Endometriosis
Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus. This tissue can cause inflammation, scarring, adhesions, cysts and pain, particularly during periods. Endometriosis most commonly affects the ovaries, fallopian tubes and lining of the pelvis, but it can sometimes involve other organs such as the bowel or bladder.
Commonality
Endometriosis affects around 1 in 10 women of reproductive age in the UK. Despite being common, diagnosis is often delayed because symptoms can vary widely and may be mistaken for other conditions, such as irritable bowel syndrome, or normal menstrual pain.
Causes
The exact cause of endometriosis is not fully understood, but several factors are believed to contribute.
Possible causes include:
Retrograde menstruation, where menstrual blood flows backwards into the pelvis
Genetic factors and family history
Immune system changes
Hormonal influences, particularly oestrogen
Endometriosis is a medical condition and is not caused by lifestyle choices or stress.
Symptoms
Symptoms can vary from mild to severe and may affect daily life.
Common symptoms include:
Pelvic pain, often worse during periods
Heavy or prolonged periods
Pain during intercourse
Pain when passing urine or opening the bowels during menstruation
Persistent fatigue
Abdominal bloating (“endo belly”)
Difficulty conceiving
Effects on Fertility
Endometriosis can affect fertility by causing inflammation, scarring and distortion of the pelvic organs. In some women, this may make conception more difficult.
However, many women with endometriosis are still able to conceive naturally. Early specialist assessment can help determine the most appropriate treatment or fertility support if needed.
Diagnosis
Diagnosis begins with a detailed discussion of symptoms and medical history.
Investigations may include:
Pelvic examination
Transvaginal ultrasound
MRI scanning for suspected deep endometriosis
Diagnostic laparoscopy (keyhole surgery) to confirm the diagnosis
Accurate diagnosis is important to guide treatment and long-term management.
Endometriosis vs Adenomyosis
Endometriosis is sometimes confused with adenomyosis because both can cause heavy, painful periods. The two conditions can occur together, and imaging or further investigation is often required to differentiate between them.
Treatments
Although there is currently no cure for endometriosis, treatments can help control symptoms, suppress endometriosis activity and improve quality of life.
Medical treatments may include:
Hormonal therapies such as the combined oral contraceptive pill or progestogens
Hormonal intrauterine systems such as the Mirena coil
Pain relief medication
Surgical treatment may be recommended when symptoms are severe or fertility is affected. Options may include:
Laparoscopic excision surgery to remove endometriosis deposits
Robotic-assisted surgery for complex disease
Fertility-preserving surgical techniques where appropriate
Ongoing Care
Living with the Condition
Endometriosis can affect many aspects of daily life, including work, relationships and emotional wellbeing. Chronic pain, fatigue and fertility concerns may have a significant impact on quality of life.
With accurate diagnosis and an individualised treatment plan, many women experience meaningful improvement in symptoms and daily functioning.
When to See a Specialist
You may benefit from specialist assessment if you experience:
Persistent pelvic pain
Severe or heavy periods
Pain during intercourse
Pain with bowel movements or urination during periods
Unexplained fertility difficulties
Symptoms that interfere with daily life
Early specialist evaluation can help confirm the diagnosis and guide appropriate treatment.