At this stage, the fruit's flesh is crunchy and watery in texture, similar to cucumber, chayote, or green bell pepper, but bitter.

The pith becomes sweet and intensely red; it can be eaten uncooked in this state and is a popular ingredient in some Southeast Asian salads.

When the fruit is fully ripe, it turns orange and soft and splits into segments that curl back to expose seeds covered in bright red pulp.

The cultivar common in China is 20–30 cm (7.9–11.8 in) long, oblong with bluntly tapering ends and pale green in colour, with a gently undulating, warty surface.

The bitter melon more typical of India has a narrower shape with pointed ends and a surface covered with jagged, triangular "teeth" and ridges.

The fruit is bitter raw and can be soaked in cold water and drained to remove some of those strong flavours.

In North Indian cuisine, it is often served with yogurt on the side to offset the bitterness, used in curry such as sabzi, or stuffed with spices and then cooked in oil.

In South Indian cuisine, it is used in numerous dishes such as thoran / thuvaran (mixed with grated coconut), pavaikka mezhukkupuratti (stir-fried with spices), theeyal (cooked with roasted coconut), and pachadi (which is considered a medicinal food for diabetics), making it vital in Malayali's diet.

Other popular recipes include preparations with curry, deep-frying with peanuts or other ground nuts, and Kakara kaya pulusu (కాకర కాయ పులుసు) in Telugu, a tamarind-based soup with mini shallots or fried onions and other spices, thickened with chickpea flour.

Also commonly seen is kattu pagarkkai, a curry in which bitter melons are stuffed with onions, cooked lentils, and grated coconut mix, then tied with thread and fried in oil.

In Bengal, where it is known as korola (করলা) or ucche (উচ্ছে) in Bengali, bitter melon is often simply eaten boiled and mashed with salt, mustard oil, sliced thinly and deep fried, added to lentils to make "tetor" dal (bitter lentils), and is a key ingredient of the Shukto, a Bengali vegetable medley that is a mixture of several vegetables like raw banana, drumstick stems, bori, and sweet potato.

In northern India and Nepal, bitter melon, known as tite karela (तीते करेला) in Nepali, is prepared as a fresh pickle.

In Burmese cuisine, bitter melon is sauteéd with garlic, tomatoes, spices, and dried shrimp and is served as an accompaniment to other dishes.

Another dish in Pakistan calls for whole, unpeeled bitter melon to be boiled and then stuffed with cooked minced beef, served with either hot tandoori bread, naan, chappati, or with khichri (a mixture of lentils and rice).

Bitter melons stuffed with ground pork are commonly served as a summer soup in the south.

In the cuisine of the Philippines, bitter melon, known as Ampalaya in Filipino and Paria in Ilokano, may be stir-fried with ground beef and oyster sauce, or with eggs and diced tomato.

In Trinidad and Tobago, bitter melons, known as caraille or carilley, are usually sautéed with onion, garlic, and scotch bonnet pepper until almost crisp.