Endometriosis: Symptoms, Causes, Diagnosis & Treatment

Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the uterus. Although this tissue behaves in ways similar to the uterine lining, it has no natural way to leave the body during the menstrual cycle. Over time, this can lead to inflammation, scar tissue, and ongoing pain.

The condition affects millions of women and people assigned female at birth during their reproductive years, yet it often goes undiagnosed for many years because its symptoms can resemble those of other pelvic or digestive conditions. While some people experience severe pelvic pain and painful periods, others may have mild symptoms or no symptoms at all.

Recognizing the early signs of endometriosis and seeking a timely medical evaluation can help reduce complications, improve quality of life, and support future fertility goals. If you are experiencing persistent pelvic pain, unusually painful periods, or other concerning symptoms, an online healthcare provider can help assess your symptoms and determine whether further testing or referral is appropriate.

What Is Endometriosis?

Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside the uterus, causing inflammation, pain, scar tissue, and sometimes fertility problems.

Endometriosis occurs when tissue that resembles the uterine lining (endometrium) grows outside the uterus. Unlike the normal uterine lining, which is shed during menstruation, this misplaced tissue remains trapped inside the body. As a result, it may become inflamed, bleed during the menstrual cycle, and gradually form scar tissue (adhesions) or ovarian cysts known as endometriomas.

Although endometriosis is considered a gynecological condition, its effects often extend beyond the reproductive system. Many people experience chronic pelvic pain, bowel or bladder symptoms, fatigue, and difficulties with fertility, making it a condition that can affect daily life in multiple ways.

The severity of symptoms does not always reflect how extensive the disease is. Some individuals with mild endometriosis experience significant pain, while others with advanced disease may have few noticeable symptoms.

How Endometriosis Develops

Researchers do not yet know the exact cause of endometriosis, but they understand how the condition behaves once it develops. Tissue similar to the uterine lining responds to hormonal changes during each menstrual cycle. It can thicken, break down, and bleed, just like normal endometrial tissue.

Because this tissue is located outside the uterus, the blood and inflammatory cells cannot leave the body normally. Over time, this process may lead to:

• Chronic inflammationScar tissue (adhesions)
• Ovarian cysts (endometriomas)
• Irritation of nearby organs
• Persistent or recurring pelvic pain

These changes may also interfere with the normal function of reproductive organs and, in some cases, affect fertility.

Where Can Endometriosis Occur?

Endometriosis most commonly develops within the pelvis, but in rare cases it can affect other areas of the body. The location of the tissue often influences the type of symptoms a person experiences.

Is Endometriosis a Chronic Condition?

Endometriosis is generally considered a chronic (long-term) condition. Symptoms may improve, worsen, or fluctuate over time, particularly in response to hormonal changes such as the menstrual cycle, pregnancy, or menopause.

Although there is currently no permanent cure for endometriosis, many people successfully manage their symptoms with medical treatment, lifestyle modifications, or surgery when appropriate. Early diagnosis and ongoing follow-up can help reduce pain, slow disease progression, and improve quality of life.

It is also important to remember that endometriosis affects each person differently. A personalized care plan is often the most effective approach for managing symptoms over the long term.

Endometriosis Symptoms

The symptoms of endometriosis vary widely from person to person. Some individuals experience severe pain that interferes with work, school, or daily activities, while others have few or no noticeable symptoms despite having extensive disease.

Symptoms often become more noticeable around the menstrual cycle, but they may also occur throughout the month. Recognizing these warning signs can help support earlier diagnosis and treatment.

Common Symptoms of Endometriosis

The most common symptoms include:

• Painful periods (dysmenorrhea) that are more severe than typical menstrual cramps
• Chronic pelvic pain that may occur before, during, or between periods
• Pain during or after sexual intercourse
• Pain during bowel movements, especially during menstruation
• Heavy menstrual bleeding or bleeding between periods
• Fatigue that persists despite adequate rest

Many people experience more than one symptom at the same time, and symptom intensity may change from month to month.

Less Common Symptoms

Although pelvic pain is the hallmark symptom, endometriosis can also affect nearby organs and produce symptoms that resemble digestive or urinary conditions.

