Endometriosis pain

Overview

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the womb. This tissue can swell and bleed during your period, causing pain, inflammation, and sometimes scarring. It often affects the ovaries, fallopian tubes, and the lining of the pelvis.

Yes, endometriosis is a common condition. It affects millions of people worldwide, though it often goes undiagnosed or misdiagnosed for years.

It mostly affects women and people assigned female at birth during their reproductive years, typically between the ages of 15 and 49. It can also affect teenagers and, rarely, postmenopausal women.

Symptoms

Common symptoms

• Pelvic pain that is worse during your period (dysmenorrhea)
• Pain during or after sex
• Pain with bowel movements or urination, especially during your period
• Heavy menstrual bleeding or bleeding between periods
• Fatigue and low energy
• Difficulty getting pregnant (infertility)

Symptoms in children

• Severe cramping with periods that gets worse over time
• Pain that keeps them from going to school or activities
• Chronic pelvic pain even when not on their period

Symptoms in older adults

• Pelvic pain that may continue or even start after menopause if hormone therapy is used
• Bloating, abdominal discomfort, or bowel symptoms like painful bowel movements

Causes

Main causes

• The exact cause is not fully understood. One theory is that menstrual blood flows backward through the fallopian tubes into the pelvis (retrograde menstruation) and implants there.
• Genetics may play a role – endometriosis can run in families.
• Problems with the immune system might allow the tissue to grow and spread.

Risk factors

• Starting your period at an early age (before age 11)
• Having shorter menstrual cycles (less than 27 days)
• Having heavy or long periods (more than 7 days)
• Never having given birth
• Having a close family member (mother, sister, or daughter) with endometriosis

When to see a doctor

See a doctor urgently if:

• You have severe pain that suddenly gets worse or does not improve with usual care
• You have heavy bleeding that makes you feel dizzy or weak
• You think you might be pregnant and have sharp lower belly pain

Book a routine appointment if:

• You have painful periods that affect your daily life and have not responded to over-the-counter pain relievers
• You have pain during sex, with bowel movements, or when you urinate
• You have been trying to get pregnant for a year (or 6 months if over 35) without success

Diagnosis

Diagnosis usually starts with a detailed discussion of your symptoms and a pelvic exam. The only sure way to diagnose endometriosis is with a surgery called laparoscopy, where a doctor looks inside the pelvis with a camera.

Tests that may be done

• Pelvic exam – to feel for lumps or cysts
• Ultrasound – to check for ovarian cysts (endometriomas) but does not rule out endometriosis
• MRI – may give more detail before surgery
• Laparoscopy – a minor surgery done under anesthesia. The doctor inserts a tiny camera through a small cut in the belly to see directly and can also take a tissue sample (biopsy).

What to expect at your appointment

Diagnosis can take time because symptoms vary and overlap with other conditions. Your doctor will work with you step by step. If surgery is suggested, it is usually done in a hospital and you can go home the same day.

Treatment

There is no cure for endometriosis, but treatment can help manage pain, improve fertility, and slow the growth of the tissue. Treatment depends on your symptoms, age, and whether you want to get pregnant. Options include pain relief, hormone therapy, and surgery.

Self-care at home

• Apply a heating pad or warm water bottle to your lower belly for cramping
• Try gentle exercise like walking, yoga, or stretching to ease pain
• Practice relaxation techniques such as deep breathing, meditation, or warm baths
• Use over-the-counter pain relievers like ibuprofen or naproxen (check with your doctor or pharmacist first)

Medical treatments

Doctors may recommend hormonal contraceptives (such as the pill, patch, or ring) to reduce pain by making periods lighter and less frequent. Other hormone medications like progestins or GnRH agonists can also help by putting the endometriosis tissue to rest. These treatments do not cure the condition but can control symptoms. Always discuss the benefits and side effects with your doctor.

When is surgery considered?

Surgery may be considered if pain is severe and other treatments have not worked, or if endometriosis is causing fertility problems. The surgeon can remove or destroy the patches of endometriosis tissue. In some cases, removal of the womb (hysterectomy) may be done, but this is not a cure all and should be discussed thoroughly. Surgery does not guarantee that pain will not return.

Living with this condition

Living with endometriosis often means managing chronic pain and fatigue. It can be helpful to track your symptoms, plan rest days, and communicate with friends, family, and your employer about your needs. You may need to adjust your schedule during flare-ups.

Lifestyle tips

• Get enough sleep – aim for 7–9 hours each night
• Find gentle movement that feels good, such as swimming or pilates
• Manage stress with mindfulness, hobbies, or talking to a therapist
• Consider joining a support group to connect with others who understand

Diet and exercise

Some people find that reducing red meat, processed foods, and caffeine helps with inflammation. Eating more fruits, vegetables, and whole grains may also be beneficial. Gentle exercise like walking or yoga can reduce stress and improve blood flow, but listen to your body and rest when needed.

Mental health and emotional wellbeing

Living with chronic pain and the challenges of endometriosis can take a toll on your mental health. It is common to feel frustrated, anxious, or depressed. Talking to a counsellor or therapist can help. If you are having thoughts of harming yourself, reach out to a crisis helpline immediately.

Prevention

There is no known way to prevent endometriosis. Because the exact cause is not clear, there are no sure steps to stop it from developing. However, early diagnosis and treatment can help manage symptoms and prevent complications.

Vaccines

No vaccines exist for endometriosis.

Screening programmes

There is no routine screening test for endometriosis. If you have symptoms, it is important to see a doctor for evaluation.

Complications

If left untreated

• Chronic pelvic pain that worsens over time
• Infertility – endometriosis can affect the ovaries and fallopian tubes, making it harder to get pregnant
• Ovarian cysts (endometriomas) that can rupture or cause pain
• Scar tissue and adhesions that can cause organs to stick together
• Fatigue and reduced quality of life

Long-term outlook

With proper treatment and support, most people with endometriosis can manage their symptoms and lead full, active lives. Fertility may be affected, but many people still conceive, especially with medical help. It is a lifelong condition, but there are many ways to control pain and improve daily wellbeing. Stay hopeful and work closely with your healthcare team.

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