And yet, even as conflict unfolds not in distant lands but before our very eyes, another war continues quietly—relentlessly—inside the bodies of millions of women across the globe.
Endometriosis is not simply the presence of menstrual-like tissue outside the uterus. That definition, while historically accepted, is biologically incomplete, medically unacceptable, and morally insufficient.
Endometriosis begins as a response—an immune and inflammatory reaction to displaced endometrial material. Over time, it evolves into something far more complex: a systemic, nerve-centric inflammatory disease that reshapes anatomy, physiology, and identity. It infiltrates the pelvis, abdomen, diaphragm, sciatic nerve, bladder, bowel—and ultimately, the brain.
Men may die in war.
Women, too often, suffer in silence—and sometimes die slowly from neglect.
Across history and across cultures, women have been subjected to suffering encoded into social structures: menstrual exile, childhood deprivation, psychological and physical abuse, femicide, honor killings, dowry violence, female genital mutilation, acid attacks. These are visible violences.
Endometriosis is an invisible one.
It is a nerve-centric disease. It recruits nociceptive pathways—somatic and visceral. It entangles parasympathetic and sympathetic networks. It stimulates aberrant nerve sprouting, central sensitization, and chronic pain amplification. It alters the brain’s perception of safety, giving rise to panic, anxiety, depression, and, in tragic circumstances, substance dependence.
We speak of nerve-sparing surgery.
But the ultimate organ to be spared is the brain.
For many patients, adolescence marks the beginning—pain dismissed as “normal.” Years follow: misdiagnosis, undertreatment, fragmentation of care. Young women grow into adulthood carrying invisible trauma. Careers are compromised. Fertility is threatened. Relationships fracture. Children watch mothers debilitated by pain. Families destabilize. Society loses productivity, creativity, and leadership.
There are suicides.
There are ruined lives.
There are futures diminished—not by fate—but by delay.
As physicians—particularly as gynecologic endoscopists—we carry a profound responsibility.
Early recognition.
Timely diagnosis.
Thoughtful intervention.
At present, the intervention most consistently capable of altering disease trajectory is precise, complete surgical excision performed at the right time by adequately trained surgeons. Yet even surgery is not enough.
Technical brilliance without continuity of care is failure.
We may perform radical, complex procedures with excellence. But if we fail to follow, to support, to educate, and to advocate, we have treated tissue—not the person. The measure of success is not operative time or surgical virtuosity, but restoration of dignity and quality of life.
Our collective perspective on endometriosis must continue to evolve. It is not merely ectopic tissue. It is a chronic inflammatory, neuro-immune disease affecting the whole individual—biologically, psychologically, socially.
We must move:
From reductionism to responsibility.
From dismissal to validation.
From delay to decisive action.
And perhaps, echoing the words of John Lennon during another era of conflict:
Let us give peace a chance.
Peace in the pelvis.
Peace in the nervous system.
Peace in the brain.
Peace in the life of every woman who has waited too long to be heard.
As surgeons, scientists, and caregivers, this is our charge.
Not only to operate well.
But to care deeply.
And to end this silent war.