Less common symptoms include:

• Bloating, sometimes called "endo belly"
• Constipation or diarrhea, particularly during menstruation
• Nausea
• Lower back pain
• Painful urination
• Frequent urination during menstrual periods
• Blood in the urine or stool (rare, depending on the affected organs)

Because these symptoms overlap with conditions such as irritable bowel syndrome (IBS) or urinary tract disorders, endometriosis may initially be overlooked.

Read more: Can a UTI Go Away on Its Own?

When Symptoms Become Severe

While mild menstrual discomfort is common, certain symptoms should not be ignored. Persistent or worsening pain may indicate that further medical evaluation is needed.

Consider seeking prompt medical assessment if you experience:

• Pelvic pain that prevents normal daily activities
• Menstrual pain that does not improve with over-the-counter pain medication
• Heavy bleeding that soaks through pads or tampons every hour for several consecutive hours
• Pain during sex that becomes frequent or severe
• Ongoing bowel or bladder symptoms associated with your menstrual cycle
• Difficulty becoming pregnant after trying to conceive

Early evaluation can help identify the cause of your symptoms and determine whether additional testing or referral to a gynecology specialist is appropriate, particularly if endometriosis is suspected.

What Causes Endometriosis?

The exact cause of endometriosis remains unknown. However, researchers believe that retrograde menstruation, genetic factors, immune system dysfunction, and hormonal influences all contribute to its development.

Despite decades of research, there is no single explanation for why endometriosis develops. Most experts believe that several biological and environmental factors work together, which explains why the condition affects people differently.

Possible Causes

Although no theory explains every case, the following are the most widely accepted explanations for how endometriosis may develop.

Retrograde Menstruation

Retrograde menstruation occurs when some menstrual blood flows backward through the fallopian tubes instead of leaving the body through the vagina. This blood may carry endometrial-like cells into the pelvic cavity, where they can attach to surrounding tissues and continue responding to hormonal changes.

While retrograde menstruation is relatively common, only some individuals develop endometriosis, suggesting that additional factors are involved.

Genetics

Family history plays an important role in endometriosis risk. People with a mother, sister, or daughter diagnosed with endometriosis are significantly more likely to develop the condition themselves.

Researchers continue to identify genes that may influence inflammation, hormone regulation, and immune responses associated with the disease.

Immune Dysfunction

A healthy immune system normally removes misplaced cells from the body. In people with endometriosis, immune function may not eliminate these cells effectively, allowing them to survive, grow, and trigger chronic inflammation.

Immune-related abnormalities may also contribute to ongoing pain and the formation of scar tissue.

Hormonal Factors

Endometriosis is strongly influenced by estrogen, a hormone that stimulates the growth of endometrial-like tissue. Higher estrogen activity may encourage lesions to grow and contribute to inflammation throughout the menstrual cycle.

Hormonal changes also help explain why symptoms often improve after menopause or with hormone-based treatments.

Risk Factors

Certain factors increase the likelihood of developing endometriosis, although having one or more risk factors does not guarantee that someone will develop the condition.

Can Endometriosis Be Prevented?

Currently, there is no proven way to prevent endometriosis because its exact cause is still unknown.

However, maintaining regular medical care and seeking evaluation for persistent pelvic pain or unusually painful periods may help identify the condition earlier. Early diagnosis can improve symptom management and may reduce the risk of long-term complications.

How Endometriosis Is Diagnosed

Endometriosis is diagnosed using a combination of medical history, symptom assessment, pelvic examination, imaging tests, and, when necessary, laparoscopic surgery to confirm the diagnosis.

Because no single blood test can diagnose endometriosis, healthcare providers typically use several methods together. The diagnostic process aims to rule out other possible conditions while determining whether endometriosis is the most likely cause of a person's symptoms.

Medical History and Symptom Review

Diagnosis usually begins with a detailed discussion about symptoms and medical history.

Your healthcare provider may ask about:

• Menstrual pain and bleeding patterns
• Chronic pelvic pain
• Pain during sex
• Bowel or bladder symptoms
• Fertility concerns
• Family history of endometriosis
• Previous surgeries or gynecological conditions

Keeping a symptom diary before your appointment can help identify patterns related to your menstrual cycle.

Pelvic Examination

During a pelvic exam, a healthcare provider gently checks for abnormalities within the pelvis.

Although many people with endometriosis have a normal pelvic examination, providers may occasionally detect:

• Tender areas
• Ovarian cysts
• Scar tissue
• Fixed pelvic organs caused by adhesions

A normal pelvic exam does not rule out endometriosis.

