Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe period pain, pelvic pain, heavy bleeding, painful sex, bowel or bladder symptoms, and difficulty getting pregnant.
Despite being common, endometriosis can take years to diagnose. The World Health Organization (WHO) estimates that it affects about 10% of women of reproductive age worldwide, or around 190 million people.
The condition can affect daily life, relationships, work, mental wellbeing, and fertility. Understanding the symptoms and available treatment options can help people seek appropriate care earlier.
What Is Endometriosis?
Normally, the endometrium is the tissue lining the inside of the uterus. During each menstrual cycle, it thickens in preparation for pregnancy and is shed during a period if pregnancy does not occur.
With endometriosis, endometrium-like tissue grows outside the uterus. It commonly affects areas around the reproductive organs, including the ovaries, fallopian tubes and the tissue lining the pelvis. It can also affect the bowel, bladder and, more rarely, areas outside the pelvis.
This tissue responds to hormonal changes during the menstrual cycle. It can become inflamed and bleed, causing irritation and inflammation in surrounding tissues. Over time, this may contribute to scar tissue and adhesions, which can cause organs to stick together.
What Causes Endometriosis?
There is no single known cause of endometriosis.
According to the Endometriosis Foundation of America, researchers are studying several possible factors, including genetic, hormonal, inflammatory, and immune-system-related mechanisms. A family history may also increase the likelihood of developing the condition.
Importantly, endometriosis is not caused simply by having a particular lifestyle or by doing something wrong. There is currently no proven way to prevent it.
What Are The Symptoms Of Endometriosis?
Symptoms vary widely. Some people have severe symptoms, while others have few or none.
The most common symptom is pelvic pain, particularly before or during menstruation. However, pain that is severe enough to interfere with normal activities should not simply be dismissed as 'normal period pain'.
Possible symptoms include:
- Severe or worsening period pain
- Pelvic or lower abdominal pain
- Chronic pelvic pain between periods
- Heavy menstrual bleeding
- Pain during or after sex
- Pain while passing stools, particularly during periods
- Pain or burning while urinating
- Bloating or abdominal swelling
- Nausea
- Fatigue
- Difficulty getting pregnant
Some people may experience bowel symptoms such as constipation, diarrhoea or painful bowel movements, particularly around menstruation.
The location of the endometriosis can influence symptoms. For example, disease involving the bowel or bladder may cause symptoms related to those organs.
Is Severe Period Pain Always Endometriosis?
No. Period pain can have several causes, and having painful periods does not automatically mean someone has endometriosis. However, severe, persistent, or worsening period pain deserves medical assessment, particularly if pain interferes with school, work, exercise, sleep, relationships, or daily activities.
Other conditions, including adenomyosis, fibroids, pelvic inflammatory disease and certain ovarian conditions, can cause similar symptoms. This is one reason proper evaluation is important.
How Does Endometriosis Affect Fertility?
Endometriosis can affect fertility, although having the condition does not mean that pregnancy is impossible.
According to the World Journal of Biology Pharmacy and Health Sciences, inflammation and scar tissue can interfere with the normal movement of eggs and sperm. In more extensive disease, adhesions can affect or block the fallopian tubes.
Endometriosis can also affect the ovaries and the pelvic environment.
WHO reports that endometriosis is associated with infertility and that among women with infertility, an estimated 25-50% may have endometriosis.
If someone with known or suspected endometriosis is trying to conceive, fertility planning should be discussed with a gynaecologist or fertility specialist. Treatment needs to take into account whether pregnancy is currently a priority.
Fertility treatment may include surgery in selected cases, medicines to assist ovulation, or assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), depending on the individual situation.
How Is Endometriosis Diagnosed?
Diagnosis can be challenging because symptoms overlap with several other conditions.
A doctor will usually begin with a detailed history of menstrual cycles, pain, bleeding, bowel and bladder symptoms, sexual pain and fertility concerns. A physical or pelvic examination may also be performed when appropriate.
Ultrasound
Offering a transvaginal ultrasound to people with suspected endometriosis, even when a pelvic examination is normal. It can help identify ovarian endometriomas, deep endometriosis and other possible causes of symptoms.
A normal ultrasound does not rule out endometriosis. Further assessment may still be needed if symptoms strongly suggest the condition.
MRI
A specialist ultrasound or pelvic MRI may be used when deep endometriosis is suspected, particularly to assess how extensively it involves structures such as the bowel, bladder or ureters.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure in which a camera is inserted through a small abdominal incision to examine the pelvic organs.
It may be considered when endometriosis is suspected, including when ultrasound or MRI has not shown the condition. Depending on the findings and prior consent, treatment may sometimes be performed during the same procedure.
