Endometriosis: symptoms, assessment and treatment

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause inflammation and scar tissue. The World Health Organization estimates that it affects about 10% of women and girls of reproductive age worldwide.

Symptoms

Possible symptoms include severe period pain, persistent pelvic pain, pain during or after sex, pain with bowel movements or urination, heavy bleeding, fatigue and difficulty becoming pregnant. Symptoms vary, and pain severity does not reliably show how extensive the condition is. These symptoms can also have other causes.

How it is assessed

The World Health Organization reports an average diagnostic delay of 4 to 12 years. Assessment may include a symptom history, examination and imaging such as ultrasound or MRI. A normal scan does not always exclude endometriosis. Laparoscopy is not an automatic first step. ESHRE recommends considering it when imaging is negative or empirical treatment is unsuccessful or inappropriate.

What a normal scan can and cannot show

Ultrasound and MRI can identify some forms of endometriosis, but negative imaging does not exclude the condition, particularly superficial peritoneal endometriosis. A normal clinical examination also does not end the assessment. The next step depends on symptoms, imaging findings and whether treatment without surgical confirmation is appropriate or helpful.

There is no routine blood test that confirms it

CA-125 and other biomarkers measured in blood, urine, menstrual fluid or uterine fluid are not currently recommended for diagnosing endometriosis. New tests are being studied, but a test described as emerging or under development cannot yet confirm or exclude the condition in routine care.

How treatment choices are made

There is currently no cure. Care may include pain management, hormonal treatment, surgery, fertility support and help with the wider effects of chronic pain. Decisions may differ according to pain, pregnancy goals, personal preferences, side effects, long-term safety, cost and availability. Symptoms can persist or return after medical treatment or surgery, so no single path is right for everyone.

Be cautious with cure claims

Non-medical strategies can be discussed as part of quality-of-life support. ESHRE could not recommend a specific diet, exercise programme, acupuncture, physiotherapy or psychological intervention as a treatment for endometriosis pain because the benefits and harms remain unclear. None should be presented as removing lesions or curing the condition.

When to seek care

Talk to a GP if period or pelvic symptoms disrupt work, school, sleep, sex or everyday activities. Bring a short symptom record and ask what other causes are being considered, whether imaging or referral is appropriate, and what the follow-up plan will be if initial treatment does not help.