Endometriosis

Built by in-house doctors

What Is Endometriosis?

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterine cavity. Lesions most often occur on the ovaries, fallopian tubes, pelvic lining, and tissues behind the uterus, but can occasionally involve the bowel, bladder, diaphragm, or other sites.

The condition can cause pain, infertility, organ-specific symptoms, and a major reduction in quality of life. The severity of symptoms does not always match the amount or location of visible disease.

What Causes Endometriosis?

The cause of endometriosis is not fully understood. Proposed mechanisms include retrograde menstruation, altered immune responses, transformation of local cells, stem-cell activity, genetic susceptibility, and spread through blood or lymphatic pathways.

Estrogen supports lesion activity and inflammation. Family history increases risk, but endometriosis is not caused by personal behavior and can occur in adolescents as well as adults.

Diagnosis

Diagnosis begins with the symptom history, pelvic examination when appropriate, and imaging such as transvaginal ultrasound or MRI. A normal examination or scan does not exclude superficial disease; laparoscopy may confirm and treat endometriosis when clinically indicated.

Treatment Options

Treatment is individualized according to symptoms, fertility goals, lesion location, previous treatment, and patient preference. Options include pain-relieving medicines, combined hormonal contraception, progestin therapy, and medicines that suppress ovarian hormone production.

Surgery may remove lesions, release scar tissue, and treat ovarian endometriomas or organ involvement. Multidisciplinary pain care, pelvic-floor physiotherapy, fertility treatment, and psychological support may also be important, particularly when pain persists after lesion treatment.

‍

Living With Endometriosis

Tracking pain, bleeding, bowel or bladder symptoms, medication effects, and cycle patterns can help guide treatment. Heat, adapted exercise, sleep support, pelvic-floor therapy, and workplace or school accommodations may reduce the impact of flares.

People seeking pregnancy should discuss timing and fertility options early, especially with ovarian endometriomas, previous ovarian surgery, older reproductive age, or prolonged infertility. Treatment plans may need to balance pain control with fertility goals.

When to Seek Emergency Care

Seek urgent care for sudden severe pelvic or abdominal pain, fainting, heavy bleeding with weakness, fever with worsening pain, persistent vomiting, inability to pass urine or stool, or pain with a positive pregnancy test. These symptoms may indicate ovarian torsion, ectopic pregnancy, infection, obstruction, or another emergency.

Prognosis

Endometriosis is a long-term condition and symptoms may recur after medication is stopped or following surgery. Many patients achieve meaningful pain control and improved function through individualized medical, surgical, fertility, and supportive care.

‍

Risks

Risk is higher with a close family history of endometriosis, early onset of menstruation, short menstrual cycles, heavy or prolonged bleeding, and conditions that obstruct menstrual flow. Complications can include chronic pelvic pain, painful intercourse, bowel or bladder symptoms, infertility, ovarian endometriomas, adhesions, reduced quality of life, and repeated surgery.

Symptoms

Symptoms include severe menstrual pain, chronic pelvic pain, pain during or after sex, painful bowel movements or urination—often worsening around menstruation—heavy or irregular bleeding, abdominal bloating, fatigue, lower back pain, and difficulty becoming pregnant. Some people have minimal symptoms despite extensive disease, while others have severe pain with limited visible lesions.

Diagnosis

Diagnosis is based on a detailed history of pain timing, bleeding, bowel and bladder symptoms, sexual pain, fertility, and previous treatment. Pelvic examination may identify tenderness, reduced organ mobility, nodules, or an ovarian mass, but can also be normal.

Specialist transvaginal ultrasound and MRI can detect ovarian endometriomas and many forms of deep endometriosis and help plan surgery. Superficial disease may not appear on imaging. Laparoscopy with direct visualization and, when appropriate, tissue sampling remains an option when diagnosis is uncertain or surgery is needed.