Last Updated March 2024 | This article was created by familydoctor.org editorial staff and reviewed by Peter Rippey, MD, CAQSM

What is endometriosis?

Endometriosis is a medical condition in which the lining of the uterus grows outside the uterus in the belly.

Symptoms of endometriosis

Endometriosis can cause a variety of symptoms including:

  • Heavy menstrual bleeding
  • Severe cramping or pain before and/or during your period
  • Frequent spotting or bleeding between periods
  • Pain while going to the bathroom during your period
  • Pain with sex
  • Pain in your stomach, low back, or rectum
  • Problems with fertility
  • Unexplained exhaustion or lack of energy
  • Digestive or gastrointestinal issues or symptoms

It’s important to recognize red flags when it comes to your period and uterine health.

This Uterine Health Guide is here to help you better understand it all.

What causes endometriosis?

Doctors and researchers do not know the cause of endometriosis. Those with a family history are at higher risk.  Retrograde (backwards) menstrual flow is another possible cause. This is when some of the tissue that is shed during your period flows up instead of out. It ends up in your fallopian tubes and other parts of your pelvis.

Other factors include your body’s response to estrogen and progesterone. If your body resists progesterone, it can have a hard time shedding the uterine lining. Some people have flawed immune systems. This means their bodies don’t destroy all of the lining. The leftover lining then attaches to other tissues outside of your uterus.

How is endometriosis diagnosed?

Endometriosis can be difficult to diagnose.  Your doctor will do a physical and pelvic exam. They also will review your symptoms, health history, and family history.

Laparoscopic surgery confirms the diagnosis. This common procedure allows the doctor to look inside your belly for the uterine tissue. Your doctor will make a small cut in your abdomen. They will use a small, lighted camera to look for patches of endometriosis. Your doctor may send a sample of tissue to the lab.

Can endometriosis be prevented or avoided?

You cannot prevent or avoid endometriosis. Some women have an increased risk for the condition. Factors that increase your risk include:

  • Family history
  • Starting menstruation early (before the age of 11)
  • Short menstrual cycles (27 days or less)
  • Long, heavy periods (7 days or more)
  • Starting menstruation late
  • Low body fat
  • Regular exercise (4 or more hours each week)
  • Pregnancy

Endometriosis treatment

Several types of medicine can treat endometriosis:

  • Over-the-counter medicine can relieve pain and inflammation.
  • Birth control pills can regulate your hormones and reduce heavy bleeding.
  • The hormone progestin can manage symptoms over time. It comes in the form of a shot or a pill.
  • Danazol and GnRH analog are hormone shots that stop your periods. This gives your uterus a break from a buildup of tissue. Unfortunately, these shots have side effects similar to menopause, including hot flashes, vaginal dryness, and unwanted facial hair. Taking a daily estrogen pill can reduce these side effects.
  • Aromatase inhibitors, such as exemestane and letrozole, are a newer type of hormonal treatment.

Birth control pills, danazol, and GnRH analogs are taken for 6 to 9 months. During that time, your pain should get better. However, it may come back if you stop taking the medicine.

Your doctor may recommend surgery or a diagnostic laparoscopy. In this procedure, the doctor removes the endometrial tissue that has grown outside of your uterus. As a last resort, your doctor may recommend a hysterectomy. This is the surgical removal of your uterus, and sometimes ovaries.

Living with endometriosis

Endometriosis can make it harder to get pregnant. You may need surgery and/or fertility treatments to help. Talk to your doctor if you plan to become pregnant. Your doctor may advise you to not put it off. The condition can get worse with age, so your chances of getting pregnant lessen over time. Usually, symptoms go away while you’re pregnant. Do not take prescription medicine when you’re trying to get pregnant.

Some studies have suggested that endometriosis may put you at a higher risk of getting ovarian cancer. However, the overall risk is low. Endometriosis often goes away or becomes milder with menopause. Until menopause, medicine and/or surgery may be able to help with symptoms.

Questions to ask your doctor

  • What are the benefits and risks of surgery?
  • What is causing my endometriosis?
  • What can I do to improve my chances of getting pregnant?
  • What is the recovery time for a laparoscopic procedure?
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