Endometriosis is a condition in which the tissue that’s usually on the inside of the uterus grows on the outside of the uterus as well. Endometriosis can cause pelvic pain that can range from mild to severe, and can interfere with fertility Let’s break this down! Inside the uterus, there is a lining of cells. These are called endometrial cells or the endometrial lining. Endometriosis is a disease in which that kind of tissue (that’s usually on the inside of the uterus) grows on the outside of the uterus as well. It can grow in small nodules or cover other body parts in the abdominal cavity. Endometriosis can cause pelvic pain that can range from mild to severe, and can interfere with fertility when trying to conceive.
Endometriosis is extremely common, as according to the American College of Obstetricians and Gynecologists, it affects around 1 in 10 women of reproductive age. It can show up as early as the first few years after puberty. Though often a diagnosis isn’t made until people are much older – in their 30s and 40s. But this is partially because the average diagnosis can take 7-10 years from the first time a person seeks help.
Signs and symptoms
Pelvic pain is the most common, defining symptom of endometriosis, but it isn’t the only one. Other common symptoms of endometriosis include:
- Heavy bleeding: Since the endometrial tissue on the outside of the uterus still acts like it would if it was on the inside of the uterus, thickening before breaking down into blood at each menstrual cycle, endometriosis can cause either unusually heavy bleeding during periods or some bleeding between periods.
- Pelvic cramps: During or leading up to menstruation, endometriosis can cause cramps that are stronger or more painful than usual.
- Painful sex: Pelvic pain from endometriosis can also show up as painful sexual intercourse.
- Painful urination or bowel movements: Especially during menstruation, endometriosis can cause painful urination or bowel movements.
- Infertility: Somewhere between one-third and one-half of all women with endometriosis experience infertility. One way endometriosis interferes with fertility is when endometrial tissue in the fallopian tube gets in the way of the sperm and the egg meeting each other. Endometriosis also causes inflammation that makes conception more difficult and causes scar tissue which can displace structures in the pelvis and make conception more difficult to impossible.
- Other symptoms: Endometriosis may also cause other symptoms that aren’t always easy to distinguish from a regular period, like fatigue, constipation, diarrhea, bloating or nausea, most commonly during menstruation.
Causes
It’s not certain exactly what causes this tissue to grow out of control. There are several theories for what might cause it, and research is also exploring the genetic link between family members who all have endometriosis. If you’re interested in reputable sources of information on potential causes, we have those linked below in our sources!
Diagnosis
Endometriosis can be diagnosed clinically, although your provider may suggest other tests to rule out other possible causes of your symptoms.. These could be things like a pelvic exam, ultrasound, blood tests, and vaginal cultures to check for infection.
Treatment
Depending on the severity of your case and your fertility goals, there are several different courses of treatment that may be recommended.
- Observation and lifestyle changes: For those whose symptoms are mild, simple observation is often an early starting point for treatment. On the other hand, those who are diagnosed with endometriosis because they’re having trouble conceiving may need more active treatment. Lifestyle changes that can help manage endometriosis pain include a healthy diet, getting enough rest, and even relaxation techniques. Healthcare providers may also recommend over-the-counter pain relievers like ibuprofen or naproxen products.
- Laparoscopic surgery: In a laparoscopy, the laparoscope, a thin tube that allows the doctor to look inside the body, is passed into the abdomen through a tiny incision. The doctor can then look at the outside of the uterus, ovaries, fallopian tubes, and other nearby organs. There may be a second incision to pass surgical instruments through, or surgical instruments can be attached to the laparoscope to take tissue samples. During a laparoscopy the doctor may cut or burn away endometrial lesions, especially in early or less extensive cases. Endometriosis that covers a larger area may be harder to treat this way. This treatment is shown to reduce pain in most patients, and though it’s less clear whether it improves fertility, some evidence suggests it could.
- Hormone therapy: Hormone therapy can reduce pain in endometriosis patients. Although it isn’t a permanent fix, and symptoms often come back after stopping treatment, hormones work because they directly influence endometrial tissue growth. Targeted hormonal treatment can do the opposite, and slow or stop endometrial growth, though this treatment generally isn’t able to be used when trying to conceive.
- Hysterectomy: Endometriosis generally resolves after menopause for those who don’t use menopause hormone therapy. A complete hysterectomy with bilateral oophorectomy, which includes the removal of the uterus and the cervix, as well as both ovaries, causes surgical menopause and has the same effect. This is an irreversible treatment and is major surgery, so it is often only considered after trying other treatment options mentioned above.
Prognosis
While there isn’t a 100% cure for endometriosis, these treatments can relieve symptoms for years or more. A hysterectomy gives the best chance of a full cure, for women who don’t continue to take hormonal medication.
However, pain management techniques can help endometriosis patients to live more comfortably with it, and in cases where endometriosis causes infertility, a healthcare provider may eventually recommend trying assisted reproductive technology like in vitro fertilization for women who are trying to conceive.
Reviewed by the Ovia Health by Labcorp Clinical Team
Sources
- Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.
- “Endometriosis: Does It Cause Infertility?” ASRM. American Society of Reproductive Medicine, 2012. Web.
- “Endometriosis: A Guide for Friends, Siblings, and Significant Others.” Youngwomenshealth. Boston Children’s Hospital, November 22,2023. Web.
- ACOG “Diagnosis of Endometriosis” Clinical Practice Guideline Number 11. March 2026. Web.
- Mayo Clinic Staff. “Endometriosis.” Mayo Clinic. Mayo Clinic, August 202024. Web.
- “Endometriosis Surgery” my.clevelandclinic. The Cleveland Clinic Foundation, Sept. 13, 2022 Web.
- Johns Hopkins Medicine “Endometriosis.” Web.
