In this episode of The Care Circle powered by Motherhood Hospitals, host Snehaa is joined by Dr. Preety Aggarwal, Medical Director, Obstetrics and Gynaecology at Motherhood Hospitals, Gurgaon, to shed light on endometriosis and the hidden fertility barriers it can create.
Together, they explore a condition that affects millions of women worldwide but is often misunderstood, dismissed, or diagnosed years after symptoms begin. Dr. Aggarwal explains what endometriosis truly is, a condition where tissue similar to the uterine lining grows outside the uterus, and how it can lead to chronic inflammation, severe pelvic pain, and long-term reproductive challenges.
The conversation breaks down why severe period pain should never be normalised, why diagnosis can take six to eight years globally, and the wide range of symptoms women may overlook, from painful periods and fatigue to pain during intercourse and difficulty conceiving. The episode also examines how endometriosis can impact fertility through inflammation, scar tissue formation, ovarian cysts, and changes in the uterine environment that affect implantation.
Importantly, the discussion reassures listeners that infertility is not inevitable with endometriosis. Dr. Aggarwal explains when women should seek fertility consultation, how early ovarian reserve testing can help guide reproductive planning, and the treatment options available, including pain management, hormonal therapy, laparoscopic surgery, and assisted reproductive techniques such as IUI or IVF.
Beyond the medical aspects, the episode also acknowledges the emotional toll of living with chronic pain and being dismissed for years, reinforcing the importance of validation, early consultation, and individualised care. The conversation ultimately encourages women to trust their symptoms, seek timely evaluation, and approach fertility planning with knowledge, support, and confidence

Here are the key points you shouldn’t miss from this episode:

• Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing inflammation, pain, and sometimes scar tissue.
• Severe period pain that disrupts daily life is not normal and should always be medically evaluated.
• Many women experience a diagnosis delay of six to eight years because symptoms are often normalized or dismissed.
• Common symptoms include painful periods, chronic pelvic pain, pain during intercourse, fatigue, heavy bleeding, and difficulty conceiving.
• Endometriosis can affect fertility by causing inflammation, scar tissue formation, blocked fallopian tubes, and reduced ovarian reserve.
• Ovarian cysts known as endometriomas can impact both egg quantity and egg quality.
• Infertility is not inevitable with endometriosis and many women conceive naturally or with appropriate treatment.
• Early evaluation, including ovarian reserve testing such as AMH and ultrasound, can help guide proactive fertility planning.
• Treatment options may include pain management, hormonal therapy, laparoscopic surgery, and fertility treatments such as ovulation support, IUI, or IVF.
• Surgery can improve fertility in selected cases but must be carefully timed to protect ovarian reserve.
• Endometriosis affects more than physical health and can impact mental wellbeing, relationships, work productivity, and self esteem.
• Early consultation, validation of symptoms, and individualized care can significantly improve both quality of life and fertility outcomes.

Dr. Preety Aggarwal, Medical Director, Obstetrics and Gynaecology at Motherhood Hospitals, Gurgaon.

0:15 – Intro: Women’s Day & women’s health focus
0:49 – Topic: Endometriosis – pain & fertility impact
1:19 – Guest: Dr. Preety Aggarwal
1:35 – What is endometriosis? Tissue outside uterus → inflammation & scarring
2:27 – Symptoms: Severe periods, pain during intercourse/bowel, heavy/irregular bleeding, fatigue, fertility issues
3:57 – Importance of early evaluation
6:09 – Fertility impact: Egg quality, blocked tubes, ovarian reserve
6:55 – Infertility not inevitable; early assessment helps
7:27 – When to consult: <35 → 6 months trying; >35 → 3–4 months
8:10 – Myth-busting: Severe pain, pregnancy, hysterectomy, scans, infertility
10:05 – Treatment: Pain meds, hormones, surgery, IUI/IVF
11:38 – Rapid-fire: Teens, genetics, diet, exercise, IVF
12:25 – Emotional burden: Mental health & relationships
13:29 – Advice: Pain is real → seek early evaluation
14:23 – Closing: Personalized care at Motherhood Hospitals
15:00 – Outro: Stay informed, take care, keep care circle close

