Endometriosis – Causes, Symptoms, Stages, And Treatment

Perhaps you would like to wear the clothes of your choice without worrying about how they will fit once the endo belly (endometriosis bloat) has set in. Maybe you would like to get past your period without experiencing crippling stress and misery.

Dr. Hrishikesh Pai Created on 28th Mar, 22

Do you feel like endometriosis is in charge of your life, goals, and even your relationships? Are you weary of taking sick leaves and being exhausted all of the time?

Perhaps you would like to wear the clothes of your choice without worrying about how they will fit once the endo belly (endometriosis bloat) has set in. Maybe you would like to get past your period without experiencing crippling stress and misery.


Please do not worry; get in touch with Dr. Hrishikesh Pai, founder of Budget Fertility Centre and among the best gynecologists in Mumbai, for a safe and effective solution.


Read on to understand endometriosis, its causes, stages, and treatment in Mumbai.


What is endometriosis?

The uterus is made up of 2 kinds of cells - muscular and glandular cells. The muscular cells make up your uterine walls (myometrium), and the glandular cells make up your uterine cavity lining (endometrium).


Dr. Hrishikesh Pai, an acclaimed fertility specialist in Mumbai, explains that endometriosis is a painful condition where the endometrium cells start growing outside your uterus. Endometriosis most commonly occurs in the pelvic area, the ovaries, bowel, and bladder.


What can cause endometriosis?

Despite extensive research worldwide and the condition's long history, a clear root cause for endometriosis remains elusive. There is no single universally accepted explanation that explains all occurrences to date.


Scientists and researchers have proposed some theories, which include:

Retrograde menstruation

Endometrial cells from inside the uterus flow out with your menstrual blood during menstruation. Retrograde menstruation occurs when the endometrial cells flow back into your pelvic cavity via the fallopian tubes. Some of them flow into your abdominal cavity and continue to grow.


Disorder of the immune system

Your body may be unable to detect and destroy the endometrial-like tissue growing outside your uterus due to an immune system dysfunction.


Scar implantation after surgery

Endometrial cells may cling to the surgical incision after a procedure such as a C-section or a hysterectomy.


Genetic theory

According to a new theory, endometriotic lesions may arise from endometrial, stem cells, or bone marrow with inherited genetic abnormalities.

Certain families are more prone to endometriosis than others. Women, who have a close female relative suffering from endometriosis, have a 7-fold greater risk of having the disease, implying a genetic predisposition.


What are the symptoms of endometriosis?

The primary symptom that characterizes endometriosis is pain, which may increase over the years. Since endometriosis manifests itself in a number of ways, the type and intensity of pain might differ.


The common symptoms include:

Dysmenorrhea (painful periods): Pelvic pain and cramps can start before a menstrual cycle and last several days. You may also experience pain in your lower back and abdomen.


Dyspareunia (pain during sex): Endometriosis can cause pain during or after a sexual encounter.


Painful urination and bowel movements: Endometriosis can make urinating and passing stool a painful experience during your periods.


Intermenstrual bleeding and/or heavy flow: You may occasionally bleed between your periods and experience excessive bleeding during menstruation.


Infertility: In some cases, endometriosis is the first diagnosis in women seeking infertility treatments.


Other symptoms: You may experience constipation, diarrhea, fatigue, migraines, nausea, or bloating, especially during your menstrual periods.


Dr. Hrishikesh Pai, among the leading gynecologists in Mumbai, says that the symptoms are not affected by the stage of your condition in most cases.


Sometimes women with stage 4 endometriosis may not feel much pain, while others with stage 1 endometriosis may experience worse pain. 


What are the 4 stages of endometriosis?

Endofound.org - Endometriosis Foundation of America has proposed a staging system known as the Endofound Endometriosis Classification using the anatomical position and infiltration level.


This system was designed to understand and diagnose the disease, develop better treatments, improve research, and streamline interaction between researchers and health providers.


Endofound Endometriosis Classification


Stage I: Peritoneal endometriosis

The most minimal stage of endometriosis in which the endometriosis tissue infiltrates the peritoneum (the membrane lining your abdomen). 


Stage II: Ovarian Endometriomas (Chocolate Cysts)

In this stage, endometriosis has already settled inside your ovaries. These ovarian cysts are particularly risky because they can break and spread endometriosis throughout your pelvic cavity.


Stage III: Deep Infiltrating Endometriosis I (DIE I)

The first type of deep infiltrating endometriosis affects the organs within your pelvic cavity, including the ovaries, uterus, and rectum. It can significantly alter the anatomy of your pelvic organs.


Stage IV: Deep Infiltrating Endometriosis II (DIE II)

This is a more severe form of DIE which affects organs both inside and outside your pelvic cavity. The organs affected can include the heart, lungs, diaphragm, appendix, and bowels.


How is endometriosis treated?

We provide several endometriosis treatments in Mumbai at Budget Fertility Centre, a state-of-the-art fertility clinic. Our treatments include:


Hormonal treatment, which may comprise:

Oral contraceptives, with a combination of estrogen and progestin (a synthetic variant of progesterone) hormones, suppress ovulation and menstrual flow.

Gonadotropin-releasing hormone inhibits the production of ovarian hormones, resulting in a kind of "medical menopause”.


Laparoscopic surgery

A minor procedure during which a laparoscope, a slender tube attached with lens and light, is inserted through an incision in your abdominal wall. This procedure enables the doctor to look into your pelvic area and extract the endometrial growths.


Infertility treatment

If an endometrioma is discovered during a regular ultrasound, it can be treated as part of a standard infertility screening. Our specialists can look for tubal patency and utilize IUI to induce ovulation. If that does not work, we may suggest IVF.



More extensive surgery, such as a hysterectomy, may be considered in a small proportion of women with serious complications that are not resolved by medication or surgical treatment. This is especially true for women with adenomyosis, a type of endometriosis in which the endometrium infiltrates the muscle layer of the uterine walls.


The eminent fertility specialist, Dr. Hrishikesh Pai, cautions that a hysterectomy is not an option for women who want to retain their fertility, as pregnancy is not possible after such an operation.


How can I ease the pain of endometriosis?

  • Some simple tips to ease the pain of endometriosis include:
  • Take painkillers 24 hours before you expect menstrual cramps
  • Physical activities such as stretching, walking, dancing, swimming, or other activities
  • Get adequate rest, meditate, and try abdomen or back massages
  • Use a heating pad on your tummy or back
  • Try acupuncture
  • Speak with a close friend, relative, or counselor to de-stress your mental discomfort


If you are looking for ways to manage your endometriosis effectively, look no further. Please speak with the highly experienced Dr. Hrishikesh Pai. He has over 35 years of experience and has helped women living with various conditions improve the quality of their lives.



Endometriosis affects around 190 million reproductive-age women and girls worldwide. Despite this, you may feel isolated in moments of distress and uncertainty. Although further study is needed, following a healthy diet may help to lessen symptoms. 

Physical pain can have an emotional impact as you try to cope with endometriosis. If you have exhausted all other choices and cannot stand enduring symptoms like this any longer, do not delay. It is time to make a change and take back control of your life. 


Fix an appointment with Dr. Hrishikesh Pai, a top-notch gynecologist in Mumbai, so he can help you take charge of your life once more.