Importantly, current guidance does not require everyone to undergo surgery before treatment can begin. Symptoms and imaging can help guide management.
Does The Severity Of Pain Show How Severe The Disease Is?
Not necessarily.
Some people with relatively extensive endometriosis may have few symptoms, while others with less extensive disease can experience significant pain.
This is why treatment decisions should not be based only on the stage or appearance of the disease. It is recommended to consider symptoms, personal preferences, and priorities, including pain and fertility goals.
How Is Endometriosis Treated?
There is currently no treatment that permanently cures endometriosis, but symptoms can often be managed.
According to the National Institutes of Health (NIH), treatment depends on the person's symptoms, age, overall health, extent of disease, side effects, preferences, and whether they want to become pregnant.
Painkillers
Pain-relieving medicines may be used to manage symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be considered when appropriate. Experts recommend discussing the benefits and risks of pain medicines based on individual circumstances.
Hormonal treatment
Because endometriosis is influenced by hormones, hormonal treatments can help reduce pain and control symptoms.
Options may include:
- Combined hormonal contraceptives
- Progestogen-only treatments
- Hormonal intrauterine systems
- Gonadotrophin-releasing hormone (GnRH) medicines
These treatments can reduce or suppress hormonal stimulation of endometriosis and may decrease pain. However, many hormonal treatments prevent pregnancy while they are being used, so they are not suitable when someone is actively trying to conceive.
Surgery
Surgery can remove endometriosis lesions and adhesions. It may be considered when symptoms are severe, medical treatment has not worked or is unsuitable, or in certain situations where fertility is a priority.
The benefits and risks need to be discussed carefully, particularly when endometriosis affects the ovaries or other organs. Surgery does not guarantee that symptoms will never return.
Hysterectomy
A hysterectomy, which removes the uterus, may be considered in selected people with severe symptoms who have completed their family and have not responded adequately to other treatments.
However, hysterectomy is not automatically a cure for endometriosis, because endometriosis occurs outside the uterus. Symptoms can persist or recur, particularly if endometriosis remains elsewhere.
Can Endometriosis Come Back After Treatment?
Yes.
Endometriosis is a chronic condition, and symptoms can return after treatment. Even after surgery, some people experience recurrent pain or disease. Medication after surgery may sometimes help extend the period without symptoms when pregnancy is not being pursued.
Regular follow-up may be particularly important for people with deep endometriosis involving the bowel, bladder or ureters, or larger ovarian endometriomas.
Can Lifestyle Changes Cure Endometriosis?
There is no diet, supplement or lifestyle change proven to cure endometriosis.
However, healthy habits may support general wellbeing and help some people manage the impact of chronic pain. Depending on individual needs, this can include regular physical activity, adequate sleep, a balanced diet and strategies for managing stress.
Some people explore supplements, elimination diets or herbal remedies after reading about them online. These should not replace medical treatment, and evidence for many such approaches remains limited.
Endometriosis And Mental Wellbeing
Living with persistent pain, fatigue or fertility problems can affect emotional wellbeing.
People with endometriosis may experience anxiety, low mood, social isolation and difficulties with relationships or sexual health. These effects are not simply a result of overthinking the pain. Chronic pain itself can significantly affect quality of life.
Pain management may therefore need to involve more than medicines or surgery. Depending on the person, physiotherapy, psychological support and other multidisciplinary approaches can form part of care.
When Should You See a Doctor?
Speak to a gynaecologist or other healthcare professional if you have:
- Period pain that prevents normal activities
- Persistent pelvic pain
- Pain during sex
- Pain when passing stools or urine, especially around periods
- Very heavy periods
- Ongoing bloating or abdominal symptoms linked to your menstrual cycle
- Difficulty conceiving
- Symptoms that keep returning despite treatment
Keeping a pain and symptom diary can be useful. Record when symptoms occur, their severity, bleeding patterns, bowel or bladder symptoms and whether they are linked to your menstrual cycle.
Final Word
Endometriosis is much more than painful periods. It is a chronic condition that can affect the pelvis, bowel, bladder, sexual health, fertility and emotional wellbeing. There is no single symptom or test that identifies every case, and a normal scan does not always exclude the condition. At the same time, modern guidance supports earlier clinical assessment, imaging and appropriate treatment rather than waiting years for a definitive diagnosis.
The right treatment depends on the individual. For some, pain medicines or hormonal treatment may be enough; others may need surgery, fertility treatment or a combination of approaches. Most importantly, severe period pain should not simply be accepted as something you have to live with. Persistent or disruptive symptoms deserve proper medical evaluation and a treatment plan tailored to your needs.
