Prefer HTon GooglePeriods shouldn’t leave you curled up in pain every month. (Pexel) Think debilitating period pain is normal? Gynaecologist explains the warning signs that mean your menstrual cramps need medical attention.Menstrual cramps are common; disabling pain is not. Discomfort managed with a hot pack and an occasional painkiller is normal physiology. Pain that keeps a girl out of school, sends a woman to the emergency room, causes vomiting or fainting, or does not respond to over-the-counter painkillers is a symptom of disease until proven otherwise. In an interview with HT Lifestyle, Dr Abhishek Mangeshikar, director of the Indian Centre for Endometriosis, Mumbai, shared when period pain needs a closer look.​Also read | Are painful periods normal? Gynaecologist shares when menstrual cramps are concerning: 'Endometriosis can cause…Reason behind severe period painDr Abhishek Mangeshikar said the commonest cause is endometriosis, affecting roughly one in ten women of reproductive age — around 42 million in India. Adenomyosis, fibroids, pelvic infection and, in adolescents, obstructive uterine anomalies account for much of the rest.The commonest cause is endometriosis, affecting roughly one in ten women of reproductive age. (Pexel)“The global delay from first symptom to diagnosis is seven to ten years, and in India, it is often longer. That delay is not caused by a shortage of scanners or surgeons. It is caused by the pain being dismissed — first at home, then by teachers, then too often by doctors,” said Dr Abhishek. Meanwhile, the disease progresses. Superficial deposits become deep infiltrating disease involving bowel, bladder and ureters. The ovarian reserve is lost to endometriomas. Years of untreated pain rewire the nervous system, so pain persists even after the disease is removed.Years of untreated pain rewire the nervous system, so pain persists even after the disease is removed. (Pexel)Signs to watch out forPain requiring absence from school or workPain not controlled by standard painkillersPain during intercourse; pain on passing stool or urine during periodsCyclical bloatingDiarrhoea or blood in urine or stoolCyclical chest or shoulder-tip painDifficulty conceivingAnd a normal ultrasound does not rule out endometriosis. Superficial disease is invisible on imaging. Dr Abhishek suggests not accepting severe pain as it's normal if pain is controlling your life. Pain that stops you from living is not a rite of passage. It is a symptom.Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.Anukriti Srivastava thrives at the intersection of words and voice, where journalism meets storytelling. A digital editor and journalist with over 5 years of experience, she has written across lifestyle, women issues, relationships, entertainment, fashion, and travel. She did her Masters in Broadcast Journalism and has published more than 500+ lifestyle content pieces across platforms.