screening for endometriosis pain

Overview

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the womb. This tissue responds to hormones in the same way as the womb lining, so it can become inflamed and cause pain, especially during periods. There is no simple screening test for endometriosis, but understanding the signs and getting help early can lead to a diagnosis and better management.

Yes, endometriosis is fairly common. It is estimated to affect about 1 in 10 people assigned female at birth during their reproductive years.

It most often affects people in their 30s and 40s, but it can start in the teenage years. It can affect anyone who has periods, including transgender men and non-binary people who still have a uterus.

Symptoms

Common symptoms

• Painful periods that are severe enough to stop you from doing daily activities
• Pelvic pain that is not only during periods
• Pain during or after sex
• Heavy or irregular periods
• Pain when going to the toilet during periods
• Tiredness, low energy, or fatigue
• Difficulty getting pregnant

Symptoms in children

• Teenagers and younger people may have severe period pain that does not get better with usual pain relief
• They may miss school or social activities because of pain
• The pain may be dismissed as 'normal period pain', but it is not normal to have pain that interferes with life

Symptoms in older adults

• Symptoms can continue after menopause, although they often improve because hormone levels drop
• If hormone replacement therapy is used, it may sometimes reactivate symptoms
• Pelvic pain in older women can have many causes, so it is important to see a doctor for an accurate diagnosis

Causes

Main causes

• The exact cause is not fully understood.
• One idea is that menstrual blood flows backward through the fallopian tubes into the pelvis, which is called retrograde menstruation.
• Hormones, the immune system, and genetics may also play a role.
• Endometriosis is not caused by anything you did or did not do.

Risk factors

• Starting your period at an early age
• Having short monthly cycles (less than 27 days)
• Heavy or long periods
• Low body weight
• A family member (like your mother or sister) with endometriosis
• Having never given birth

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pain or heavy bleeding, seek medical help immediately.
• If you have pain with a fever, see a doctor the same day.

Book a routine appointment if:

• If you have painful periods that affect your daily life, make an appointment with your GP or gynecologist.
• If period pain does not improve with over-the-counter pain relievers that are safe for you (ask your pharmacist), see a doctor.
• If you have pelvic pain outside of periods, after sex, or when using the toilet, get it checked.

Diagnosis

There is no single blood test for endometriosis. A doctor will ask you about your symptoms, your periods, and any family history. They may do a pelvic examination, which is a physical check of your reproductive organs. If the doctor suspects endometriosis, they may refer you for an ultrasound scan. The only way to confirm the diagnosis with certainty is with a small operation called a laparoscopy.

Tests that may be done

• Pelvic examination – a doctor checks your uterus, ovaries, and pelvis for any tender areas or growths.
• Ultrasound scan – a scan that uses sound waves to look at your pelvic organs. It cannot always see endometriosis, but it helps rule out other conditions.
• Laparoscopy – a keyhole surgery with a camera that lets the doctor look directly inside your pelvis. Endometriosis patches can be seen and sometimes treated during the same procedure.

What to expect at your appointment

Your appointment will usually involve talking about your symptoms and medical history. The doctor may ask you to keep a symptom diary. If you need a laparoscopy, you will be given anaesthetic so you are asleep during the procedure. Recovery time varies, but many people go home the same day or the next day.

Treatment

There is no cure for endometriosis, but treatment aims to reduce pain, shrink the endometriosis tissue, and improve quality of life. The right treatment depends on your symptoms, whether you want to have children in the future, and what you prefer.

Self-care at home

• Try gentle heat on your lower abdomen, like a hot water bottle or heat pad
• Take over-the-counter pain relief such as paracetamol or ibuprofen if it is safe for you – ask your pharmacist for advice
• Rest when you need to, and try gentle activity like stretching or walking on good days
• Use a period tracking app or diary to see when pain is likely to happen and prepare in advance
• Talk to someone you trust about how pain affects you – it is not just physical

Medical treatments

Doctors can offer different types of treatment. Hormonal treatments, like the combined pill, progestogen-only methods, or other medicines that reduce hormone levels, may help shrink endometriosis tissue and reduce pain. These are available as pills, patches, implants, or injections. Another option is a hormone-releasing intrauterine system (IUD) placed in the womb. These treatments do not cure endometriosis, but they can help keep symptoms under control. Some people try medicines that are not hormonal, such as pain relievers, or complementary therapies like acupuncture, but talk to your doctor about what is safe for you. All medicines have benefits and side effects, so your doctor will discuss the options with you based on your needs and plans for pregnancy.

When is surgery considered?

Surgery may be considered if other treatments do not help or if you are trying to get pregnant. A surgeon can remove or destroy areas of endometriosis during a laparoscopy. In severe cases, and for people who do not want children or have completed their family, surgery to remove the uterus or both ovaries may be offered. Surgery does not always cure the condition, and symptoms can return.

Living with this condition

Living with endometriosis means learning to manage pain and fatigue. You may need to plan rest days around your cycle. Work, school, and social life can be affected, so it is important to be kind to yourself. Keep a symptom diary and discuss flexible work or study options if needed.

Lifestyle tips

• Try stress-reducing activities like yoga, meditation, or breathing exercises
• Get enough sleep and try to keep a regular sleep schedule
• Move your body in ways that feel good – gentle exercise can ease pain for some people
• Use a hot water bottle or warm baths during painful times
• Ask for help from family, friends, or support groups when you need it

Diet and exercise

Some people find that eating anti-inflammatory foods, like fruits, vegetables, whole grains, and omega-3 fats from fish or nuts, helps their symptoms. There is no one diet that works for everyone, but avoiding processed foods and too much caffeine or alcohol may help. Regular, low-impact exercise like swimming, walking, or cycling can improve energy and mood. Always listen to your body and rest when you need to.

Mental health and emotional wellbeing

Living with chronic pain can be emotionally tiring. You may feel anxious, depressed, or frustrated. It is normal. If you are struggling with your mental health, please talk to your doctor or a mental health professional. Remember that your feelings matter, and seeking support is a sign of strength.

Prevention

There is no known way to prevent endometriosis, but early diagnosis and management can help reduce pain and protect your quality of life. There is some evidence that eating vegetables and omega-3 fats may lower the risk, but this is not proven.

Screening programmes

There is currently no national screening programme for endometriosis in most countries. Screening would mean checking healthy people for a condition before symptoms appear. Because endometriosis is hard to detect without surgery, screening is not recommended. Instead, the focus is on recognising symptoms early and seeing a doctor promptly.

Complications

If left untreated

• Chronic pelvic pain that gets worse over time
• Painful periods that interfere with school, work, or relationships
• Fertility problems – endometriosis can make it harder to get pregnant
• Adhesions – scar tissue that can bind organs together
• Ovarian cysts (endometriomas) that may need treatment

Long-term outlook

Although endometriosis is a long-term condition, most people can manage their symptoms well with the right support. Treatment can significantly improve pain and quality of life. Many people with endometriosis go on to have children, with medical help if needed. You are not alone, and there are many care options available to help you live well.

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