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Overview

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue may affect the ovaries, fallopian tubes, pelvic lining, bowel, or bladder and can cause inflammation and scarring. Symptoms and severity vary widely, and some people have few symptoms while others experience significant pain or fertility problems. Endometriosis most often affects people during their reproductive years.

Symptoms

Endometriosis Symptoms

Symptoms of endometriosis can range from mild to severe and may change over time. The amount of pain does not always match the number, size, or location of lesions.

  • Painful periods (dysmenorrhea) may cause cramping that interferes with daily activities.
  • Chronic pelvic pain may occur between periods.
  • Pain with sex (dyspareunia) may occur during or after intercourse.
  • Painful bowel movements (dyschezia) may be worse during menstruation.
  • Painful urination may occur, particularly during a period.
  • Heavy or irregular menstrual bleeding may occur.
  • Bloating, nausea, constipation, or diarrhea may occur around menstruation.
  • Fatigue may affect daily activities and quality of life.
  • Difficulty becoming pregnant may be a sign of endometriosis.
  • Lower back or leg pain may occur with pelvic pain.

Causes

What Causes Endometriosis?

The exact cause of endometriosis is not known. Possible contributors include retrograde menstruation, in which menstrual blood flows backward through the fallopian tubes; changes in cells outside the uterus; immune-system factors; and genetic susceptibility. These are possible mechanisms rather than a single proven cause, and more than one factor may contribute in an individual person.

Can Endometriosis Run in Families?

Endometriosis may run in families, so having a close relative with the condition can raise a person’s likelihood of developing it. However, family history does not determine whether someone will develop endometriosis. The condition can also occur in people with no known family history, so the question of whether endometriosis is genetic has a complex answer.

Risk Factors

Risk Factors for Endometriosis

  • A close family history of endometriosis is associated with a higher likelihood of developing it.
  • Starting menstruation at an early age may be associated with increased risk.
  • Shorter menstrual cycles may increase the number of menstrual periods over time and may be associated with risk.
  • Heavy menstrual bleeding may be associated with a higher likelihood of endometriosis.
  • Never having given birth may be associated with endometriosis, although this relationship requires individual clinical context.
  • Certain reproductive or menstrual patterns may expose pelvic tissues to more frequent hormonal cycling.

Complications

Endometriosis Complications

  • Infertility or difficulty conceiving can occur when inflammation, adhesions, or ovarian involvement affects reproductive organs.
  • Ovarian endometriomas are cysts that contain old blood and develop in an ovary.
  • Adhesions can cause pelvic organs or tissues to stick together.
  • Bowel involvement can cause pain or changes in bowel movements.
  • Bladder involvement can cause pelvic pain or urinary symptoms.
  • Persistent pelvic pain can affect sleep, work, relationships, and physical activity.
  • Anxiety, depression, or emotional distress may develop in response to chronic pain and its effects on daily life.

Diagnosis

How Is Endometriosis Diagnosed?

Diagnosis begins with a discussion of symptoms, menstrual patterns, medical history, and reproductive goals. A clinician may perform a physical or pelvic examination when appropriate and consider other conditions that can cause similar symptoms. The evaluation is tailored to the individual rather than relying on one test alone.

  • Pelvic ultrasound can identify ovarian endometriomas and other pelvic findings.
  • MRI may be used when more detailed imaging is needed or deep endometriosis is suspected.
  • Laboratory tests may help evaluate other possible causes of pelvic pain or abnormal bleeding.
  • Laparoscopy may be considered for direct visualization of lesions and can sometimes allow treatment during the same procedure.

Treatment & Management

Endometriosis Treatment and Management

Endometriosis treatment is individualized because symptoms, fertility plans, age, health history, and personal preferences differ. Goals may include reducing pain, limiting disease activity, preserving or supporting fertility, and improving quality of life. A treatment plan may change over time as symptoms and goals change.

  • Nonsteroidal anti-inflammatory drugs may help relieve pain and inflammation when they are appropriate for the person.
  • Hormonal contraception can reduce or suppress menstrual bleeding and pain for some people.
  • Progestin therapy may slow endometrial-like tissue activity and reduce symptoms.
  • Other hormonal medicines may suppress ovarian hormone production when first-line options are not enough.
  • Pelvic pain support may include physical therapy, pain specialists, heat, exercise, and emotional support.
  • Fertility-focused care may include consultation with a reproductive specialist and treatment based on pregnancy goals.
  • Ongoing follow-up helps monitor symptoms, medication effects, recurrence, and changing reproductive plans.

When Is Surgery Considered?

Surgery may be considered when pain remains significant despite medication, when endometriomas or adhesions cause problems, or when treatment is being planned around fertility. A laparoscopic procedure may remove or treat lesions and adhesions, although symptoms can recur after surgery. Before an operation, discuss expected benefits, possible risks, effects on ovarian reserve, fertility plans, and the surgeon’s experience with endometriosis.

Outlook and Prognosis

Outlook and Prognosis for Endometriosis

Endometriosis is a chronic condition, so symptoms may improve, recur, or change over time. Many people achieve meaningful symptom control with medication, surgery when appropriate, pain support, and ongoing follow-up, although treatment does not guarantee permanent elimination of the disease. Fertility outcomes and long-term experiences vary from person to person.

  • The pattern, timing, and severity of symptoms can influence the overall experience.
  • Lesion location may affect pain, bowel or bladder symptoms, and fertility concerns.
  • Response to medication, surgery, and pain-management strategies can shape long-term control.
  • Recurrence after surgery is possible and may affect future treatment decisions.
  • Fertility goals may influence the timing and type of treatment.
  • Access to an endometriosis specialist and coordinated care may affect evaluation and management options.

When Should You See a Doctor

When Should You See a Doctor for Endometriosis Symptoms?

  • Schedule a medical visit for severe or worsening menstrual pain.
  • Seek evaluation when pelvic pain disrupts work, school, sleep, exercise, or other daily activities.
  • Discuss pain with sex with a clinician.
  • Arrange an evaluation for bowel or urinary pain that is linked to periods.
  • Talk with a clinician about unusually heavy menstrual bleeding.
  • Seek medical advice for difficulty becoming pregnant.
  • Ask about an endometriosis specialist when symptoms persist or initial treatment does not help.

Seek urgent care

When symptoms need prompt attention

Seek urgent medical care for sudden, severe pelvic pain, fainting, heavy uncontrolled bleeding, fever, or symptoms that feel unusually different or rapidly worsen. These signs may indicate another acute condition and should not be assumed to be endometriosis.

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