Endometriosis: Understanding the Condition and Treatment

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing pelvic pain, heavy periods, and potential infertility. Learn about symptoms and treatment options.

Endometriosis is a chronic condition that can be very painful, making everyday life tough. It happens when tissue like the lining of the uterus grows outside the uterus. This causes symptoms such as pelvic pain, heavy periods, and maybe problems getting pregnant. About 2 to 10 percent of women in the U.S. between 25 and 40 have this condition.12

People with endometriosis might feel a lot of pain or cramps during their period. They might also have very heavy periods or pain during sex. To know for sure if someone has endometriosis, a doctor can perform a surgery called laparoscopy. This surgery can also help treat the condition.1

Key Takeaways

  • Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing pelvic pain and potential infertility.
  • Endometriosis affects an estimated 2 to 10 percent of American women between the ages of 25 and 40.
  • Symptoms of endometriosis may include excessive menstrual cramps, abnormal or heavy menstrual flow, and pain during intercourse.
  • Laparoscopy, a minimally invasive surgical procedure, can be used to diagnose and treat endometriosis.
  • Hormonal contraceptives and medication can help manage endometriosis symptoms, while surgery may be an option for more severe cases.

What is Endometriosis?

Endometriosis is a health issue where the tissue lining the uterus grows elsewhere, such as on pelvic organs like fallopian tubes or ovaries.2 This tissue acts like the lining inside the uterus. It thickens, breaks down, and bleeds during each period. Yet, being outside the uterus, it can’t leave the body. This situation causes pain, scarring, and the sticking together of organs.

Endometrial Tissue Growth Outside the Uterus

This condition involves tissue that looks much like the uterus’s lining growing in off places.3 It can appear on the fallopian tubes, ovaries, even the bladder and intestines. It comes with many symptoms and issues.

Common Areas of Endometriosis Growth

Endometrial tissue often grows in areas like the fallopian tubes, ovaries, bladder, and intestines.3 This growth can cause inflammation, scarring, and adhesions. These effects lead to severe pelvic pain and other troubling symptoms.

Causes of Endometriosis

The cause of endometriosis is complex and not fully known yet. But, researchers have a few ideas. They think endometrial tissue might move to other places through blood or lymph systems2. Also, cells might stick to other places after surgery3. There’s a thought that it might be linked to genes too, passing from one family member to another3.

Blood or Lymph System Transport

One thought is that tissues might move through blood or lymph systems to different parts of the body2. This is similar to how cancer can spread. It might explain why endometriosis is found in areas far from the uterus.

Direct Transplantation

After surgeries like C-sections, endometrial cells might attach in different places3. This could cause endometriosis to develop in these places.


There is evidence suggesting endometriosis is linked to genes. Women with close family members who have it are at a higher risk23. It means genes may play a part in making some people more likely to get it.

Reverse Menstruation

Reverse menstruation theorizes that tissue flows back into the abdomen instead of out the body3. This could let tissue grow in places it shouldn’t, causing endometriosis.


Some scientists believe that certain cells in the body might change into endometrial-type cells3. This process could also be a reason for endometriosis.

Endometriosis causes

Symptoms of Endometriosis

Many women with endometriosis feel pain in their pelvis and during their periods. Their menstrual cramps can be strong, reaching their lower back and stomach.4

Pelvic Pain and Painful Periods

Endometrial tissue can also make sex painful, calling it painful intercourse.4

Pain During Intercourse

Some endometriosis patients find bowel movements hard and feel very tired. These problems and fatigue are also common symptoms.4

Digestive Issues and Fatigue

The severity of endometriosis symptoms doesn’t always match its stage. A woman with a severe case might have mild symptoms, and vice versa.4

Risk Factors and Prevention

Being a certain size over your life, adult height, and early periods can affect endometriosis risk.5 Your risk is also linked to if you breastfed.5 Plus, eating plenty of fruits and veggies could lower your chances of getting it.5

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Family History of Endometriosis

If your mom, sister, or daughter has endometriosis, you might get it too.6 Women in this situation have a 7 times greater risk.6

