endometriosis

Overview
Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside of the uterus. These tissue growths can be found on the ovaries, fallopian tubes, outer uterus, and other pelvic organs. Unlike the normal uterine lining, this tissue doesn’t shed during menstruation, causing pain, inflammation, and scarring over time. Endometriosis is a leading cause of pelvic pain and infertility in people of reproductive age.

Why It’s Important
Endometriosis is often underdiagnosed or misdiagnosed, leading many to suffer silently for years. If left untreated, it can cause chronic pain, painful periods, bowel or bladder issues, and reduced fertility. Early diagnosis and management can improve quality of life, preserve fertility, and reduce the need for invasive procedures later on.

Quick Facts

  • Primarily affects women and people assigned female at birth, typically between ages 15 and 49

  • Affects an estimated 1 in 10 women of reproductive age worldwide

  • Chronic condition that can last for years or be lifelong

  • Notable types/forms include:

    • Superficial peritoneal endometriosis (most common)

    • Ovarian endometriomas ("chocolate cysts")

    • Deeply infiltrating endometriosis (more severe, affects nearby organs)

What Happens in the Body
Endometrial-like tissue growing outside the uterus responds to hormonal changes, especially estrogen. Each menstrual cycle, this tissue thickens, breaks down, and bleeds, but the blood has no way to exit the body. Over time, this leads to inflammation, scarring, adhesions, and cyst formation. In more severe cases, organs may become bound together by scar tissue, further worsening pain and complications.

Common Signs and Symptoms

  • Painful periods (dysmenorrhea), often severe

  • Pelvic pain outside of menstruation

  • Pain during intercourse (dyspareunia)

  • Painful bowel movements or urination, especially during menstruation

  • Excessive menstrual bleeding or spotting between periods

  • Infertility or difficulty getting pregnant

  • Fatigue, bloating, or nausea

Diagnosis

  • Diagnosis often starts with a detailed symptom history and pelvic exam

  • Imaging (e.g., transvaginal ultrasound or MRI) may suggest endometriomas but can’t confirm all cases

  • Laparoscopy (minimally invasive surgery) is the gold standard for definitive diagnosis and staging

  • Red flag symptoms include:

    • Severe, persistent pelvic pain

    • Menstrual pain not relieved by over-the-counter medications

    • Pain that worsens over time or spreads

    • Unexplained infertility

Treatment and Management

  • No cure, but treatment focuses on relieving symptoms and improving quality of life

  • Options include:

    • Hormonal therapies: birth control pills, IUDs, GnRH agonists/antagonists to suppress periods

    • Pain management: NSAIDs or other prescription pain relievers

    • Surgery: Laparoscopic removal of lesions or hysterectomy in severe cases

    • Fertility treatment: IVF or other assisted reproductive technologies for those struggling to conceive

    • Lifestyle support: pelvic physical therapy, anti-inflammatory diet, stress management

  • Some people require a multi-disciplinary approach including gynecologists, pain specialists, and mental health providers

Risks and Complications

  • Infertility (affects up to 50% of people with endometriosis)

  • Chronic pelvic pain

  • Formation of adhesions and scar tissue

  • Ovarian cysts (endometriomas)

  • Increased risk of autoimmune conditions and mood disorders

  • Possible link to certain cancers, though risk is low

Who Is at Risk

  • People with a family history of endometriosis

  • Early onset of menstruation or short menstrual cycles (<27 days)

  • Heavy menstrual bleeding

  • Delayed pregnancy or never having given birth

  • Structural abnormalities in the reproductive tract

  • High estrogen levels or exposure to estrogen-like chemicals

Related Conditions

  • Polycystic Ovary Syndrome (PCOS)

  • Interstitial cystitis (painful bladder syndrome)

  • Irritable bowel syndrome (IBS)

  • Chronic fatigue syndrome

  • Pelvic inflammatory disease (PID)

  • Depression and anxiety

When to See a Doctor

  • Period pain that interferes with daily life

  • Pain that worsens over time or resists treatment

  • Difficulty getting pregnant after trying for a year

  • Bowel or bladder pain during menstruation

  • If you’ve been previously diagnosed and symptoms return or worsen

Last Updated: June 22, 2025