Imaging Tests

Medical imaging cannot diagnose every case of endometriosis, but it can identify ovarian cysts and rule out other pelvic conditions.

Laparoscopy for Confirming Diagnosis

Laparoscopy remains the gold standard for confirming endometriosis.

During this minimally invasive procedure, a surgeon inserts a small camera through a tiny abdominal incision to directly examine pelvic organs. If endometriosis is found, tissue samples (biopsies) may be collected to confirm the diagnosis under a microscope.

In many cases, surgeons can also remove or treat visible endometriosis during the same procedure.

Because laparoscopy is an invasive procedure, it is generally recommended only when symptoms persist despite conservative evaluation or when surgery is expected to improve treatment outcomes.

Why Diagnosis Often Takes Years

Endometriosis diagnosis is often delayed because its symptoms overlap with other conditions, vary widely between individuals, and cannot be confirmed with a simple blood test. A combination of clinical evaluation, imaging, and sometimes laparoscopy is needed for diagnosis.

Several factors contribute to this delay:

• Symptoms can resemble IBS, bladder disorders, or normal menstrual cramps.
• Pain severity does not always reflect disease severity.
• Symptoms vary greatly from person to person.
• Some individuals experience only infertility without significant pain.
• There is no simple screening test that confirms endometriosis.

Earlier recognition of persistent pelvic pain and painful periods can help reduce delays and allow treatment to begin sooner.

Endometriosis Stages

After endometriosis is diagnosed, healthcare providers may classify the condition into stages based on the location, depth, size, and extent of endometrial implants, scar tissue, and ovarian cysts.

It is important to understand that staging describes how much disease is present, not how much pain someone experiences.

Stage I (Minimal)

Stage I involves a small number of superficial endometrial implants with little or no scar tissue.

Although classified as minimal disease, some individuals may still experience significant pelvic pain.

Stage II (Mild)

Stage II includes a greater number of lesions than Stage I, with some implants extending deeper beneath the tissue surface.

Small areas of scar tissue may also begin to develop.

Stage III (Moderate)

Moderate endometriosis is characterized by multiple deep implants, ovarian endometriomas, and more extensive adhesions within the pelvis.

At this stage, fertility may be affected in some individuals.

Stage IV (Severe)

Stage IV is the most extensive form of endometriosis.

It typically involves:

• Multiple deep lesions
• Large ovarian endometriomas
• Dense scar tissue
• Significant adhesions affecting pelvic organs
• Possible involvement of the bowel or bladder

Treatment at this stage often requires a multidisciplinary approach depending on symptom severity and fertility goals.

Do Stages Match Symptom Severity?

The stage of endometriosis does not necessarily predict how severe symptoms will be.

For example, someone with Stage I disease may experience debilitating pelvic pain, while another person with Stage IV endometriosis may have relatively mild symptoms.

Pain depends on multiple factors, including lesion location, inflammation, nerve involvement, and individual pain sensitivity, not simply the amount of visible disease.

Key Takeaway: Endometriosis stages describe the extent of disease, not the severity of symptoms. Treatment decisions are based on a person's symptoms, quality of life, fertility goals, and clinical findings rather than stage alone.

Endometriosis Treatment Options

Endometriosis treatment depends on symptom severity, age, fertility goals, and the extent of the disease. Common treatment options include pain-relieving medications, hormone therapy, surgery, and fertility treatments for people trying to conceive.affects daily life.

There is no single treatment that works for everyone with endometriosis. Healthcare providers create individualized treatment plans based on symptoms, medical history, reproductive goals, and how the condition affects daily life.

Pain Management

Pain relief is often the first step in managing endometriosis symptoms, especially for people with mild to moderate disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may help reduce inflammation and relieve menstrual cramps and pelvic pain. These medications are generally most effective when taken early in the menstrual cycle or at the first sign of pain, following a healthcare provider's recommendations.

For people with persistent or severe pain, additional therapies may be considered as part of a personalized treatment plan.

Hormonal Treatments

Because endometriosis is influenced by estrogen, hormone therapy is commonly used to reduce or suppress the growth of endometrial-like tissue and improve symptoms.