Early Menstruation and Heavy Periods

Your period starting before age 12 could make you more likely to get endometriosis.6 Also, if your menstrual cycle is shorter than 28 days, your risk increases.6

Pregnancy and Diet

Having a child can lower your risk significantly.6 Some studies hint that being pregnant and breastfeeding, combined with a diet rich in fruits, especially citrus fruits, might reduce your risk too.5

Endometriosis risk factors

Endometriosis and Infertility

Endometriosis is a common cause of female infertility. It affects between 20-40% of infertile women.7 About 30-50% of those with endometriosis might face infertility. The reason for this link isn’t fully clear. But, it likely disrupts how our reproductive organs work, harms sperm or eggs, and adds scar tissue.7 It causes issues by creating inflammation, scar tissue, and changing our body’s hormonal and immune systems. These problems can hamper embryo implantation and reduce egg quality.

For instance, severe cases of endometriosis might make pregnancy harder. This is because women with endometriosis might not have normal uterine movements. These affect how likely they are to get pregnant from in-vitro fertilization.8 Studies show that uterine movements during embryo transfer greatly impact the success of in vitro fertilization.

But, many women with endometriosis can still have children. Treatments like in vitro fertilization (IVF) can help.7 The monthly pregnancy chance for someone with surgically confirmed endometriosis is just 1-10%. This is much lower than the 10-20% chance for those without endometriosis.

7 Estimated worldwide affected by endometriosis200 million people
8 Prevalence of endometriosis in infertile women20-40%
7 Chance of getting pregnant each month for individuals with no endometriosis10-20%
7 Chance of getting pregnant each month for individuals with surgically documented endometriosis1-10%

8 Doctors have looked into laparoscopic surgery for mild endometriosis. It can affect future fertility.8 They’ve also studied the impact of previous surgery on in vitro fertilization outcomes.8 But, surgeries to remove endometriosis might not always solve the problem completely. Some might need more surgeries or still have symptoms.8 Laser surgery is being researched as a way to ease endometriosis-linked pelvic pain.

Endometriosis is one of the most common conditions linked to female infertility.

Diagnosing Endometriosis

Diagnosing endometriosis isn’t easy with just one test.1 Doctors first take your history and do a pelvic exam. This is to find any issues. They might also use other tests to confirm endometriosis.

Pelvic Exam and Ultrasound

A pelvic exam is where the doctor checks for any unusual growths or scars.1

They might also do an ultrasound. This test helps find endometriotic cysts or lesions, but it can’t confirm the illness.1

Laparoscopy and Biopsy

Laparoscopy is a small surgery to look inside the pelvic area. The doctor can take tissue samples too. This helps confirm endometriosis.12

Staging of Endometriosis

Doctors divide endometriosis into four stages (I-IV) based on where it grows and how much. These stages also look at any scarring caused.9 There are four levels: minimal, mild, moderate, and severe.9 A degree of 15 or below is seen as minor or light. A score over 16 may mean the situation is more severe.9 But, the stage doesn’t always tell us how bad someone’s symptoms will be.9

Some people with serious endometriosis might not feel much pain. But others with less may have really bad pain.9 The stage helps in suggesting treatments. Although, the symptoms and general health of the person are very vital in choosing a care plan.9

The Endofound offers a different way to look at endometriosis– maybe called Category I, II, DIE I, or DIE II.9 The last two categories involve endometriosis in deeper places like the rectum.9 Category IV of the Endofound includes the most severe cases. It affects organs outside the pelvic area like the diaphragm or lungs.9

StageASRM PointsDescription
Stage I (Minimal)1-5 pointsFew superficial implants10
Stage II (Mild)6-15 pointsMore and deeper implants10
Stage III (Moderate)16-40 pointsMany deep implants, small cysts on one or both ovaries, presence of filmy adhesions10
Stage IV (Severe)>40 pointsMany deep implants, large cysts on one or both ovaries, many dense adhesions10
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The Endometriosis Foundation of America arranges endometriosis into five types. These go from mild to severe.10 A score of 15 or below shows it’s likely not too bad. A score over 16 means it might be worse.10

Canis et al. (1992) also proposed a new stage 5 for really severe endometriosis with a score over 70.10 The Endometriosis Fertility Index (EFI) suggests if the chance of pregnancy without help is low with a score of 71 or more.10

Non-Surgical Treatment Options

Endometriosis has no cure, yet many non-surgical treatments can help. They aim to manage pain and regulate hormones. This slows or stops endometrial tissue growth.

