not planning to conceive, she underwent surgery on her gynaecologist’s advice to manage the pain.

“Even though I was diagnosed at the most severe stage, I’m grateful I was able to give birth to a healthy child three years after the surgery,” she added.

 UNDERDIAGNOSED AND OFTEN MISUNDERSTOOD

Endometriosis is an inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, affecting other organs.

It impacts one in 10 women of reproductive age, with symptoms ranging from chronic pelvic pain and painful periods to discomfort during intercourse and infertility.

According to Health Ministry Indicators 2025, there were 1,937 hospital discharges related to endometriosis nationwide — a figure experts believe underrepresents the true scale of the problem.

Consultant gynaecologist at Hospital Picaso, Dr Tan Ee Ping, said low awareness and the widespread normalisation of menstrual pain contribute to delayed diagnosis.

“Severe menstrual pain should not be dismissed, especially when it interferes with daily life,” she said in a recent Zoom interview.

Warning signs include regular dependence on painkillers, missing work or school due to pain, pain radiating beyond the lower abdomen and fatigue and disruption to daily activities,

“If the pain worsens over time or is accompanied by symptoms such as vomiting, gastric issues, leg numbness, diarrhoea, frequent urination or severe bloating, it is not normal,” she stressed.

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She added that even women who develop period pain later in life — in their 20s, 30s or 40s — should treat it as a red flag.

Dr Tan explained that endometriosis is linked to the backflow of menstrual blood, causing inflammation in various parts of the body.

“Symptoms like diarrhoea or gastric pain may indicate bowel or stomach inflammation, while painful urination could point to bladder involvement,” she said.

She also debunked a common misconception: pregnancy is not a cure.

“Symptoms may improve after childbirth but will recur after three to five years. They may improve during pregnancy due to hormonal changes, but they often return afterwards,” she noted, adding that untreated endometriosis may persist until menopause and increase the risk of ovarian cancer.

 INFERTILITY AND THE NEED FOR ADVANCED TREATMENT

Many women with endometriosis experience chronic pelvic pain, heavy bleeding, painful intercourse and unexplained infertility, often without recognising these as warning signs.

“Nearly 50 per cent of women with endometriosis face infertility,” Dr Tan said.

The condition can lead to inflammation, ovarian cysts and scar tissue, making conception difficult.

“Often, women only discover the condition when they struggle to conceive, by which time significant damage may have already occurred,” she added.

Meanwhile, endometriosis specialist at Hospital Picaso, Dr Sharifah Halimah Jaafar, highlighted advances in surgical treatment.

Procedures such as laparoscopy and robotic-assisted surgery can remove endometrial tissue and adhesions with greater precision.

“Robotic surgery has transformed treatment, offering enhanced visualisation, greater precision and faster recovery,” she said.

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However, she emphasised that surgery alone is not a cure.

“A comprehensive treatment plan is essential. This includes hormonal therapy, lifestyle adjustments such as diet and stress management, and regular follow-ups to prevent recurrence,” she said.

CALL FOR A DEDICATED ENDOMETRIOSIS CENTRE

Dr Tan noted that many patients require multiple surgeries, particularly when diagnosis comes late.

Citing a UK study, she said 62 per cent of women with endometriosis undergo repeat surgeries, while only 38 per cent require just one.

“About half of those needing further treatment may undergo three to five surgeries in their lifetime,” she said.

She explained that endometriosis is a complex, multi-organ disease that may affect the bladder, bowel and even the diaphragm.

“Many gynaecologists are trained to focus on the uterus and ovaries, creating gaps in treatment,” she said.

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Effective management often requires a multidisciplinary team, including urologists, colorectal surgeons and cardiothoracic specialists.

“This is why accredited endometriosis centres are crucial; they provide comprehensive care across all affected organs,” she added.

Dr Sharifah echoed the need for a Centre of Excellence for Endometriosis in Malaysia.

“Such a centre would offer advanced diagnostics, cutting-edge treatments like robotic surgery and high-intensity focused ultrasound (HIFU), and most importantly, coordinated and personalised care,” she said.

She stressed that endometriosis should be recognised as a public health issue requiring stronger awareness, better training and improved policy support.

EARLY DETECTION IS KEY

Dr Tan urged women to take menstrual pain seriously and seek medical advice early.

“Severe period pain is not normal. Early detection can prevent complications,” she said.

“If diagnosed at stage one or two, many patients may avoid surgery entirely and reduce their risk of infertility.”

She added that early intervention can significantly improve long-term outcomes and quality of life.

“We want more women to come forward sooner. Early treatment can make all the difference.”