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Endometriosis: what it is, and when to get checked

Painful periods are common, but pain that stops you working, studying or sleeping is worth a closer look.

Dr Dharshini GopalakrishnakoneMRCOG (UK), Specialist in O&G
Published 3 min read
Draft: pending medical review
A hot water bottle and a cup of ginger tea on soft bedding

What is endometriosis?

Each month, hormones from the ovaries make the lining of the womb (the endometrium) thicken, and it is shed during your period. In endometriosis, tissue similar to this lining grows outside the womb, most often on the ovaries, the fallopian tubes and the lining of the pelvis.

This tissue responds to the same monthly hormones. It can bleed and cause inflammation, which may lead to scar tissue (adhesions) and cysts on the ovaries, sometimes called endometriomas.

Common symptoms

  • Period pain that is severe, or getting worse over time
  • Pain during or after sex
  • Pelvic or lower back pain between periods
  • Pain when opening your bowels or passing urine during your period
  • Difficulty getting pregnant
  • Tiredness that does not settle

Some women with endometriosis have few or no symptoms, and the amount of pain does not always match how much endometriosis there is.

How it is diagnosed

Because period pain is so often seen as normal, endometriosis can take time to recognise. Diagnosis usually starts with a detailed history and examination, followed by a pelvic ultrasound, which can show cysts on the ovaries. Many women start treatment based on symptoms and scans, without surgery.

If symptoms continue despite treatment, a keyhole operation (laparoscopy) can confirm and treat endometriosis at the same time.

Treatment options

Treatment depends on your symptoms, your age and whether you are planning a pregnancy.

  • Pain relief: anti-inflammatory painkillers often work best when started a day before your period is expected.
  • Hormonal treatment: options include the combined pill, progestogens, a hormonal intrauterine system, and medicines that temporarily lower oestrogen levels.
  • Surgery: laparoscopic removal of cysts, endometriosis and adhesions, which can also help when endometriosis affects fertility.

When to see a doctor

Book a visit if period pain regularly stops your daily life, is not helped by over-the-counter pain relief, comes with pain during sex, or if you have been trying to conceive for 12 months (6 months if you are 35 or older).

This article is general information and does not replace a consultation with a doctor. If you are worried about your health, please book a visit or, in an emergency, call +65 6535 8833.

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