Pain Medications

Anti-inflammatory drugs, both over-the-counter and prescription, help ease pelvic pain and cramps.1 They can make life more manageable for endometriosis patients.

Hormone Therapy

Treatments like birth control, progestins, and GnRH agonists are known to work. They regulate the hormones linked to endometrial tissue growth.12 It’s key to remember that these treatments might impact fertility, making them not ideal for those trying to conceive.2

Treatment plans should always be personalized to meet individual needs. Working with an experienced healthcare provider is crucial. Regular check-ins and clear communication with your medical team are vital for managing this condition over the long term.

Surgical Treatment: Laparoscopy

If medicines don’t help or if endometriosis is severe, doctors may suggest surgery. The main surgery for endometriosis is laparoscopy. This is a simple surgery that uses very small cuts.11

Excision and Ablation

In laparoscopy, the doctor either cuts out (excises) or burns (ablates) the endometrial implants.11 Which method the doctor uses depends on where the implants are and how big they are.12

Scar Tissue Removal

The surgeon also tries to cut out any scar tissue from endometriosis.11 Sometimes, you might need more surgery if endometriosis has spread to places like your bowel or ureter. This kind of surgery would be done by other experts.12

Even though surgery helps, endometriosis can still come back.11 But, for most women, endometriosis doesn’t come back for five years after a laparoscopy.12

Doctors at NYU Langone often suggest laparoscopy for endometriosis.13 It uses small cuts and special tools to remove the problem areas. The good news is you can usually go home the same day and go back to normal life in two weeks.13 When they use a robot to help, it’s called robotic-assisted laparoscopy. Recovering from this type of surgery is about the same as with the standard surgery.13

There are very low chances of big problems with laparoscopy, like heavy bleeding or hurting your organs (one in five hundred cases).12 The risk of dying from this surgery is much lower (about one in twenty thousand). But sometimes, mistakes in surgery can be serious. They might need you to have more surgery later.12

Laparoscopy is good because it can find out if you have endometriosis and treat it at the same time.12 How well treatment works depends on where the endometriosis is and how much there is.12


Endometriosis is a serious, often painful condition. It happens when the tissue from the inside of the uterus grows outside it.3 Just like the uterine lining, this tissue thickens, breaks down, and bleeds each cycle. As it can’t leave the body, it causes problems like inflammation, scarring, and adhesion between organs.14 This leads to symptoms such as severe pelvic pain, painful periods, pain during sex, and sometimes infertility.

Some factors raise the risk of getting endometriosis. They include never having a child, too frequent periods, heavy and long periods, and high estrogen levels.3 Others are low body weight, issues with the vagina or uterus, family history, and certain ages of starting periods or reaching menopause.3 Symptoms can show as belly, back, or leg pain, heavy or painful bleeding, painful sex, trouble urinating or defecating, and even nausea, vomiting, or fatigue.14

The diagnosis process involves the patient describing symptoms, a pelvic exam, and possibly ultrasound or MRI.3 A confirmed diagnosis might need surgery, like laparoscopy, to check tissue.3 Treatment might mean managing with pain killers or hormones, like birth control, to stabilize hormone levels. If these don’t work, removing the tissue surgically could be an option.3 Living with endometriosis is hard emotionally. Support from groups can help deal with the pain, complications, and fertility challenges.3

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Long-Term Management

Endometriosis is long-lasting and needs continuous care. To help, doctors use a mix of treatments. They aim to ease symptoms and slow down the disease.1 This might include medications, like those for pain and hormones, alongside surgeries like laparoscopy. All these together can lead to better results over time.15