(0:15) Snehaa: Hello and welcome back to The Care Circle, a podcast series by Motherhood Hospitals where we create safe, honest conversations around women and children’s health, fertility and everything in between.
As we celebrate International Women’s Day throughout the month of March, our focus is simple yet powerful, empowering everyone with knowledge, encouraging early action and validating experiences that are often dismissed.
And today we are shedding light on a condition that affects millions of women worldwide, yet often goes underdiagnosed for years.
A condition where pain is normalized, symptoms are brushed aside and fertility concerns quietly build over time. We are talking about endometriosis, the silent struggle behind severe period pain, chronic pelvic discomfort and heavy fertility barriers.
If you have ever questioned whether your period pain is truly normal, if you have wondered why conception feels difficult despite normal reports or if you have struggled for years without clear answers, this episode is for you.
To help us understand this condition and its impact on fertility, we have with us Dr. Preety Aggarwal, Medical Director, Obstetrics & Gynecology at Motherhood Hospitals, Gurgaon.

(1:30) Snehaa: Let’s begin at the very start Dr. Preety, what exactly is endometriosis?

(1:35) Dr. Preety Aggarwal: Endometriosis is actually a condition where there is tissue which is similar to the inner lining of the uterus, that is the endometrium. If this is growing outside the uterus, it is growing in places like the ovaries, it may be growing in the tubes, it may be growing in the bowel and the bladder area.
So this kind of a tissue now responds to the normal cycle of hormone change that occurs in the human body every cycle in the woman, but obviously the endometrium is shed during every menstrual cycle, but the endometrial tissue which is growing at abnormal places is not shed, so it causes inflammation, it causes pain and it causes scarring in the areas around the uterus and the ovaries.
Now this leads to symptoms in women which are very painful periods, may be difficulty in conception, can cause infertility, can also cause some kind of large ovarian cysts and tumours.
So this is debilitating condition with very painful periods for most of the women.

(2:47) Snehaa: So it’s not just back cramps doctor, right? It’s more than that, is it?

(2:50) Dr. Preety Aggarwal: No, any painful periods which are very painful for the patient should always be evaluated. If it is a young girl, a teenager or an older woman, everybody needs to be assessed and checked.

(3:04) Snehaa: So doctor, why does diagnosis of this condition take so long to detect?

(3:08) Dr. Preety Aggarwal: Because we all feel that pain during periods is very normal, most of the people will say that pain is very very normal, so they tell everybody that you don’t have to worry, you can take a painkiller or a hot water bottle and wait.
Symptoms again can be very very variable. So people with very severe disease may have very less symptoms and people who have, you know, mild disease may have very painful periods. So that’s also confusing.
Always good imaging cannot happen in different places and therefore sometimes it’s very difficult to detect. So you have to use, you know, mix of investigations to check all this. And many women, like, they do not, you know, they feel that this could just be normal, so they do not come for a medical checkup and, you know, get to the doctors.

(3:57) Snehaa: Understood, doctor. So doctor, let’s list some symptoms clearly because many women listening might relate. If you can name certain common symptoms that are related to this particular gynae condition.

(4:08) Dr. Preety Aggarwal: Yes, so the most common symptom is very severe period cramps that the patient can have or severe period pain. But also there can be pain during intercourse, there can be pain during bowel movements and also the patient can have irregular or heavy bleeding. Sometimes there may be extreme fatigue that the patient faces and there may be difficulty in conception or fertility may be a challenge, patient may require some help and treatment.

(4:37) Snehaa: Many women tend to normalize severe period pain, doctor, especially in their teens or early 20s. So from a medical standpoint, when should a woman take this condition seriously and is there a structured way to evaluate and plan if she is diagnosed early?

