Endometriosis

What endometriosis is

Endometriosis is a condition where tissue similar to the womb lining grows outside the womb — most commonly on the ovaries, the pelvic lining and the ligaments supporting the uterus, sometimes on the bowel or bladder. Each month this tissue responds to the same hormonal cycle as the womb lining: it thickens, breaks down and bleeds, but with nowhere for that blood to go, causing inflammation, pain and — over time — scar tissue and adhesions.

It affects around 1 in 10 women of reproductive age, making it one of the most common gynaecological conditions there is. It is also one of the most under-diagnosed: UK diagnosis takes years on average, with many women living with severe pain for years before it is recognised. Severe pain is not something you should have to put up with.

Is my period pain normal — or endometriosis?

The honest dividing line: normal period discomfort responds to over-the-counter painkillers and doesn’t stop your life. Pain that regularly costs you work, school, sleep or plans — pain you organise your month around — is not normal. Other flags that push towards endometriosis: pain that starts days before bleeding or continues after it, pain with sex, pain opening your bowels during your period, and heavy bleeding alongside the pain.

None of these proves the diagnosis on its own. Together, in a pattern, they earn proper assessment — not reassurance.

Endometriosis stages — and why symptoms don't match them

Surgically, endometriosis is often described in four stages, from minimal (stage 1) to severe (stage 4), based on the extent and depth of tissue found. Counterintuitively, stage predicts symptoms poorly: some women with stage 1 disease have disabling pain; some with stage 4 have little. Stage matters most for fertility planning and surgical decisions — it is not a measure of how much your pain counts.

This mismatch is one reason symptom-dismissal is so common, and why a clinician who treats the symptoms in front of them — rather than waiting for a stage number — makes the difference.

How endometriosis is diagnosed

Assessment starts with the thing most often skipped: a detailed pain-and-cycle history, taken seriously. Examination and pelvic ultrasound follow — a scan can identify ovarian endometriomas (“chocolate cysts”) and some deeper disease, but a normal scan does not rule endometriosis out. Definitive diagnosis sometimes requires laparoscopy, a keyhole look inside the pelvis, though NICE guidance supports starting treatment on the strength of symptoms without waiting for surgery.

Practically, that means the years of limbo are avoidable: history taken properly, imaging arranged, treatment started, surgical referral made when it’s genuinely the right step.

Treatment — managing hormones, pain and the long game

There’s no cure yet, but symptoms can be genuinely controlled. Hormonal treatment aims to quiet the cyclical stimulation driving the pain — options include the combined pill (often taken back-to-back), progestogens, and the hormonal coil, which also tames heavy bleeding. Pain management strategy, pelvic health physiotherapy for the muscular guarding chronic pain creates, and dietary support each earn their place. Surgery to excise endometriosis is an option for some — particularly for fertility or severe disease — via gynaecology referral.

Two situations need specialist hormone knowledge above all: endometriosis meeting perimenopause, and HRT after hysterectomy for endometriosis, where regimes are chosen carefully because oestrogen alone can reactivate residual disease.

Endometriosis and fertility

Many women with endometriosis conceive without difficulty. For others it’s a significant factor — adhesions and ovarian involvement can affect egg release and tubal function, and stage matters more here than it does for pain. If you have symptoms and you’re struggling to conceive, or planning pregnancy in the next few years, assessment now protects your options: some treatments help, timing matters, and referral pathways exist for exactly this.