Combination of Treatments

The fight against endometriosis includes medications such as dienogest and GnRH analogues. Adding hormone therapy to these can be effective in reducing pain in the long run.15 Still, choosing the best treatment depends on several things, including how well it works, side effects, cost, doctor’s knowledge, and if patients can stick with it.15

Regular Follow-Up

Seeing your healthcare provider often, especially one who knows about endometriosis, is very important. They will keep an eye on how you’re doing and change your treatment if necessary.1 Endometriosis can get worse, causing pain at other times beside your period.1 Having check-ups regularly helps find and handle any changes early on.


Endometriosis is complex and chronic, affecting life quality significantly.16 Treatment can’t cure it, but it can help manage symptoms and slow its growth.17 With the right health expert, a treatment plan can be made. This might include meds, surgery, and lifestyle changes to get the best results.

For effective endometriosis management, staying in touch with your medical team is vital.17 Studies over the years have looked deeply into endometriosis. They’ve shed light on its prevalence, risk factors, and effects on sexual function and life quality.18 This research shows the need to keep learning about this complex disorder.

Keeping up with endometriosis news and pushing for personalized care are crucial.17 By being proactive in your health alongside healthcare experts, you can face endometriosis’s challenges. Doing so can lead to better life quality.


What is endometriosis?

Endometriosis is when tissue similar to the uterine lining grows outside the uterus. This leads to pelvic pain and heavy periods. It can also cause infertility.

What are the common symptoms of endometriosis?

Common signs include pelvic pain, painful periods, and pain during sex. You might also have digestive issues and feel tired often.

What are the possible causes of endometriosis?

The cause is not clear, but several theories exist. These include blood or lymph system transport, genetics, and cellular changes. Reverse menstruation is also a possible cause.

How is endometriosis diagnosed?

Diagnosis starts with a medical history and pelvic exam. Then, doctors use tests like pelvic ultrasound and laparoscopy. This surgery looks inside to check for endometriosis and takes a small tissue sample.

How is endometriosis treated?

Unfortunately, there is no known cure for endometriosis. However, pain can be managed with medications. Hormone therapy and sometimes surgery are also options to remove or destroy problem tissue.

How does endometriosis affect fertility?

Endometriosis is a top cause of female infertility. It’s found in 24% to 50% of women with fertility issues. Its effects on infertility are not fully understood but are likely linked to the harm caused to eggs and sperm, as well as the formation of scar tissue.

How is endometriosis staged?

Doctors assign stages (I-IV) based on the implants, their depth, and adhesions. However, the stage does not always reflect symptom severity.

Can endometriosis be prevented?

There’s no sure way to prevent endometriosis. Yet, some evidence supports that pregnancy and breastfeeding, along with a diet rich in fruits, especially citrus, may lower the risk.

How is endometriosis managed long-term?

Ongoing care for endometriosis includes medicine and sometimes surgery. It’s important to see a specialist who can help with your treatment over time.

Source Links

  1. https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
  2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
  3. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  4. https://my.clevelandclinic.org/health/diseases/10857-endometriosis
  5. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/at-risk
  6. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=42&contentid=Endometriosis_MRA
  7. https://www.massgeneral.org/obgyn/fertility/news/endometriosis-and-its-impact-on-fertility
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/
  9. https://www.advancedgynaecologymelbourne.com.au/endometriosis/stages
  10. https://www.endofound.org/stages-of-endometriosis
  11. https://www.webmd.com/women/endometriosis/laparoscopic-surgery
  12. https://www.thewomens.org.au/health-information/periods/endometriosis/laparoscopy-and-endometriosis
  13. https://nyulangone.org/conditions/endometriosis/treatments/surgical-treatment-for-endometriosis
  14. https://www.webmd.com/women/endometriosis/women-endometriosis-vs-adenomyosis
  15. https://pubmed.ncbi.nlm.nih.gov/28139239/
  16. https://www.cmaj.ca/content/195/10/E363
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737931/
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370081/