Endometriosis
Endometrial-like tissue growing outside the uterus, causing pain and infertility.
Overview
Endometriosis is a chronic oestrogen-dependent disease in which endometrial-like tissue grows outside the uterus, most often in the pelvis. It causes painful periods, chronic pelvic pain, deep dyspareunia and infertility, and frequently goes undiagnosed for years.
Symptoms
- • Severe period pain (dysmenorrhoea) not relieved by simple analgesia
- • Chronic pelvic pain
- • Deep pain during or after intercourse
- • Painful bowel movements or urination, especially around periods
- • Heavy menstrual bleeding
- • Subfertility
- • Fatigue
Risk factors
- • Family history of endometriosis
- • Early menarche, late menopause, short cycles, heavy periods
- • Nulliparity
- • Müllerian anomalies
Causes
- • Retrograde menstruation with implantation
- • Coelomic metaplasia, lymphatic/vascular spread
- • Immune and genetic factors
🚨 Red flags — seek urgent care
- • Sudden severe pelvic pain with collapse — possible ruptured endometrioma, emergency
- • Cyclical rectal bleeding or haematuria — consider deep infiltrating disease
- • Acute urinary retention
When to seek care
- • Persistent painful periods or pelvic pain affecting life
- • Difficulty conceiving after 12 months (6 if >35)
- • Pain with bowel or bladder symptoms
Diagnosis
- • Clinical suspicion from symptoms
- • Pelvic examination
- • Transvaginal ultrasound (good for endometriomas and deep disease)
- • MRI pelvis for deep infiltrating disease
- • Diagnostic laparoscopy ± biopsy remains the gold standard
Treatment
- • Analgesia (NSAIDs and paracetamol)
- • Hormonal: combined or progestogen-only contraceptives, IUS, GnRH agonists/antagonists with add-back
- • Laparoscopic excision/ablation of endometriosis
- • Specialist multidisciplinary care for deep infiltrating or bowel/urinary involvement
- • Fertility specialist input if conception difficulty
Prevention
- • No proven primary prevention
- • Early treatment may reduce progression
Complications
- • Chronic pelvic pain
- • Infertility
- • Endometriomas
- • Bowel or ureteric obstruction in deep disease
- • Depression and reduced quality of life
Prognosis
Endometriosis is chronic but very manageable. Most people achieve symptom control with hormonal therapy or surgery; fertility outcomes are good with specialist input.
Education & self-care
Endometriosis is common and treatable. If period pain limits your life or you have difficulty conceiving, seek specialist assessment early.
Frequently asked questions
Does pregnancy cure endometriosis?
Pregnancy and breastfeeding may temporarily suppress symptoms but do not cure the disease.
Will a hysterectomy cure it?
Hysterectomy alone is not curative; deposits outside the uterus may persist. It is reserved for selected cases after counselling.
How is endometriosis diagnosed?
Diagnosis often combines history with pelvic examination, transvaginal ultrasound and MRI. Laparoscopy with biopsy remains the gold standard but is no longer mandatory before starting treatment.
Will I be able to have children?
Many people with endometriosis conceive naturally, although fertility can be reduced. Where conception is difficult, surgery and assisted reproduction (IUI, IVF) both have established roles.
Does menopause cure it?
Symptoms usually improve after menopause as oestrogen levels fall, but some women continue to have pain, especially if on hormone replacement therapy. Surgical removal of disease can still help in selected cases.