(4:54) Dr. Preety Aggarwal: So this is a very, very pertinent and important question. We do tend to normalize period pain a lot, but it is really, really important that we diagnose it.
So anybody who’s having very severe menstrual pain, like you need to, you know, I mean, you can take lots of painkillers or you’d need to stay back from work or you have a real problem when your period starts. So those patients really need evaluation. Evaluate this condition early.
So not only ensure pain relief, but we can, you know, ensure reproductive health and also quality of life in the later years.
So from a fertility perspective, the impact is seen more in the 20s and 30s when we see that the ovarian reserve tends to fall. But at the same time, even in teenagers, if we diagnose it, we will be able to treat it earlier for them and they’ll have less problems.
And if we diagnose a woman, I mean, later also, we can preserve her ovarian fertility. We can also take care that we ensure fertility for her. We can tell her alternate methods and evaluate what is the entire situation. So the evaluation part is very, very important.

(6:05) Snehaa: Now let’s address the question that brings many women to the clinic and that is fertility. Doctor, how does this condition affect fertility?

(6:18) Dr. Preety Aggarwal: So endometriosis affects fertility in many ways. So it can damage the egg quality, the inflammation that happens. There may be scar tissue which causes adhesions between the tubes, ovaries, uterus. It can even block the fallopian tubes. There may be ovarian cysts which occupy the normal ovarian tissue and therefore decrease the ovarian reserve. And also the uterine environment may become, you know, not so conducive for implantation and all. So they do face challenges for fertility and for conceiving.

(6:55) Snehaa: So doctor, is infertility inevitable with endometriosis?

(6:59) Dr. Preety Aggarwal: No, it is not inevitable. All patients with endometriosis do not face problems in conceiving. Some of them will conceive naturally if the disease is in a mild stage. But about 30 to 50% of the endometriosis patients can experience fertility challenges. So important is to again, as we were discussing earlier, first of all to evaluate the patient as soon as possible and then to decide a course of management according to that.

(7:27) Snehaa: So when should a woman with endometriosis seek fertility consultation?

(7:31) Dr. Preety Aggarwal: See, if she has any idea that she has endometriosis, I mean, she’s got a scan done or she had severe pain and visited a doctor, then she must evaluate her fertility right then. But otherwise also, all women who are, say, less than 35 years, who have tried for about six months, they are unable to conceive, they must go to the doctor. They must evaluate to rule out any other problems. And the people who are over 35, even if they’ve tried for three, four months, I think they should reach a doctor immediately. Because waiting too long, you know, you might miss something that can cause you a problem later.

(8:10) Snehaa: Understood, doctor. Alright, doctor. It’s a myth bursting time. I’ll say a statement. You have to tell me whether it’s a myth or a fact. My first statement to you is severe period pain is normal.

(8:22) Dr. Preety Aggarwal: So this is a myth because severe pain, which is causing you to, you know, is compromising your lifestyle is not normal. I mean, if you have to stay back from school or work, such pain definitely needs to be evaluated.

(8:37) Snehaa: My second statement is pregnancy cures endometriosis.

(8:43) Dr. Preety Aggarwal: So symptoms do improve during the period of pregnancy because you’re not having your periods for nine months, but the disease does not get cured as such.

(8:57) Snehaa: Hysterectomy cures endometriosis completely.

(9:02) Dr. Preety Aggarwal: So hysterectomy may not cure it completely because you can have endometriosis deposits on the bowel and bladder. So the disease process may not get cured completely.

(9:11) Snehaa: If scans are normal, you don’t have endometriosis.

(9:13) Dr. Preety Aggarwal: So many cases may not clearly show up on an ultrasound and therefore we cannot say that only an ultrasound. If you’re still clinically suspecting it, sometimes you would require an MRI. Sometimes laparoscopy is required to diagnose. So you do not always come to know on a scan.

(9:37) Snehaa: Endometriosis always leads to infertility.

(9:39) Dr. Preety Aggarwal: That’s a myth because many women with endometriosis will conceive naturally and have healthy pregnancies. Or you know, if you give them some treatment or assist them again, they would conceive. So it’s not always infertility.

(10:01) Snehaa: Thank you so much, doctor. That’s really reassuring and very eye-opening insights that you gave. Now my next question to you is, let’s talk about the solutions part, doctor.

