Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus. It can cause pain, inflammation and fertility difficulties, although symptoms do not always reflect disease extent.
Symptoms
Common symptoms include severe period pain, chronic pelvic pain, pain during or after sex, painful bowel movements or urination around periods, heavy bleeding and difficulty conceiving.
Some people have significant endometriosis with limited pain, while others have severe pain with less visible disease.
Diagnosis
Assessment includes a detailed symptom history and examination. Ultrasound or MRI may help identify ovarian endometriomas or deep disease, but normal imaging does not always exclude endometriosis.
Laparoscopy may be considered when surgery is needed for diagnosis or treatment.
Treatment options
Pain relief and hormonal treatment are commonly used when appropriate. Surgery may be considered for persistent symptoms, specific cysts or deep disease, fertility-related indications or when diagnosis remains uncertain.
Treatment choices should consider age, symptom pattern, previous treatment, fertility goals and surgical risks.
Living with endometriosis
Long-term care may include pelvic-floor physiotherapy, pain-management strategies, support for bowel or bladder symptoms and fertility counselling. Recurrence can occur after treatment.
Clinical decision points beyond the diagnosis
Imaging has limits
Ultrasound and MRI can map ovarian endometriomas and deep disease, but normal imaging does not exclude superficial endometriosis. The value of a scan is in answering a management question, not simply attaching a stage to pain.
Medical versus surgical strategy
Hormonal suppression can reduce symptoms while it is used but does not improve fertility during treatment. Surgery may help selected pain or fertility problems but carries risks including recurrence, adhesions and reduction in ovarian reserve when ovarian endometriomas are treated.
Fertility planning
The plan should integrate age, ovarian reserve, tubal and semen factors, symptom burden and previous surgery. Repeated ovarian surgery without a fertility strategy can be counterproductive.