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Heghine Khachatryan: Endometriosis Is Not Only a Pain Disorder

Heghine Khachatryan/LinkedIn

Apr 14, 2026, 15:42

Heghine Khachatryan: Endometriosis Is Not Only a Pain Disorder

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:

”Endometriosis is not only a pain disorder.

It should increasingly be recognized as a systemic clinical condition, associated not only with chronic pelvic pain, dysmenorrhea, and infertility, but also with fatigue, significant impairment in quality of life, heavy menstrual bleeding, and iron deficiency.

Recent international evidence suggests that women with endometriosis are at increased risk of iron deficiency, and in many cases, low ferritin may be present even before overt anemia develops.

This requires a shift in our clinical thinking.

When a patient presents with:

heavy menstrual bleeding
pronounced fatigue
pelvic pain
subfertility
and ‘borderline normal’ hemoglobin

we should not limit management to symptomatic pain control alone.

A comprehensive evaluation should include:

ferritin levels
complete blood count indices
assessment of iron deficiency
evaluation for abnormal uterine bleeding / adenomyosis overlap
and the overall inflammatory and functional burden of disease

Modern management of endometriosis is multidimensional:

early clinical suspicion
targeted imaging
individualized management of pain and bleeding
timely identification and correction of iron deficiency
and, when appropriate, consideration of newer therapeutic options, including oral GnRH antagonists in selected patients

The key message is clear:

Low ferritin in a woman with endometriosis is not a minor laboratory finding.

It may represent a clinically meaningful indicator of:

ongoing blood loss
disease burden
and unrecognized functional compromise

Contemporary endometriosis care must go beyond lesion detection and focus on: iron status, bleeding burden, and the full impact on a woman’s daily life.”

Heghine Khachatryan: Endometriosis Is Not Only a Pain Disorder