Letters from the Blind Spot: What We Miss about Menstrual Pain

Paola Carrillo-Bustamante
Sep 22
5 min read

Updated: Oct 28

A silent story of endometriosis.

I used to think I understand pain. Until I learned what I had been missing.

The Disappearing Act

Every month, she would vanish into her room. Wrapped in layers of cozy blankets, whether in the freezing Dutch winter or the moody excuse for a summer, she prepared for what we jokingly called "her cave time": water bottles, ice cream, snacks, and all the seasons of Game of Thrones.

She was my best friend and flatmate. I knew she was struggling. She had just moved far from home for the first time. Work was tough. The culture shock was real. And she had what she called "a horrible period."

I thought she was overwhelmed. Or maybe just homesick. Surely, I reasoned, she was using her period as an excuse to hide from the world.

“Just take some ibuprofen,” we’d say. “Push through. Pull yourself together.”

Looking back, I see we weren’t being supportive. We were dismissing her pain.

Ten years later, during a casual phone call, she said it almost in passing: “I found out I have endometriosis. Quite severe.”

I didn’t know what that meant. I had never even heard the word. But once I looked it up, I was stunned. And ashamed.

What Is Endometriosis?

The endometrium is the tissue lining the uterine wall. It thickens each month in preparation for a potential pregnancy, and if an egg is not fertilized, the lining is shed during menstruation.

Endometriosis is a condition where tissue resembling this lining grows outside the uterus—on ovaries, fallopian tubes, the bladder, and sometimes even the bowel or diaphragm. This tissue behaves like it would in the uterus: it thickens, breaks down, and bleeds with each menstrual cycle. But because it has no way to exit the body, it becomes trapped. This causes chronic inflammation, debilitating cramps, fatigue, and, in many cases, infertility.

Globally, it affects 1 in 10 women of reproductive age. That means over 7 million women in Mexico, 3.5 million in Colombia, and millions more across Argentina, Chile, Brazil, and Ecuador.

Diagnosis

Because its symptoms are broad and often dismissed, endometriosis can be difficult to diagnose. The standard begins with a clinical evaluation. Doctors take a detailed medical history and perform a pelvic exam, looking for signs such as pelvic tenderness, a fixed retroverted uterus, or nodules.

Imaging tools like transvaginal ultrasound (TVUS) and MRI are now first-line options in many urban medical centers. TVUS with bowel preparation can detect ovarian cysts and deep endometrial lesions. MRI helps map complex cases and guide surgical planning. However, access to these diagnostics can be limited in rural or public clinics.

Historically, laparoscopy (a minimally invasive surgery) was required to confirm diagnosis. But this is a painful and expensive procedure, often inaccessible to many women. While still valuable, many healthcare systems now recognize that treatment can begin based on clinical and imaging evidence alone.

Emerging innovations like menstrual blood biomarker testing, such as the ETH Zurich color-changing microstrip and MenstruAI app, may offer low-cost, non-invasive diagnostic alternatives in the near future.

Treatment Options

There is no known cure for endometriosis, but treatments aim to manage symptoms and improve quality of life. Options include:

Hormonal therapies: Birth control pills, progestins, and GnRH agonists help suppress menstruation and slow the growth of endometrial tissue.
Pain management: NSAIDs like ibuprofen can relieve symptoms, though they’re often insufficient for severe cases.
Surgical interventions: Laparoscopic excision or ablation of endometrial implants is used when hormonal treatments fail or fertility is a concern.
Fertility treatments: Options like IVF may be recommended for women trying to conceive.

Multidisciplinary care: In Latin America, specialized centers now provide coordinated care involving gynecologists, radiologists, fertility experts, and pain specialists.

The Hidden Cost

My friend found out too late. Her ovaries and fallopian tubes were so affected that the eggs couldn’t be released or fertilized. Even when they were, implantation was nearly impossible due to inflammation and disrupted pH levels. By the time she had answers, her options had narrowed.

We all should have known. I should have known. Her boyfriend. Our flatmates. She, of course, should have known. But this is a piece of education that goes missing in our society.

In Latin America, the average time from first symptoms to diagnosis is 7 to 10 years. In Mexico, it’s nearly nine years. In Ecuador, between five and eight. In Colombia, delays can stretch from four to eleven years.

That’s not just a gap in care. That’s a generation of women dismissed, told that their pain is normal.

In fact, a regional study found that 42% of healthcare providers in Latin America had received no training on endometriosis. Worse, over one-third considered severe menstrual pain "normal."

Innovation and Hope

Endometriosis remains under-researched. There’s no known cause, no prevention, and no cure. But there is hope.

Chile has issued national guidelines to improve early diagnosis. Colombia has introduced legislation to create standardized diagnostic pathways and fund specialized care. Mexico has developed multidisciplinary centers, like the one at INPer (National Institute of Perinatology), offering comprehensive, team-based treatment.

Technology is also opening new frontiers. Particularly exciting is a color-changing microstrip in menstrual pads developed at ETH Zurich. Like the paper used in COVID tests, the strip changes color if menstrual blood contains abnormal levels of certain proteins (biomarkers) associated with conditions like endometriosis. A user can take a picture, upload it to MenstruAI (an app that analyzes the results), and receive a preliminary result to discuss with their doctor.

This is a major step forward in early, non-invasive, fast, and affordable diagnosis. But we still need better treatments. The science is gaining momentum, and so must our awareness.

A Brave Face, and a Bigger Question

My friend’s chances of having a child are now slim. Her pain was silent, but constant. Still, she smiled. She pushed through. She finished her PhD. She wore a brave face.

But must bravery always come at such a cost?

This isn’t just a “women’s issue.” It’s a human blind spot. We dismiss what we don’t understand. And in doing so, we leave people to suffer alone.

Call to Care

If you’ve never heard of endometriosis, you’re not alone. But maybe it’s time we all started listening harder.

Because when someone disappears behind closed doors every month, maybe it’s not just a bad day. Maybe it’s a call to care.

👉 Let’s stop normalizing pain. Share this story. Ask questions. Listen. And if you suspect something’s not right—with yourself or someone you love—don’t wait. Speak up.

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