Common hormonal treatments include:

• Birth control pills, patches, or vaginal rings to regulate hormone levels and reduce menstrual pain
• Progestins, which help thin endometrial tissue and may reduce inflammation
• GnRH agonists or antagonists, which temporarily lower estrogen levels to shrink endometriosis lesions

Hormonal treatments can effectively control symptoms for many people, but they do not permanently cure endometriosis. Symptoms may return after treatment is stopped.

Read more: Hormonal Imbalance in Women

Surgical Treatment

Surgery may be recommended when symptoms remain severe despite medication, when large ovarian cysts are present, or when endometriosis is affecting fertility.

The most common surgical approach is laparoscopic surgery, a minimally invasive procedure performed through small abdominal incisions.

During surgery, specialists may:

• Remove visible endometriosis lesions
• Excise scar tissue (adhesions)
• Remove ovarian endometriomas when appropriate
• Preserve healthy reproductive organs whenever possible

Compared with simply destroying lesions (ablation), excision surgery completely removes affected tissue and is often preferred for deep or extensive endometriosis because it may provide longer-lasting symptom relief.

Fertility Treatment Options

Although many people with endometriosis conceive naturally, others may benefit from fertility treatment depending on their age, ovarian reserve, and the severity of the disease.

Possible options include:

• Fertility medications to stimulate ovulation
• Intrauterine insemination (IUI) for selected patients
• In vitro fertilization (IVF) when pregnancy does not occur naturally or after other treatments
• Surgical removal of endometriosis before fertility treatment in carefully selected cases

A fertility specialist can recommend the most appropriate approach based on an individual's reproductive goals and overall health.

Lifestyle Changes That May Help Manage Endometriosis

Healthy lifestyle habits cannot cure endometriosis, but they may help reduce pain, improve overall well-being, and support medical treatment.

Lifestyle strategies should be viewed as complementary to, not a replacement for professional medical care. Many people find that combining healthy habits with appropriate treatment improves symptom control and quality of life.

Diet and Nutrition

Although no specific diet has been proven to treat endometriosis, a balanced eating pattern may help support overall health and reduce inflammation.

Some people find it helpful to:

• Eat plenty of fruits and vegetables
• Choose whole grains and high-fiber foods
• Include omega-3-rich foods such as salmon or walnuts
• Limit highly processed foods and added sugars
• Stay well hydrated

Because individual responses to foods vary, keeping a food and symptom diary may help identify personal triggers.

Exercise and Physical Activity

Regular physical activity may help reduce stress, improve circulation, and support overall pain management.

Low-impact activities are often well tolerated, including:

• Walking
• Swimming
• Cycling
• Yoga
• Stretching exercises

The goal is to remain active without worsening symptoms. Exercise plans should be adjusted based on pain levels and individual fitness.

Stress Management

Living with chronic pain can affect both physical and emotional well-being.

Stress management techniques that may be helpful include:

• Mindfulness meditation
• Deep breathing exercises
• Gentle yoga
• Counseling or therapy when needed
• Joining support groups for people living with endometriosis

Reducing stress may improve coping skills and enhance overall quality of life, even though it does not directly treat the disease.

Heat Therapy and Home Care

Simple home care measures can provide temporary relief during painful episodes.

Common strategies include:

• Applying a heating pad or hot water bottle to the lower abdomen
• Taking a warm bath
• Getting adequate sleep
• Staying hydrated
• Planning rest periods during severe menstrual symptoms

These approaches may help relieve discomfort but should not replace medical evaluation if symptoms become persistent or progressively worse.

Can Endometriosis Affect Fertility?

Endometriosis can make it more difficult to become pregnant, but many people with the condition are still able to conceive naturally or with fertility treatment.

Not everyone with endometriosis experiences infertility. However, the condition is one of the leading causes of reduced fertility because it can interfere with the normal function of the reproductive organs.

The likelihood of pregnancy depends on factors such as age, disease severity, ovarian reserve, and overall reproductive health.

How Endometriosis Impacts Fertility

Endometriosis may affect fertility in several ways.

It can:

• Distort pelvic anatomy through scar tissue and adhesions
• Block or damage the fallopian tubes
• Reduce egg quality in some individuals
• Create an inflammatory environment that interferes with fertilization or embryo implantation
• Affect ovarian function when endometriomas are present

The degree of fertility impairment varies significantly from person to person.

Can You Get Pregnant With Endometriosis?

