Endometriosis
What is endometriosis?
Endometriosis is a common condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. It most commonly affects structures within the pelvis, including the ovaries and the ligaments supporting the uterus, but can also involve the bowel, bladder and, less commonly, the appendix.
Although the exact cause of endometriosis remains uncertain, it is likely to result from a combination of factors rather than a single cause. Current theories include genetic predisposition, hormonal influences, immune system changes, retrograde (reverse) menstrual flow and changes to the cells lining the pelvic cavity.
How common is endometriosis?
Endometriosis affects up to one in seven women and people assigned female at birth (AFAB) during their reproductive years. It is one of the most common causes of chronic pelvic pain and infertility, yet diagnosis is often delayed because symptoms can vary considerably between individuals.
What does endometriosis do?
Like the lining of the uterus, endometriosis tissue responds to hormonal changes throughout the menstrual cycle. Each month, this tissue becomes active and can trigger inflammation, irritation and the formation of scar tissue (adhesions).
Over time, adhesions may cause pelvic organs to stick together, contributing to ongoing pain and affecting the normal function of the reproductive organs. Endometriosis involving the ovaries may also form cysts known as endometriomas. These are often referred to as ‘chocolate cysts’ because they contain old blood.
What are the symptoms?
The symptoms of endometriosis vary widely and do not necessarily reflect the severity of the disease. Some people with extensive endometriosis experience few symptoms, while others with relatively mild disease may have significant pain.
Symptoms may include:
- painful periods
- pain during ovulation
- pain during sexual intercourse
- pain when passing urine or opening the bowels
- ongoing pelvic or lower back pain
- difficulty becoming pregnant (infertility)
- bowel or bladder symptoms that worsen during the menstrual cycle.
How is endometriosis diagnosed?
There is currently no simple screening test, such as a blood test, for endometriosis.
The only definitive diagnosis is made by laparoscopy, a minimally invasive (keyhole) surgical procedure that allows the pelvic organs to be examined directly. During the procedure, a tissue sample (biopsy) may be taken to confirm the diagnosis.
Further information about this procedure is available in the CHARLI information sheet on laparoscopy.
What are the treatment options?
Treatment depends on your symptoms, the extent of disease, your age and whether you are planning a pregnancy. Your specialist will recommend an individualised management plan based on your circumstances.
Surgery
Surgical treatment can reduce pain and improve fertility outcomes for many people with endometriosis. Wherever possible, surgery aims to remove endometriosis while preserving healthy reproductive organs.
Medication
Medication can play an important role in managing pain and reducing disease activity. While medical treatment has been shown to improve symptoms, it has not been shown to improve fertility.
Medications that may be recommended include:
- non-steroidal anti-inflammatory medications (NSAIDs)
- progestogens
- the combined oral contraceptive pill
- GnRH analogues.
Complementary therapies
Many people find complementary therapies helpful alongside medical treatment. These approaches may assist with symptom management and overall wellbeing and can also support recovery following surgery or other treatments.
Examples include:
- dietary modification
- regular exercise
- massage
- yoga
- Traditional Chinese Medicine (TCM)
- herbal medicine
- aromatherapy
- homeopathy.
If you choose to use complementary therapies, it is important to consult a qualified practitioner and let your healthcare team know about any treatments you are using, particularly if you are also receiving medical therapy.
What can I expect?
Although effective treatments are available, there is currently no cure for endometriosis.
Regardless of the treatment chosen, symptoms may recur over time. Approximately one in five women experience a recurrence of symptoms within five years of treatment.
Regular follow-up with your healthcare provider allows your management plan to be adjusted if your symptoms change or your fertility goals evolve.
What to remember
Endometriosis is a common condition that can affect quality of life, fertility and day-to-day wellbeing. Symptoms vary considerably between individuals, and the severity of symptoms does not always reflect the extent of disease.
An early diagnosis and an individualised treatment plan can significantly improve symptom control and, where appropriate, optimise fertility outcomes. If you experience persistent pelvic pain, painful periods or difficulty conceiving, it is important to discuss these symptoms with your GP or gynaecologist.
Further information
For additional evidence-based information and support, visit Endometriosis Australia.
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
