What is endometriosis?

Endometriosis is a common condition that can affect a large number of women during their reproductive years. Up to one in ten women will be diagnosed with endometriosis at some point in their life. A third of these women may also experience fertility issues, but luckily, there are treatment options available.

Endometriosis occurs when the lining of the uterus (the endometrium), starts growing outside the uterus which causes scar tissue. This problem results in tissue destruction and anatomical distortion. Eventually the natural function of the reproductive organs can be affected, leading to trouble falling pregnant naturally.

Causes of endometriosis

The cause of endometriosis isn’t entirely known and can vary between women. We do know that if you have a close relative with endometriosis, you’re up to ten times more likely to have it. [1]

According to the non-for profit organisation Jean Hailes for Women’s Health, there are some lifestyle factors that may have a role in causing endometriosis in women. These include things like have your first pregnancy at an older age, having your first period before the age of 11, changes in immune cells, low body weight and excessive alcohol use.

Symptoms of endometriosis

Common symptoms of endometriosis include significant and recurring period pain where regular strong pain killers are required. The pain typically starts during the period but may occur a few days earlier and lasts for variable durations. However, it is important to note that not all women who experience some kind of pain or discomfort during their cycle will have endometriosis.

Recurring period pain/pelvic pain

Endometriosis related period pain generally worsens over time and can become resistant to oral pain killers. Some women may develop other pain patterns such as back and bowel pain, and sometimes the pain becomes more entrenched and presents at times other than during a period. The pain pattern can occasionally be used to help pinpoint which part of the pelvis and its related organ the endometriosis affects. It’s not uncommon for women with endometriosis to experience pain during regular bowel movements too.

Irregular bleeding/spotting

Often, premenstrual bleeding or spotting days before your period is due can be a sign of endometriosis. Most women will generally find that their periods start in quite a defined manner and therefore spotting that starts earlier than 12-24 hours before menstruation is due to begin can indicate endometriosis.

Painful intercourse

According to an analysis completed by Reproductive Sciences in 2017, two-thirds of women with endometriosis will experience sexual dysfunction of some sort [2]. The type and severity of the pain will vary from woman to woman. If something doesn’t feel right during intercourse, it’s best to bring it up with your GP.

No symptoms

Some women may not have any symptoms whatsoever to suggest they have endometriosis. It can often come as a surprise diagnosis discovered during a routine surgery or when trying to conceive. Therefore, we know that the severity of the disease does not necessarily go hand in hand with symptom severity. Some women may have a “frozen pelvis”, where the internal pelvic organs are matted together and they may display minimal symptoms. Whereas others have significant pelvic pain and minimal disease discovered at laparoscopy. This is why some women don’t discover they have endometriosis until they have difficulty when trying to have a baby.

Diagnosing endometriosis

It is important to note that not all women who experience some kind of pain or discomfort during their cycle or during intercourse will have endometriosis. It is this reason that often makes a clinical diagnosis a challenge.

If your doctor or fertility specialist suspects you have endometriosis, often an expert vaginal ultrasound is requested as this can detect deeply infiltrating endometriosis. A laparoscopy can then be performed to confirm this. Whilst medical management is usually tried first, the small procedure is the only way to be certain of a correct diagnosis. Laparoscopic surgery allows your doctor to look directly inside your abdomen for signs of endometriosis. Generally completed under anaesthesia, the surgery can provide information about the size, severity and location of any endometriosis.

Treating endometriosis

Most commonly, endometriosis is treated with either medications or surgery. The best approach will vary from woman to woman and is something that your doctor will discuss with you. Some treatment options may not be suitable if you’re currently trying to have a baby.

Often, doctors will try a conservative approach first with surgery being the last option.

Pain medication

Sometimes, treatment for endometriosis may be as simple as taking some pain medication in the form of tablets or nasal sprays. Often these are over-the-counter pain reliefs such as ibuprofen to try and ease the abdominal pain. If taking the maximum dose of pain relief medications does not help the symptoms, you may need to look into something a little more advanced such as hormone therapy.

Hormone therapy

Although hormone therapy isn’t a permanent fix for women with endometriosis, it can often provide temporary relief by eliminating the pain. During a regular period, the rise and fall of hormones can cause the endometrial implants to thicken, break down and bleed. By using hormone medication to change the usual hormonal pattern, the endometrial tissue growth may slow and prevent new endometriosis from presenting.

Often, birth control pills, patches or implants are used. If trying for a baby, this would not be an appropriate option.

Laparoscopic surgery

Similarly to the way the surgery is the only way to correctly diagnose endometriosis, a laparoscopy is the best way to remove as much endometriosis as possible while preserving the reproductive organs. If the ultrasound also showed endometriosis on the bowel, your specialist may need to invite other surgeons to assist with the surgery. For women with severe endometriosis who are trying to have a baby, this may be an option to discuss with their fertility specialist.

Unfortunately, endometriosis and pain may return.


In extremely severe cases of endometriosis, a hysterectomy – which removes the uterus, cervix and ovaries – may be the best form of treatment. This type of surgery is a last resort for many patients and often not considered for women in their reproductive years as you would not be able to fall pregnant after a hysterectomy.

Endometriosis and fertility

Endometriosis can cause infertility in different ways. The female reproductive system, including the ovaries and fallopian tubes, is quite delicate and can be easily compromised. If it damages the tubes and the ovaries then this will significantly reduce your ability to conceive.

When the fallopian tubes are affected, the delicate fimbrial ends of the tubes are matted together. The fimbrias are like the delicate petals of a flower. They sweep the surface of the ovaries picking up the egg during ovulation. When they are heavily affected by endometriosis, they lose this function.

Endometriosis may also affect your fertility by inducing inflammatory changes within your pelvis to create a “hostile” environment for the egg, sperm and embryo. The uterus lining known as endometrium is often affected in severe cases and this in turn can affect the implantation of an embryo.

Unfortunately, endometriosis cannot be prevented but early diagnosis helps to prevent disease progression and worsening of fertility prospects. However it is important to remember that not all women diagnosed will experience infertility. Some women with endometriosis will have no trouble conceiving naturally and having a successful pregnancy.

For the vast majority of women with endometriosis who experience infertility, there is good news – there are fertility treatments that can help!

Depending on the severity of the condition, you may require simple medication, a laparoscopic surgery procedure to attempt to remove the endometriosis, or IVF. In many circumstances, women are able to conceive naturally after surgery. However, there may be other fertility issues present, such as poor sperm quality and IVF may then be the preferred option.

It’s really important for woman to speak with their fertility specialist if they have any concerns or think they may have endometriosis.

Coping with endometriosis

Although endometriosis cannot be prevented and not all treatment options are suitable for everyone, there are some lifestyle and home remedies that you can try to help ease the discomfort of the disease.
These include things like

  • Having a warm bath or using heating pads or heats bags. The warmth can help relax the pelvic muscles which can help in reducing pain and cramping.
  • Keep moving. Regular exercise can help improve some of the discomfort and can boost your overall mood too.
  • Talk to someone. If you find that you feel quite alone dealing with endometriosis, it might help to join a support group or talk to someone who also suffers with endometriosis or fertility problems.
  • Make sure you talk to your doctor and discuss all suitable options.