Gynecologic Conditions
Endometriosis: Symptoms, Diagnosis and Treatment Options
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, most often on the ovaries, fallopian tubes and the lining of the pelvis. The hallmark symptoms are painful periods, ongoing pelvic pain, pain during sex and trouble getting pregnant. It's managed with pain relievers, hormonal medicine and, for some people, surgery.
It's also common. The World Health Organization estimates it affects roughly 1 in 10 women and girls of reproductive age. Yet many people live with symptoms for years before anyone names it, usually because they were told that severe period pain is "just cramps."
Is my period pain normal? A quick gut check
Normal cramps usually start a day or two before or at the start of your period, last two to three days, and get noticeably better with ibuprofen or naproxen. You might feel lousy, but you can still get to work.
These are signs your pain may be something more:
- You've called out of work or school because of your period, more than once
- You've been sent home, or gone to urgent care, for period pain
- Over-the-counter pain relievers barely touch it
- Pooping or peeing hurts during your period
- Sex hurts deep inside, not at the entrance
- The pain has gotten worse over the years instead of better
- You have pelvic pain on days you're not bleeding
If several of those sound familiar, bring this list to a gynecologist. Many people say they didn't realize how abnormal their pain was until someone asked these questions directly.
What is endometriosis, exactly?
Each month the lining of the uterus (the endometrium) thickens and then sheds as your period. With endometriosis, endometrial-like tissue grows where it shouldn't, such as:
- The ovaries, where it can form cysts called endometriomas
- The fallopian tubes
- The outer surface of the uterus
- The lining of the pelvis (peritoneum)
- The bowel or bladder, in some cases
This tissue responds to hormones, which causes inflammation, pain and scar tissue (adhesions). Over time, adhesions can make organs stick together.
What are the symptoms of endometriosis?
Here's the confusing part: the amount of endometriosis doesn't match the amount of pain. Some people with extensive disease have mild symptoms, and some with small spots have severe pain. Common symptoms:
- Painful periods (dysmenorrhea) that are worse than typical cramps or get worse over time
- Chronic pelvic pain, including between periods
- Pain during or after sex, often deep
- Pain with bowel movements or urination, especially during your period
- Heavy periods or bleeding between periods
- Infertility or trouble getting pregnant
- Fatigue, bloating, diarrhea, constipation or nausea, often worse around your period
Some people have no symptoms and only find out during surgery for something else or during a fertility workup.
What causes endometriosis?
Nobody knows exactly. Leading theories include retrograde menstruation (period blood flowing backward through the tubes into the pelvis), immune system factors and genetics. You may be more likely to have it if:
- Your mother or sister has endometriosis
- You started your period young
- You have short cycles or long, heavy periods
It isn't caused by anything you did, and it isn't a sexually transmitted infection.
How is endometriosis diagnosed?
It starts with a conversation and usually a pelvic exam. From there, your clinician may suggest:
- Transvaginal ultrasound. Can find endometriomas and sometimes deeper disease. It often can't see small surface spots, so a normal result doesn't rule endometriosis out.
- MRI. Sometimes used to map deep endometriosis before surgery.
- Laparoscopy. Minimally invasive surgery with a camera placed through a small cut near the belly button. The surgeon can see endometriosis directly, take a biopsy, and often remove it in the same procedure. Most people go home the same day and are back at a desk job within about a week or two, though your surgeon will give you your own timeline.
Good news if you dread surgery: you don't always need it before starting treatment. ACOG notes that clinicians can diagnose endometriosis based on symptoms and exam findings and begin treatment with medicine. If that doesn't help, surgery may be next. See what to expect from laparoscopy.
What are the treatment options for endometriosis?
