Causes and treatment options for endometriosis
Endometriosis is when cells from the tissue lining of your womb (endometrial cells) grow outside the womb
Symptoms can vary: some women don't have any symptoms, while other have very painful periods with chronic pelvic pain
The causes of the disease aren’t clearly known, and there isn't any treatment yet to eliminate it
However, it’s usually possible to control the symptoms
Endometriosis is a condition in which the cells from the lining of a woman’s uterus are found in other places of the body. It’s a chronic condition that affects around 10% of all women of reproductive age (women who are able to have periods), although the exact frequency is difficult to know as many women might not have been diagnosed. There is currently no cure but, with treatment, you should be able to keep your symptoms under control.
What is endometriosis?
During your menstrual cycle, if you are not pregnant, the tissue lining your womb – called the endometrium – will break down roughly once a month. The tissue breaks down into blood, which leaves your body as a period.
Endometriosis is a condition in which tissue from inside the womb is found outside the womb, usually in the pelvic region.
When this womb tissue breaks down into blood outside your womb, it can’t leave your body as a normal period. This leads to inflammation, irritation and can cause painful periods and other symptoms.
Endometriosis is not contagious, an infection, or an immune disease. Another common misconception is that endometriosis is a form of cancer, which it is not.
What causes endometriosis?
The exact cause of endometriosis is unknown.
There are several theories that try to explain it. The most common is that during the periods, some cells from the lining of the womb have gone backwards through the fallopian tubes into the abdomen, instead of going out through the vagina. This theory doesn’t explain all symptoms of endometriosis and scientific research is still going on to find the explanation of the disease.
Most doctors believe that your genes play a role. You’ll be more likely to have endometriosis if your sister, mother, or grandmother has it, too.
What are the symptoms of endometriosis?
No two women’s experience of endometriosis is the same. The condition affects every woman differently. One woman might experience severe pain during her period, with no abnormal bleeding, while another might experience the opposite.
Common symptoms of endometriosis include:
- painful periods
- pain during ovulation
- pain during and after sex
- spotting or unusual bleeding
- tiredness or fatigue
- chronic pelvic pain
Living with endometriosis can affect your overall mental, physical and social wellbeing. If you’re experiencing painful periods or pain during sex and think you might have endometriosis, you should visit your GP to discuss ways to manage your symptoms.
How is endometriosis diagnosed?
Endometriosis can be difficult to diagnose without visiting a specialist doctor or gynaecologist. At present, the only way to properly diagnose endometriosis is by performing what’s known as a laparoscopy.
A laparoscopy is an examination that’s carried out under a general anaesthetic, where you will be put to sleep. Depending on the extent of the surgery, you should be able to go home on the same day. A small tube with a camera on the end will be inserted into your abdomen through your belly button. It will record pictures so that the doctor can see if there’s any endometriosis tissue or signs of inflammation. A small tissue sample (a biopsy) may also be taken.
However, most of the time this surgery isn’t performed and the diagnosis can be suggested with a physical examination and an ultrasound.
According to recent research, it takes on average 7 to 8-and-a-half years for endometriosis to be diagnosed from the time a woman first shows symptoms. It’s important to make sure you make your GP aware of your symptoms as soon as you experience them. Don’t wait for the full diagnosis to seek help for your pain or uncomfortable symptoms.
How is endometriosis treated?
Treatment for endometriosis will be tailored to your individual situation, as every woman experiences endometriosis differently. With proper treatment and support, you should be able to carry out your usual activities and live comfortably with endometriosis.
The three main treatment options for endometriosis are: surgery, hormones, and pain management.
- Surgery (laparoscopic excision) – this is a lot like the laparoscopy exam. It can often be carried out at the same time as your diagnosis, if you wish. During the surgery, patches of endometriosis tissue will be removed in order to relieve your symptoms and help your fertility
- Hormones such as oral contraceptive pill or intrauterine hormonal contraception – your doctor may prescribe you hormonal contraceptive that stop or slow down your body’s production of the hormones. This has proven to improve symptoms, and reduce the activity of the endometriosis
- Pain management – everyday pain management is an important part of treatment. Painful symptoms can be managed with painkillers, but it’s important that you follow your doctor’s advice on how often you can take them. See below for more advice on managing your pain
Hysterectomies are no longer recommended as treatment for endometriosis. If someone offers you the option for a hysterectomy to cure your endometriosis, you should seek a second opinion, as unfortunately, there’s no cure for endometriosis.
Can my diet affect endometriosis?
There is some evidence to show that a poor diet makes the symptoms of endometriosis worse. As a general rule, the better your diet, the healthier you will be.
Generally speaking, you should avoid eating too much red meat, dairy, wheat and sugar if you have endometriosis. Soy products can also aggravate symptoms, as can caffeine or alcohol.
Diets rich in B vitamins, fibre and Omega-3 fatty acids (found in nuts and fish) are good for symptoms of endometriosis.
Endometriosis, fertility and pregnancy
While there is a link between endometriosis and infertility, it’s important to remember that having endometriosis does not mean you’ll be infertile.
Around 30-40% of women with endometriosis will have difficulty getting pregnant. However, many women are able to get pregnant naturally or with reproductive aid (like IVF). Talk to your doctor if you’re concerned about your fertility, especially if you’re about to have surgery.
If you have endometriosis and get pregnant, you might have some temporary relief from your symptoms. But pregnancy is not a complete cure. After you’ve given birth, it’s possible that your symptoms will return.
How can I manage my pain?
Alongside treatment, there are some things that you can do to manage painful symptoms of endometriosis.
Try to exercise as much as possible. It can be difficult to keep active when you’re in pain, but staying still or lying in bed often makes the pain worse. Try going for a short swim or walk when you feel up to it.
Avoid taking too many painkillers or analgesics, which can make your pain worse over time. Talk to your GP, nurse, or a pain psychologist if chronic pain is a daily concern. There are also pain clinics you can visit for further advice and treatment.
Visit Endometriosis UK for more information, to find local events and support networks in your area.
Dr Laura Joigneau Prieto
Dr Laura Joigneau Prieto joined ZAVA in April 2018 as a clinical doctor. She studied medicine at the Universidad Autónoma in Madrid, Spain, and at the Pierre and Marie Curie Faculty in Paris, France. She did a Master’s Degree in clinical medicine in 2009 at the Rey Juan Carlos University in Madrid.Meet our doctors
Last reviewed: 28 Feb 2019
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Endometriosis: diagnosis and management, NICE [accessed February 2023]
Endometriosis and infertility, Journal of assisted reproduction and genetics [accessed February 2023]
Contraceptive pills are a reliable way of reducing your risk of getting pregnant from sex. ZAVA offers most common brands of pill, so you can order your preferred brand by visiting our contraceptive pill service page.