Hulu’s adaptation of Sally Rooney’s book Conversations With Friends is full of pain, and not just hte emotional kind. As main character Frances deals with family drama and a secret affair, she also has debilitating cramps that feel way worse than a typical period. While she eventually gets answers about what’s going on with her, it’s a harrowing journey to get a diagnosis, which may resonate with many fans. Here’s everything you need to know about Frances’ mystery illness in Conversations With Friends, including why it’s often ignored despite its seriousness.
Warning: Spoilers for Conversations With Friends follow. Throughout the series, Frances is shown writhing in pain from what she attributes to period cramps, vomiting because of the pain, and even passing out. Her mom and her best friend Bobbi help her cope, but also encourage her to get a diagnosis. At one point, she believed she could have had a miscarriage, but after a doctor confirmed this was not the case, Frances got an ultrasound, and finally had her answer: endometriosis.
The Mayo Clinic describes endometriosis as “a painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus.” These outer uterine growths can cause immense pain in the pelvic region and sometimes other parts of the body.
According to the World Health Organization, the reason it’s so painful for Frances, and the millions of others who have the disorder, is that this uterine tissue outside of the uterus acts just like it would inside the uterus, meaning it gets thicker during each cycle and then bleeds. Because the tissue is in the wrong place, this uterine lining and blood doesn’t have anywhere to go, so it gets trapped and can cause scar tissue and cysts to form. On top of these symptoms, people with endometriosis can also experience pain with physical intimacy and mental health concerns such as depression or anxiety.
In Conversations, Frances is diagnosed with an ultrasound, but in real life, this is quite uncommon. According to the Cleveland Clinic, ultrasounds are often used to see whether signs of endometriosis are present, but just an ultrasound isn’t enough for a true diagnosis. Typically, a laparoscopic surgery, an expensive and potentially dangerous procedure sin which a tube with a camera on the end is inserted into an incision on the patient’s belly, is needed to provide a definitive answer.
The disorder is complex — some people have large lesions but little pain, others have small lesions and intense pain, and others still have no pain at all, the World Health Organization reports. As with a lot of disorders that primarily affect women and other marginalized genders, endometriosis is also considered largely under-researched and under-diagnosed. The BBC reports it takes an average of 7.5 years just to get an endometriosis diagnosis in the U.K.
That’s shocking, considering how common the disorder is. A 2020 international study found that endometriosis affects 10% of women and girls at reproductive age. (It’s worth noting the study did not include people who have periods but do not identify as women or girls, meaning it doesn’t even paint a whole picture of everyone who may have endometriosis.) The hashtag #endometriosis on Instagram has over 2 million posts, largely from people who call themselves Endo Warriors looking to find community and solutions for their pain, because there is currently no cure for the disorder. Here’s hoping Conversations With Friends sheds more light on the topic, or at the very least helps those with endometriosis feel seen.