Quick answer
What is endometriosis?
Endometriosis is a condition where tissue similar to the womb lining grows elsewhere in the body, often causing severe period pain, pain during sex and fertility problems. Diagnosis takes an average of 8 years in the UK — too long. See a GP if period pain stops you living normally, or pain occurs during sex or when opening bowels.
Endometriosis is common but often overlooked
Endometriosis affects an estimated 1 in 10 women of reproductive age in the UK — roughly 1.5 million women. It occurs when tissue similar to the lining of the womb grows in other places — commonly the ovaries, fallopian tubes, bowel, and bladder. This tissue responds to hormonal cycles like womb lining, causing inflammation, pain, and scarring.
Despite being common, diagnosis takes an average of 8 years from first symptoms — often because period pain is normalised. Severe pain that limits your life is not normal and deserves investigation.
Symptoms
Endometriosis symptoms vary in type and severity:
Pain:
- severe period pain — worse than typical cramps, may start days before bleeding
- pain during or after sex (deep pain)
- pain when opening bowels or urinating during periods
- chronic pelvic pain throughout the cycle, not just during periods
- lower back pain
Menstrual:
- heavy periods
- bleeding between periods (less common)
Other:
- fatigue and low energy
- difficulty getting pregnant
- pain with exercise during periods
- bloating — sometimes called “endo belly”
Some women have extensive endometriosis with mild symptoms; others have severe pain with minimal visible disease.
How it is diagnosed
There is no simple blood test for endometriosis. Assessment includes:
- History and examination — a GP listens to your symptom pattern
- Ultrasound — may show ovarian cysts (endometriomas) or deep deposits, but can miss superficial disease
- Laparoscopy — keyhole surgery under general anaesthetic; the gold standard for diagnosis and often treatment simultaneously
- MRI — useful for deep infiltrating endometriosis in some centres
If a GP dismisses your symptoms, seek a second opinion or ask for gynaecology referral.
Why diagnosis takes so long
Period pain is often treated as inevitable. Women may be told to “wait and see” or given painkillers without investigation. Endometriosis UK and NHS guidelines emphasise that pain affecting daily life warrants referral — not repeated reassurance alone.
Treatment options
Treatment is individual — based on symptoms, disease extent, age, and fertility wishes.
Pain relief:
- NSAIDs — ibuprofen, naproxen — taken regularly during periods
- paracetamol alongside if needed
Hormonal treatments — suppress ovulation and periods, reducing endometrial activity:
- combined contraceptive pill, patch, or ring
- progestogen-only pill, injection, implant, or hormonal IUD (Mirena)
- GnRH analogues (temporary medical menopause) — short-term due to side effects
Surgery:
- laparoscopic excision or ablation of endometriosis deposits
- may improve pain and fertility
- endometriosis can recur — repeat surgery sometimes needed
Fertility treatment:
- surgery or assisted reproduction (IVF) depending on individual situation
Hysterectomy — removal of womb, sometimes with ovaries — for severe disease when family is complete and other treatments failed.
Endometriosis and fertility
Endometriosis is a leading cause of infertility, but many women conceive naturally or with help. Early diagnosis, surgical treatment of deposits, and fertility specialist input all improve chances. If trying to conceive, tell your gynaecologist — some hormonal treatments are paused during fertility attempts.
Living with endometriosis
Endometriosis is a long-term condition — not curable, but manageable. Support from Endometriosis UK, workplace adjustments, and pain management plans all help. Mental health support matters — chronic pain affects mood and relationships.
When to see a GP
See a GP if period pain:
- stops you working, studying, or socialising regularly
- does not respond to standard painkillers
- comes with pain during sex, bowel movements, or urination
- is getting worse over time
You do not need to prove how bad it is — describe the impact on your life clearly. Ask for referral to a gynaecologist with endometriosis expertise if initial management fails.
Endometriosis vs period pain
Primary period pain (dysmenorrhoea) without underlying disease often improves with age and responds well to standard painkillers and the pill. Endometriosis pain is typically more severe, may occur outside periods, and worsens over time. Only investigation distinguishes them — do not assume one or the other without assessment.
Common questions
- What are the symptoms of endometriosis?
- Severe period pain, pain during or after sex, pain when urinating or opening bowels during periods, chronic pelvic pain throughout the cycle, heavy periods, fatigue, and difficulty conceiving. Symptoms vary — some women have few symptoms despite extensive disease.
- How is endometriosis diagnosed?
- A GP assesses symptoms and may refer for ultrasound. Definitive diagnosis is usually by laparoscopy — keyhole surgery where a camera views the pelvis and biopsies tissue. MRI may help in some cases. There is no simple blood test.
- Can endometriosis cause infertility?
- Yes — it is a common cause of fertility problems, though many women with endometriosis conceive naturally. Endometriosis deposits, scarring and inflammation can affect the ovaries, fallopian tubes and womb. Early diagnosis and treatment help.
- How is endometriosis treated?
- Pain relief (NSAIDs), hormonal treatments (combined pill, progestogens, GnRH analogues) to suppress periods, laparoscopic surgery to remove deposits, and in severe cases hysterectomy. Treatment depends on symptoms, age, and whether you want to conceive.
- Is endometriosis the same as adenomyosis?
- Related but different. Endometriosis is tissue outside the womb. Adenomyosis is tissue within the womb muscle wall. Both cause pain and heavy periods and can coexist.