Endometriosis

Endometriosis is tissue similar to the womb lining growing outside the womb, often causing pelvic pain, painful periods or difficulty conceiving.

Endometriosis is a condition where tissue similar to the lining of the womb grows outside it, commonly around the ovaries, fallopian tubes or pelvic lining. It responds to hormonal changes during the menstrual cycle, which can lead to irritation, inflammation and scar tissue. The amount of tissue does not reliably predict the amount of pain.

Painful periods are a very common presentation of endometriosis. Pelvic pain, pain during sex and pain around ovulation can also occur. Some people have bowel or bladder discomfort during a period, heavy bleeding or ongoing tiredness. Trouble getting pregnant is a common presentation of endometriosis, although many people with the condition conceive.

The exact cause is not known. Several processes may contribute, including menstrual blood moving backwards through the fallopian tubes, cells changing into endometriosis-like tissue, and immune or genetic influences. These explanations do not mean anything you did caused the condition.

Endometriosis may remain stable, fluctuate with hormonal cycles or form cysts and scar tissue over time. Symptoms can ease during pregnancy or after menopause, but treatment decisions depend on your symptoms and plans. A symptom diary can show links with bleeding, bowel movements, sex or ovulation.

A close family history, starting periods at a young age, shorter menstrual cycles, heavier bleeding and never having been pregnant are associated with a greater chance of endometriosis. These factors do not diagnose the condition, and it can occur without them.

A clinician will ask about periods, pain, sex, bowel or bladder symptoms and fertility goals, then examine the abdomen and pelvis when appropriate. Ultrasound can identify ovarian endometriosis and other causes, while MRI may map deeper disease. A normal scan does not exclude endometriosis. Laparoscopy may be considered when the diagnosis remains uncertain or treatment requires surgery.

Treatment is tailored to pain, bleeding, fertility plans and previous response. Anti-inflammatory therapy for period pain can reduce inflammation-related discomfort. Hormonal options such as the combined pill or hormonal coil may suppress cycling and bleeding. GnRH analogue therapy temporarily lowers ovarian hormone activity and needs medical supervision. Laparoscopic excision removes visible lesions. Hysterectomy is major surgery and is not suitable for everyone; it does not always remove pain caused outside the womb.

Gentle movement, heat, sleep routines and pacing can support symptom control alongside treatment. Record pain, bleeding, medicines and missed activities to make appointments more useful. Discuss fertility before starting or changing hormonal treatment, and seek help for persistent pain that affects work, relationships or mood.

Endometriosis can cause ovarian cysts, adhesions and ongoing pelvic pain. It may affect sex, bowel or bladder function and can be associated with difficulty conceiving. Sudden severe pain, fainting, fever or heavy bleeding needs urgent medical assessment because other pelvic problems can cause these symptoms too.

There is no proven way to prevent endometriosis. Early assessment of severe period pain and tracking symptoms can shorten the path to suitable care. Hormonal contraception may control symptoms for some people, but it should be chosen with a clinician because it does not remove established lesions.

A gynaecologist with experience in endometriosis can coordinate imaging, medicines, pain support and surgery when needed. Ask how the service evaluates deep disease, protects fertility goals and provides follow-up after treatment. Bring your symptom diary and a list of medicines.