Yes, it is possible to get pregnant with endometriosis. While the condition can reduce fertility in some people, many conceive naturally, and others achieve pregnancy with treatments such as IUI or IVF.

Others may need fertility treatment to improve their chances of conception.

Early diagnosis and appropriate management can help preserve reproductive health and support family-planning goals. Even individuals with moderate or severe endometriosis may achieve successful pregnancies with personalized care.

When to See a Fertility Specialist

Consider speaking with a fertility specialist if:

• You are under age 35 and have been trying to conceive for 12 months without success.
• You are age 35 or older and have been trying for 6 months without success.
• You have been diagnosed with moderate or severe endometriosis.
• You have a history of ovarian surgery or recurrent endometriomas.
• You are experiencing infertility along with chronic pelvic pain or irregular reproductive health concerns.

Early evaluation can help identify the most appropriate fertility options and avoid unnecessary delays in treatment.

When Should You See a Healthcare Provider?

You should see a healthcare provider if you have persistent pelvic pain, unusually painful periods, pain during sex, heavy menstrual bleeding, or difficulty becoming pregnant. Early evaluation can help identify the cause of your symptoms and prevent delays in diagnosis.

Although mild menstrual discomfort is common, severe or ongoing pain should never be considered "normal." Endometriosis symptoms can worsen over time and may affect your daily activities, work, relationships, and fertility if left unrecognized.

Consider scheduling a medical evaluation if you experience:

• Pelvic pain that regularly interferes with work, school, or everyday activities
• Menstrual cramps that are severe or do not improve with over-the-counter pain relievers
• Heavy menstrual bleeding or bleeding between periods
• Pain during or after sexual intercourse
• Pain during bowel movements or urination, especially during your menstrual cycle
• Persistent bloating or digestive symptoms that occur with your periods
• Difficulty becoming pregnant after trying to conceive
• Symptoms that continue to worsen over time

A healthcare provider can review your symptoms, discuss your medical history, perform an initial evaluation, and determine whether additional testing or referral to a gynecology specialist is appropriate.

Remember that early diagnosis often leads to earlier symptom management and better long-term outcomes.

How Avee Can Help

Managing endometriosis often starts with getting the right medical advice. If you're experiencing persistent pelvic pain, painful periods, or other symptoms that could be related to endometriosis, timely assessment can help you understand the cause of your symptoms and determine the next steps.

At Avee health, residents across British Columbia can access convenient virtual healthcare (Telehealth BC) from licensed healthcare providers without the need to visit a walk-in clinic for an initial assessment.

Depending on your symptoms and clinical needs, an Avee provider can:

• Conduct a comprehensive virtual assessment of your symptoms and medical history
• Discuss whether your symptoms may be consistent with endometriosis or another gynecological condition
• Provide Lab Requisitions for eligible laboratory tests when clinically appropriate
• Arrange specialist referrals, including Referral Without a Family Doctor, so you can access gynecology or fertility care even if you don't have a primary care provider
• Offer follow-up virtual appointments to review your symptoms, discuss test results, and adjust your care plan as needed
• Help coordinate ongoing care and guide you toward the most appropriate healthcare services

If you're concerned about symptoms that may be related to endometriosis, booking a virtual appointment with Avee can be a convenient first step toward receiving timely, evidence-based care.

For more trusted health information, practical guides, and educational resources, explore the Avee Health Blog for the latest articles on women's health, preventive care, and virtual healthcare services.

Conclusion

Endometriosis is a common but often underdiagnosed condition that can affect physical health, emotional well-being, and fertility. Because symptoms vary widely from person to person, many individuals experience years of discomfort before receiving an accurate diagnosis.

Understanding the signs of endometriosis including persistent pelvic pain, painful periods, pain during sex, and heavy menstrual bleeding, can help you recognize when it's time to seek medical advice. Early evaluation, an accurate diagnosis, and a personalized treatment plan can make a significant difference in managing symptoms and improving quality of life.

Whether your goal is finding relief from chronic pain, protecting your fertility, or simply understanding what is causing your symptoms, you don't have to navigate the process alone. Speaking with a qualified healthcare provider is the first step toward receiving appropriate care and developing a management plan that fits your individual needs.

If you're living in British Columbia and are concerned about symptoms of endometriosis, Avee health offers convenient virtual access to licensed healthcare providers who can assess your symptoms, guide your next steps, and connect you with specialist care when needed.