Endometriosis: Symptoms, Diagnosis and Management

Endometriosis is tissue similar to the lining of the uterus growing outside it, usually on the ovaries, fallopian tubes or pelvic tissue. Each cycle it responds to the same hormones as the lining does, thickening and breaking down, but with nowhere to shed, which causes inflammation, scarring and adhesions. It commonly takes years to diagnose, partly because severe period pain is often dismissed as normal. If you have symptoms, getting a diagnosis matters in its own right, separately from any question about fertility.

What are the symptoms?

• Painful periods, often severe enough to interfere with daily life.
• Pelvic pain outside menstruation.
• Pain during or after intercourse.
• Pain with bowel movements or urination, particularly around menstruation.
• Heavy or irregular bleeding.
• Fatigue.
• Difficulty conceiving, sometimes the first sign in women with no pain.

Two things are worth knowing. Symptoms vary enormously, and some women have none. And the severity of symptoms does not reliably indicate the extent of the disease, so pain is not a measure of how much endometriosis is present.

Why does it take so long to diagnose?

Because the main symptom is period pain, which is common, frequently normalised, and easy to attribute to something else. Many women are told for years that their pain is ordinary.

If your period pain regularly stops you doing normal activities, that is worth pursuing rather than accepting. The American College of Obstetricians and Gynecologists sets out the condition, and knowing what to ask makes the conversation easier.

How is it diagnosed?

• History and examination, which often raises the suspicion first.
• Ultrasound, which can identify ovarian endometriomas though it does not exclude the condition if normal.
• MRI, in some cases.
• Laparoscopy, a surgical procedure that allows the pelvis to be examined directly and treatment to be carried out at the same time.

A normal scan does not rule endometriosis out, which is a common source of confusion for patients told their imaging was clear.

How is it managed?

Management depends on whether the priority is pain, fertility, or both, and these can pull in different directions.

• Pain management, including hormonal treatments. Note that most hormonal treatments prevent pregnancy while being taken.
• Surgery, to remove endometriosis and adhesions.
• Fertility treatment, where conception is the priority.

If you have endometriosis and want to conceive, our article on getting pregnant with endometriosis covers the fertility side in detail, including the trade-off between surgery and IVF.

We at Millennium IVF Clinic assess how endometriosis is affecting fertility. You can arrange a consultation with our team.

Frequently asked questions

Is severe period pain normal?

Pain that regularly prevents you doing normal activities is worth investigating rather than accepting. Normalising it is one reason diagnosis is often delayed.

My scan was normal. Does that rule out endometriosis?

No. Ultrasound can identify some forms, particularly ovarian endometriomas, but a normal scan does not exclude the condition.

Does endometriosis get worse over time?

It varies between individuals. Discuss what is likely in your case with the doctor managing your care, particularly if you are weighing when to try to conceive.

Does pregnancy cure endometriosis?

No. Symptoms may improve during pregnancy and while breastfeeding, but the condition is not cured and symptoms commonly return.