Endometriosis is a long-term condition in which tissue similar to the lining of the womb grows outside the womb. It may cause period pain, ongoing pelvic pain, pain during sex, bowel or bladder symptoms, heavy bleeding, or difficulty becoming pregnant. Symptoms vary, and their severity does not always show how much endometriosis is present.

What is endometriosis?

The womb (uterus) has an inner lining called the endometrium. With endometriosis, tissue that acts in some similar ways is found elsewhere, often in the pelvis. It may be on the ovaries, fallopian tubes, the outer womb, bladder, bowel, or the lining of the pelvis.

This tissue can respond to hormone changes. It may lead to inflammation, which means irritation and swelling, and to scar tissue called adhesions. Adhesions can make nearby tissues or organs stick together.

The World Health Organization estimates that endometriosis affects about 10% of women of reproductive age worldwide. Some people have severe symptoms, some have mild symptoms, and some have no symptoms.

Endometriosis is not an infection, and it is not caused by something you did. Its exact cause is not fully understood.

What signs can endometriosis cause?

Possible signs include:

• Period pain that limits daily activities.
• Pelvic pain at other times of the month.
• Pain during or after sex.
• Pain when passing urine or opening the bowels, especially around a period.
• Heavy periods or bleeding that feels hard to manage.
• Bloating, tiredness, nausea, or bowel changes that follow a cycle pattern.
• Difficulty becoming pregnant.

The ACOG endometriosis guide notes that chronic pelvic pain is a common sign, but endometriosis can also exist without pain. Symptoms can overlap with adenomyosis, fibroids, irritable bowel syndrome, bladder conditions, pelvic infections, and other causes.

Pain is real even when a scan is normal or the cause is not yet clear. The effect on school, work, sleep, sex, exercise, or daily care is useful information for a clinician.

How do clinicians assess endometriosis?

The assessment usually starts with your history. A clinician may ask:

• When pain occurs and how long it lasts.
• Whether it follows your cycle.
• What bleeding is like.
• Whether sex, urination, or bowel movements are painful.
• Whether symptoms affect fertility goals or daily life.
• Which medicines or other care you have tried.

They may offer an abdominal or pelvic examination. An ultrasound can look for ovarian endometriomas, which are cysts linked with endometriosis, and for some deeper forms of the condition. Magnetic resonance imaging (MRI) may be useful in selected cases.

No single symptom proves that endometriosis is present. A normal examination or scan also may not explain all pelvic pain. Depending on your symptoms, goals, and local guidance, a clinician may discuss a working clinical assessment, further imaging, referral, or laparoscopy. Laparoscopy is keyhole surgery that lets a specialist look inside the pelvis and may allow tissue to be removed.

You do not have to rate your pain as a perfect number. Describe what it stops you doing, how often it occurs, and what comes with it.

Why can assessment take time?

Endometriosis symptoms overlap with many other concerns. They may also change from month to month. A short visit may not capture the whole pattern.

Write down your main concern before the visit. Bring dates if you have them. Ask what the clinician thinks the next step will show. If your symptoms continue, ask when the plan should be reviewed. You can seek another medical view if you feel your concerns have not been heard.

What care can involve

Care should reflect your symptoms, priorities, fertility plans, health history, and preferences. The WHO describes a range of options rather than one plan that works for everyone.

A clinician may discuss:

• Pain-relieving medicines.
• Hormonal medicines that reduce bleeding or suppress cycles.
• Surgery to remove visible endometriosis or release scar tissue.
• Pelvic-floor physiotherapy and support for persistent pain.
• Fertility assessment and specialist support when pregnancy is a goal.
• Mental health support when pain or fertility stress affects well-being.

These choices have different benefits, limits, and side effects. Hormonal options are not suitable for every person and may not fit when trying to conceive. Surgery can help some symptoms, but symptoms may return. Ask what each option aims to change and how progress will be reviewed.

Do not start, stop, or change a prescribed medicine based on general online information. A clinician who knows your history can discuss what fits your situation.

Endometriosis and fertility

Endometriosis can make pregnancy more difficult for some people, but many people with endometriosis become pregnant. Your experience cannot be predicted from a symptom list or pain level.

If pregnancy is a goal, tell your clinician early so care choices can reflect that goal. They may discuss how long you have been trying, age, cycle timing, past pregnancies, semen testing for a partner when relevant, and whether a fertility referral would help.

General preconception guidance can help you plan useful first steps without promising an outcome.

When to see a doctor

Book an appointment if period or pelvic pain affects daily life, pain is getting worse, sex is painful, or bowel or bladder symptoms follow your cycle. Also seek care for heavy bleeding or difficulty becoming pregnant.

Ask about endometriosis if the pattern fits, but stay open to other possible causes. Bring a symptom and period record if you have one. You can mention close relatives with endometriosis because family history may be relevant.

Seek care now: Get urgent medical help for sudden severe pelvic or abdominal pain, fainting, shoulder-tip pain, severe weakness, or heavy bleeding with dizziness or trouble breathing. If pregnancy is possible, say so when you ask for help. These signs can have causes other than endometriosis and need prompt assessment.

Living with endometriosis day to day

Pacing does not mean giving up. It means balancing activity and rest so a difficult day does not always lead to a longer flare. Heat, gentle movement, sleep support, and planning around demanding tasks may help some people cope, but they do not replace clinical care.

Pain during sex deserves a direct and respectful conversation. You can pause any activity that hurts. A clinician or pelvic-health specialist can discuss possible causes and support.

Work or school adjustments may also help. Examples include access to a bathroom, flexible breaks, heat packs, or remote work when possible. You do not need to share more health detail than you choose.

Build a small support plan for hard days. Keep key contact details in one place. Decide who can help with food, travel, childcare, or a medical visit. Tell that person what kind of help you want.

Review the plan when symptoms change. A plan is not proof that pain is “all in your head.” It is a way to reduce the load while you seek care.

Ask for a copy of visit notes when possible. Keep test results together. This can make the next visit easier. It can also help a new clinician see what has already been discussed.

Your pain still matters.

Keep asking for help.

How to track endometriosis in Femio

Record period dates, flow, pain, bowel or bladder symptoms, pain during sex, tiredness, and short notes about daily impact. Track only what feels useful and safe.

Look for timing, not a verdict. A repeating pattern can help you describe symptoms, but Femio cannot confirm endometriosis or judge how severe it is. Export or print a summary if you want to share it with a clinician.

Related Femio guides cover painful periods, heavy periods, common endometriosis signs, how endometriosis is assessed, and endometriosis and fertility.

Frequently asked questions

Can endometriosis exist with a normal ultrasound?

Yes. Imaging can find some forms of endometriosis, but it may not show every lesion. A clinician considers your symptoms, examination, imaging, and whether other steps are needed.

Does severe pain mean severe endometriosis?

Not always. Pain and the amount of visible disease do not match neatly. The impact of your symptoms still matters.

Is endometriosis the same as adenomyosis?

No. Endometriosis involves tissue similar to the uterine lining outside the womb. Adenomyosis involves similar tissue within the muscle wall of the womb. A person can have one or both.