(10:05) Dr. Preety Aggarwal: So basically, we’ll have to tailor the treatment options according to every person. But basically, it would depend upon the age of the person. It would depend upon the severity of the disease process, what is the pain level that they are facing, and what are their fertility goals. So it would vary for a teenager and vary for an older woman.
So the options which we would use is, some stages we just have to do pain management if it is a mild disease and it is only pain. Sometimes you would require medical therapy in the form of hormonal suppression. Some cases would also require laparoscopic surgery. And if fertility is the concern, then we should look at fertility first in the way of helping or supporting them with an IUI or an IVF or stimulation and telling them when to conceive. So it has to be individualized according to every person, you know, what age they are presenting to us at and what are their goals at that time.

(11:00) Snehaa: So Dr. Preety, does surgery improve fertility?

(11:03) Dr. Preety Aggarwal: In selected cases, yes, when, you know, you have lots of adhesions, when the anatomy of the entire, I mean, lower abdomen and pelvis is distorted and there’s lots of scar tissue interfering. But surgery has to be carefully timed because we do know that this is a disease process which tends to recur and come back. So if we are planning a pregnancy, then to do it before that is a very good idea if we are thinking in terms of surgery. And repeated surgeries can also affect the ovarian tissue and decrease our ovarian reserve as such. So everything has to be really thought out and then done.

(11:38) Snehaa: Rapid-fire round:

(11:44) Snehaa: Can teenagers have endometriosis?

(12:02) Dr. Preety Aggarwal: Yes.

(12:05) Snehaa: Is endometriosis genetic, doctor?

(12:07) Dr. Preety Aggarwal: It can have a familial tendency.

(12:09) Snehaa: Does diet cure it?

(12:14) Dr. Preety Aggarwal: So anti-inflammatory diet can help endometriosis, but not cure it.

(12:16) Snehaa: Is exercise helpful for this condition?

(12:18) Dr. Preety Aggarwal: Yes, exercise is helpful.

(12:23) Snehaa: Can IVF bypass endometriosis related infertility, doctor?

(12:24) Dr. Preety Aggarwal: Often yes.

(12:25) Snehaa: Before we close, can we talk about the emotional burden of endometriosis, the burden that women go through, doctor, if you can elaborate that?

(12:31) Dr. Preety Aggarwal: Yeah, endometriosis is physical pain as such, but mentally also it affects the person. It can affect your, you know, normal life and your work routine, everything. So it does affect the mental health of the patient. There may be difficulty in intercourse and it can affect relationships between the partners. Your work productivity does go down with endometriosis because of the severe days of pain or irregular bleeding at times. 

It does affect the self-esteem of a patient also because, you know, she sees that so many things are a challenge for her. So that’s why, and also, I mean, to express and to understand becomes difficult, like, because so many things are normalized, therefore she feels that she might not be heard properly. So yes, we have to understand the woman. We have to definitely assess everything properly and help her out in all these things.

(13:33) Snehaa: One final message for women listening today, doctor, what do you have to say to them?

(13:37) Dr. Preety Aggarwal: So we definitely know that this is a difficult condition. So all that you’re thinking about, the pain that you’re facing, that is definitely real. And the struggle that you’re facing, we understand that also. 

But it is important for you to understand yourself that if you get to a good medical person quickly, try and assess the situation and try and, you know, smoothen your further journey, that’s definitely going to help. So we have lots of solutions in medicine today for endometriosis. But the important thing is to diagnose it and to take all the help required. So please don’t, you know, sit at home, just get to a good doctor and always try and assess your situation, understand it and then take the right kind of decisions.

(14:23) Snehaa: And what an incredible, important and empowering conversation that was. If you are experiencing pelvic pain, which is persistent, painful periods that disrupt your life or difficulty conceiving, please know that your symptoms deserve attention. At Motherhood Hospitals, our specialists offer personalized evaluation and evidence-based treatment plans tailored to your age, symptoms and fertility goals.

Early consultation can truly change the trajectory of your health and fertility journey. If you would like to speak to our doctor, reach out to your nearest Motherhood Hospitals and book a consultation today. Until next time, take care, stay informed and keep your care circle close.