Endometriosis is one of the most common conditions you may never have had explained to you. It affects 1 in 10 women and those assigned female at birth. That is around 1.5 million people in the UK. At its mildest it causes heavy, painful periods. At its worst it can mean disabling pain, fertility problems and a real toll on mental health. Yet it remains under-recognised and slow to diagnose. In this article, we explore what endometriosis is, how it shows up, how it is diagnosed and treated and why getting help early matters.
What is Endometriosis?
Endometriosis happens when tissue similar to the lining of the womb grows outside it. This tissue usually settles on the ovaries, the fallopian tubes or the lining of the pelvis. In rarer cases it can reach further afield, including the bowel, bladder or, very occasionally, beyond the pelvis entirely.
The trouble is that this tissue still behaves as though it were inside the womb. Each month it responds to your hormones, builds up and bleeds. With nowhere for that blood to go, it triggers inflammation, scarring and pain. Doctors usually grade the condition from stage 1 to stage 4. The grade reflects how much tissue is present and where it sits. It is worth knowing that the stage does not always match the symptoms. Mild disease can cause severe pain, and extensive disease can cause very little.
What Causes Endometriosis?
The truthful answer is that no one knows for certain. Several theories exist, and the cause is probably a mix of them. The best-known is retrograde menstruation. Here some menstrual blood flows backwards through the fallopian tubes into the pelvis, carrying womb-lining cells with it. The snag is that most women have some retrograde flow, yet only some develop endometriosis. So it cannot be the whole story.
Other ideas point to cells outside the womb transforming into endometrial-like tissue. Another is that differences in the immune system let stray tissue survive where it should not. Genetics play a part too, since the condition often runs in families. What is clear is that endometriosis is an oestrogen-dependent condition. That is why so much of its treatment focuses on lowering or blocking oestrogen.
What Are the Symptoms of Endometriosis?
Symptoms vary enormously, and some women have none at all. When they do appear, the most common is pelvic pain tied to the menstrual cycle. This is usually worse than ordinary period cramps. It often starts before the period and carries on through it. It can also radiate into the lower back and abdomen. Painful periods like this are known as dysmenorrhoea, and they can worsen over time. Other symptoms are easy to miss or put down to something else:
- Pain during or after sex, sometimes lasting hours afterwards.
- Pain opening your bowels or passing urine, particularly during your period.
- Heavy or irregular bleeding that disrupts daily life.
- Bowel or bladder changes, including bloating, constipation or diarrhoea.
- Difficulty getting pregnant, which is sometimes the first sign noticed.
None of these is unique to endometriosis. That is part of why it is so easily overlooked. If they sound familiar and keep recurring, they are worth taking seriously and investigating further.
How Is Endometriosis Diagnosed?
Diagnosis starts with a conversation. Your doctor will ask about your periods, your pain and your medical and sexual history. They will also examine your abdomen and pelvis. They may take swabs or arrange a smear if one is due, mainly to rule out other causes such as infection.
The next step is often an ultrasound scan. This can be done over the abdomen, or internally with a transvaginal probe for a clearer view of the womb and ovaries. An ultrasound cannot show endometriosis itself, but it can reveal linked cysts known as endometriomas. An MRI is sometimes used for a more detailed picture. The definitive test is a laparoscopy. This is keyhole surgery under general anaesthetic, where a camera is passed into the pelvis to look for endometrial tissue directly. Because it is surgical, doctors often try less invasive steps first, and may begin treatment before resorting to it.
How is Endometriosis Treated?
There is no cure for endometriosis, but a lot can be done to control it. Treatment is medical, surgical or a combination. The right mix depends on your symptoms, your age and whether you are hoping to conceive. The first priority is usually pain. Pain relief can range from everyday painkillers to physiotherapy and specialist pain-clinic input.
Medical treatment often centres on hormones, since lowering oestrogen tends to shrink the stray tissue. Options include the combined pill, progesterone-only pills or implants, the hormonal coil and oestrogen-blocking medicines. Where medication is not enough, surgery may be offered. This is usually a laparoscopy to remove or destroy the tissue, clear any cysts and divide scarring. Care is best led by a specialist, often a multidisciplinary team. That way pain, fertility and the disease itself are all addressed together.
Does Endometriosis Affect Fertility?
It can, though it is far from a certainty. There is a recognised link between endometriosis and reduced fertility. Even so, having the condition does not mean you will struggle to conceive. Many women with endometriosis go on to have children. If you are having difficulty, it is worth seeing a specialist who can look for a specific cause and talk you through the options. The earlier this is explored, the more choices tend to be available.
Why Does Diagnosis Take So Long?
This is the hardest part of the endometriosis story. The symptoms overlap with many other conditions, and period pain is still too often brushed aside. So diagnosis is frequently delayed for years. In the UK the average time from first symptoms to diagnosis is now almost nine years. Worse, it has been getting longer rather than shorter. That delay matters. Untreated endometriosis can progress, and the pain can become harder to manage. So if any of this sounds like your experience, see a doctor and say plainly that you are concerned about endometriosis. Ask to be referred for investigation. Being specific can make a real difference, and early diagnosis opens up far more options.
Living with endometriosis can be exhausting, both physically and emotionally. Far too many women have spent years being told their pain is normal. It is not, and you do not have to manage it alone. For trustworthy information and support, the NHS endometriosis pages and Endometriosis UK are good places to start. Your GP is the right first step towards a diagnosis.
City Skin Clinic is an online skincare and hair clinic, so endometriosis sits outside what we treat. We have written about it because women’s health matters to us and deserves to be talked about openly. If you are looking for support with endometriosis, please speak to your GP or reach out to the organisations above.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
