This article contains minor spoilers for Conversations With Friends.
Conversations With Friends is finally here, and between the meaningful looks and long, long silences, there’s a plot more poignant than anyone’s love story.
In the latest Sally Rooney adaptation, we meet socially awkward Frances (played by newcomer Alison Oliver) during the week of her period, where she’s shown heating a water bottle and writhing on the bathroom floor in pain.
As the series progresses, so do her symptoms, to the point where she goes to A&E after losing a lot of blood, in what her mother identifies as a possible miscarriage.
But it turns out she was never pregnant and after running some tests, doctors diagnose her with endometriosis – a painful condition where tissue similar to the lining of the womb starts to grow in other places.
This on-screen representation is a huge moment for the 1.5 million people in the UK living with the condition, many of whom have had to fight for a diagnosis.
But while it’s great to see endo finally highlighted on screen, the TV show (understandably) can’t tell us everything about the condition.
Endometriosis symptoms vary from person to person, so while some sufferers (like Frances) experience flare ups around the time of their period, others can be impacted by symptoms at other times of the month.
The fact that Frances gets a diagnosis within 12 episodes – representing one single summer – is also a far cry from the experience of the majority of women, who wait, on average, a painful eight years for a diagnosis.
So, here’s what else you need to know about endo that didn’t quite make it into the drama.
What is endometriosis?
In the show, we learn that endometriosis is a condition where “cells from inside the uterus grow elsewhere in the body”.
Endometriosis UK, the leading charity on the condition, shares a little more info that explains what this actually means on its website.
“Each month these cells react in the same way to those in the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood has no way to escape,” it explains.
“This can cause inflammation, pain and the formation of scar tissue.”
Symptoms of endometriosis
Symptoms of endo can vary from person to person, according to the NHS. However, the most prevalent symptoms are:
Pain in your lower tummy or back (pelvic pain) – usually worse during your period.
Period pain that stops you doing your normal activities
Pain during or after sex
Pain when peeing or pooing during your period
Feeling sick, constipation, diarrhoea, or blood in your pee during your period
Difficulty getting pregnant.
The diagnosis delay
Frances delays seeking help for her endometriosis until her symptoms reach crisis point. However, she’s then diagnosed from what seems to be her first ever interaction with doctors. We know this rarely happens for other sufferers.
A 2020 report from the All Party Parliamentary Group on Endometriosis found that it takes eight years on average to get an endometriosis diagnosis.
According to the research – based on a survey of almost 11,00 people, including patients and healthcare practitioners – 58% of people visited a GP more than 10 times before diagnosis and 43% saw doctors in hospital more than five times.
Around 90% said they would have liked access to psychological support but were never offered it, and 35% had a reduced income due to endometriosis.
The report also highlighted the specific barriers faced by women of colour in accessing adequate care.
“Although there are commonalities for everyone affected by endometriosis with regards to misdiagnosis and lengthy diagnosis times, we know that there are health disparities and those from black, Asian, and minority ethnic communities can receive a lower quality of care,” the report said. “More needs to be done on this in respect to endometriosis diagnosis, treatment and care.”
Endo can impact your sex life
On the one hand, it’s great to see someone with a chronic illness enjoying their sex life in Conversations With Friends. And – just like Normal People which came before it – there’s a lot of sex in the show.
But the focus is on penetrative sex when in reality, this can be tricky for some endo sufferers.
Tabitha Britt, founding editor of DO YOU ENDO, a magazine on living with endometriosis, has previously written for HuffPost on this topic.
She recalled “wincing in pain and wishing it would end” during penetrative sex with her husband, until she revealed to him how painful it was.
Her husband was horrified and they’ve now adapted their sex routine to utilise toys, massage and making things “even more exciting than ‘going all the way’”.
“Before my diagnosis, I couldn’t have sex without feeling inadequate and heartbroken,” she wrote. “Once I came to terms with the fact that I’ll have to deal with chronic illness for the rest of my life, we adapted, made small changes and things became easier. They became easier because I realised I needed to accept myself: burning urethra, endo-belly, and all.”