Lena Dunham Spent Years in Pain Before Getting Answers. Your Daughter Shouldn't Have To.

Excerpt: Endometriosis affects about 1 in 10 women, yet many wait years for a diagnosis. Dr. Martin Pakideh explains why it gets missed, which symptoms deserve attention and how it's treated today.

In this article

1. What endometriosis actually is

2. Why it takes so long to diagnose

3. The symptoms that should not be ignored

4. How we diagnose it today

5. Treatment is more than "wait and see"

6. Frequently asked questions

Lena Dunham has one of the most famous endometriosis stories in Hollywood. In her 2026 memoir, Famesick, she describes years of pain and a surgery where doctors removed 37 lesions, including some on her liver, spine and abdominal wall. She had a hysterectomy at 31.

Here's the part that should make every mother of a teenage girl sit up: her story isn't unusual. The average delay from first symptoms to an endometriosis diagnosis is still measured in years, not months.

What endometriosis actually is

Endometriosis is tissue similar to the lining of the uterus growing where it doesn't belong: on the ovaries, the bladder, the bowel, the ligaments behind the uterus, and sometimes much farther away. That tissue responds to your monthly hormones. It inflames, bleeds and scars, but it has nowhere to go.

According to the Office on Women's Health, it affects at least 11% of women of reproductive age in the U.S. That's millions of women, many of whom have been told their pain is "just a bad period."

Why it takes so long to diagnose

The delay usually isn't one doctor's mistake. It's a chain of small ones.

• Pain gets normalized. Girls hear "cramps are part of being a woman" from relatives, coaches and sometimes doctors.

• Symptoms look like other things. Bowel pain gets labeled IBS. Bladder pain gets treated as recurring UTIs.

• Imaging often looks normal. A standard ultrasound can miss small or superficial lesions entirely.

• Birth control masks it. The pill often helps the pain, which is good, but it can delay the question of why the pain was there.

The symptoms that should not be ignored

Cramps are common. Cramps that run your life are not. Get evaluated if you have:

• Period pain that makes you miss school, work or plans

• Pain that over-the-counter pain relievers don't touch

• Pain with sex, especially deep pain

• Painful bowel movements or urination during your period

• Pelvic pain between periods

• Trouble getting pregnant

How we diagnose it today

You don't always need surgery to start treatment. Current guidance supports making a clinical diagnosis based on your symptoms and exam, then starting treatment right away. Specialized ultrasound or MRI can find cysts on the ovaries (endometriomas) and deeper disease.

When symptoms persist, minimally invasive surgery lets us see the disease directly, confirm it with a biopsy and remove it in the same procedure. At Monroe OBGYN, I perform these surgeries robotically through a few small incisions. You can read more about how we evaluate pelvic pain and endometriosis.

Treatment is more than "wait and see"

Options depend on your symptoms, your age and whether you want children:

1. Anti-inflammatory medication for milder pain

2. Hormonal treatment such as birth control pills, progestin therapy or a hormonal IUD

3. Newer oral medications that lower estrogen levels to calm the disease

4. Surgery to remove the endometriosis when medicine isn't enough

5. Hysterectomy for some women who are done having children, ideally with the endometriosis outside the uterus removed too

That last point matters. A hysterectomy alone doesn't remove disease that's sitting on the bowel or bladder. Dunham's own story shows how complicated this can get. I explain when a hysterectomy makes sense, and when it doesn't, in Amy Schumer Had Her Uterus and Appendix Removed. Here's Why.

You don't need to be famous to be believed. If your pain is changing your life, that alone is reason enough to see a gynecologist.

Struggling with painful periods? Book a visit at Monroe OBGYN or call (734) 242-2022.

Frequently asked questions

At what age can endometriosis start? It can start with a girl's first periods. Many women with endometriosis say their pain began in their teens, so severe period pain in a teenager is worth a visit, not a shrug.

Can a regular ultrasound show endometriosis? Sometimes. An ultrasound can find endometriomas (cysts on the ovaries) and some deeper disease, but it often misses small or surface lesions. A normal ultrasound doesn't rule endometriosis out.

Do I need surgery to be diagnosed? Not always. We can often make a clinical diagnosis from your symptoms and exam and start treatment right away. Surgery is the only way to confirm it with a biopsy, and we usually save it for when medicine isn't helping enough.

Is endometriosis the same as having bad cramps? No. Cramps are common and usually ease with over-the-counter pain relievers. Endometriosis pain tends to be severe, can happen outside your period and often comes with pain during sex, bowel movements or urination.

References

• Office on Women's Health. Endometriosis.

About the author: Dr. Martin Pakideh, DO, is a board-certified OB-GYN at Monroe OBGYN specializing in robotic and minimally invasive gynecologic surgery, pelvic reconstructive surgery and urinary incontinence treatment. He has trained surgeons from hospitals across Michigan in advanced robotic techniques.

This post is for general education and isn't medical advice. Talk to your own doctor about your situation.