Treatment depends on how severe your symptoms are, your age and whether you want a pregnancy in the future.
| Treatment | How it helps | Things to know |
|---|---|---|
| NSAIDs (such as ibuprofen or naproxen) | Reduce pain and inflammation | Treat symptoms only; ask your clinician about the right dose |
| Combined hormonal birth control (pill, patch, ring) | Lighten or stop periods, reduce pain | Can be taken continuously to skip periods |
| Progestin-only options (pills, shot, implant, hormonal IUD) | Thin the tissue and reduce pain | Spotting is a common side effect |
| GnRH agonists or antagonists | Lower estrogen to shrink endometriosis | Can cause menopause-like symptoms; some are combined with add-back hormones |
| Laparoscopic surgery | Removes or destroys endometriosis and adhesions | Pain can return over time |
| Hysterectomy, with or without removing ovaries | May help when other treatments fail and pregnancy isn't wanted | Not a guaranteed cure; endometriosis outside the uterus can remain |
Medication
Hormonal treatment is usually the first step. It doesn't cure endometriosis, but it can cut pain a lot while you're on it, and many people stay on it long-term. Give a new medicine a few months before judging it, and keep a simple pain diary (0 to 10, every day) so you and your clinician can see whether it's working.
Surgery
Laparoscopic surgery can remove lesions, endometriomas and scar tissue. It may ease pain and, for some people, improve fertility. Endometriosis can come back, so many clinicians recommend hormonal treatment afterward if you're not trying to conceive.
Hysterectomy is sometimes considered for people with severe symptoms who are done having children. It isn't always a cure, especially if endometriosis outside the uterus isn't fully removed. Our overview of hysterectomy types has more.
Endometriosis and fertility
Endometriosis can make it harder to get pregnant, but many people with it conceive. If you're trying, a reproductive endocrinologist can review your options. In New York, large-group insurance plans regulated by the state must cover IVF, which matters if you end up needing it; check whether your plan falls under state rules.
Endometriosis vs. adenomyosis
Adenomyosis is a related condition where endometrial tissue grows into the muscle wall of the uterus. It causes heavy, painful periods and an enlarged uterus. You can have both. See our adenomyosis guide.
When to see a doctor
Make an appointment with a gynecologist if you have:
- Period pain that makes you miss school, work or daily activities
- Period pain that doesn't improve with over-the-counter pain relievers
- Pain during sex
- Pelvic pain that lasts more than a few weeks or shows up between periods
- Painful bowel movements or urination during your period
- Trouble getting pregnant after 12 months of trying (or 6 months if you're 35 or older)
Get urgent care for sudden, severe pelvic pain, fever, vomiting or feeling faint. These can signal a ruptured cyst or another emergency.
Finding endometriosis care in New York
Most endometriosis care starts with a general gynecologist, with a referral to a surgeon trained in minimally invasive gynecologic surgery when needed. When you call, it's fair to ask how often the surgeon does excision surgery for endometriosis and whether they use minimally invasive approaches. If you feel dismissed, getting a second opinion is completely reasonable.
Browse gynecologists across New York, including the five boroughs, Long Island and the Hudson Valley, or use the provider search to filter by location.
Frequently asked questions
What are the first signs of endometriosis?
The most common early sign is period pain that's severe, gets worse over time, or doesn't improve with over-the-counter pain relievers. Pain with sex, painful bowel movements or urination during your period, and pelvic pain between periods are also common.
Can endometriosis be seen on an ultrasound?
An ultrasound can show endometriosis cysts on the ovaries (endometriomas) and sometimes deep endometriosis, but it often misses small spots on the pelvic lining. A normal ultrasound doesn't rule endometriosis out.
Is endometriosis curable?
There's no permanent cure, but symptoms can usually be controlled. Hormonal medicines, pain relievers and surgery to remove endometriosis can all reduce pain, and many people use more than one approach over time.
Does endometriosis go away after menopause?
Symptoms often improve after menopause because estrogen levels drop, but not always. Some people keep having pain, especially if they take hormone therapy.
Sources
- ACOG — Endometriosis (Patient FAQ)
- ACOG — Management of Endometriosis (Practice Bulletin 114)
- NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) — Endometriosis
- MedlinePlus — Endometriosis
- WHO — Endometriosis fact sheet
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.