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Pain & inflammation

Endometriosis

Period pain that stops your life is not something to be endured. It is something to be investigated.

Deposits grow outside the uterus and bleed with each cycle, with nowhere for the blood to go.

01

What it actually is

In endometriosis, tissue similar to the lining of the uterus grows where it should not — on the ovaries, the fallopian tubes, the lining of the pelvis, and sometimes the bowel or bladder. That tissue still responds to your monthly hormones. It thickens and bleeds like the lining does, but it has nowhere to drain.

The result is inflammation, and over time scar tissue that can bind organs together. This is why the pain is often out of proportion to what a scan shows, and why it is so frequently dismissed. Women wait years, on average, for a diagnosis. The single most important thing to know is that severe period pain is common — but it is not normal.

Endometriosis is commonly reported to affect around 1 in 10 women of reproductive age. Delays of several years between the first symptom and a diagnosis are well documented worldwide.

OvaryOvaryBehind the uterusBladderBowel
Each deposit responds to your cycle and bleeds, with nowhere for the blood to go. That is why the pain is cyclical, and why it can be felt far from the uterus.

For general understanding only. These are drawings, including the ultrasound view — they are built from typical measurements to explain the idea, and are not real scan images or a picture of your own baby.

02

What you might notice

  • Period pain severe enough to keep you from work, college or ordinary activity
  • Pain during or after sex, often felt deep rather than at the entrance
  • Pain when opening your bowels or passing urine, typically worse around your period
  • Pelvic pain between periods, or a constant background ache
  • Heavy bleeding, or bleeding between periods
  • Deep fatigue that arrives with the cycle
  • Difficulty conceiving — sometimes the first sign in women with little pain

Don't wait for an appointment if…

  • Pain that painkillers no longer control
  • Pain with bleeding from the bowel or in the urine around your period
  • Sudden severe pelvic pain, which needs urgent assessment
  • Not conceiving after a year of trying, alongside painful periods
03

The tests that are actually useful

Not everyone needs every test. This is what each one is for, so you know why it was ordered — or why it wasn't.

A blood testHormones, thyroid and iron — the numbers no scan can show.
An ultrasoundThe shape of the uterus, the thickness of the lining, and the follicles on each ovary.
A camera, sometimesA keyhole look inside, offered only when it would change the plan.

Not everyone needs all three. Each answers a different question — which is why a test you were not offered is often the right call.

A careful history of pain and timingWhere the pain is, when in the cycle it arrives, and what it stops you doing. This is genuinely the most important part of the assessment.
Pelvic examinationCan identify tenderness, nodules and restricted movement of the pelvic organs.
Transvaginal ultrasoundDetects endometriomas on the ovaries and signs of deeper disease. A normal scan does not rule endometriosis out.
MRIUsed where deep infiltrating disease involving the bowel or bladder is suspected, and to map before surgery.
Diagnostic laparoscopyThe definitive way to see and confirm disease — and, in trained hands, to treat it in the same operation.
04

Treatment, in the order it's usually tried

  1. Start simpleLifestyle, pain relief, or a tablet — whatever is least disruptive to your life.
  2. Add if neededA hormonal option or a longer course, if the first step has not settled things.
  3. A procedureDay-case surgery when medicine cannot fix the structure causing the problem.
  4. Specialist routeFertility treatment or a referral, planned with you rather than sprung on you.

You move up a rung only if the one below it has not done the job — and you can stop at any step you are happy with.

Pain control

Anti-inflammatory medication used correctly, started before the pain peaks.

Timing matters far more than dose. Most people take these too late in the cycle for them to work properly.

Hormonal suppression

Continuous combined pill, progestogens, or a hormonal intrauterine system.

The aim is to quieten the cycle so the deposits are not stimulated each month. Often the first-line approach where fertility is not immediately planned.

Advanced medical therapy

GnRH analogues with add-back therapy.

Used for a defined period in more severe disease, usually alongside a surgical plan.

Surgery

Laparoscopic excision or ablation of deposits and division of adhesions.

Dr Hemangi is an FMAS-certified minimal access surgeon, so diagnosis and treatment can happen in one operation rather than being referred onward.

Fertility

A fertility plan built around the stage and site of disease.

Endometriosis affects fertility in several different ways. The right next step depends on which one applies to you.

05

What you were probably told that isn't true

Bad period pain is just part of being a woman.
Pain that stops you functioning is a symptom, not a personality test. It deserves investigation.
A normal ultrasound means you do not have it.
Ultrasound misses a great deal of endometriosis, especially superficial disease. A normal scan with typical symptoms means keep looking, not stop looking.
Getting pregnant cures endometriosis.
Symptoms often quieten during pregnancy because the cycle pauses, but the disease is still there afterwards.
A hysterectomy always fixes it.
Endometriosis grows outside the uterus. Removing the uterus alone can leave the disease — and the pain — behind.
Next step

Bring this to someone who has time.

A 25–40 minute consultation, on video, with a doctor who will explain what applies to you specifically — and what doesn't.

This page is general information, not medical advice. Nothing here can diagnose you or replace an assessment of your own history, examination and results. If something here matches what you are experiencing, the next step is a consultation — not a conclusion. If you are in severe pain, bleeding heavily, or feel unwell, seek urgent care rather than waiting for an appointment. Awaiting final clinical review before publication.