Endometriosis is a common condition where tissue similar to the lining of the uterus grows elsewhere in the pelvis. It can make conceiving harder for some people, but many with endometriosis conceive. Treatment is decided case by case, and pain deserves care in its own right.
What endometriosis is
Endometriosis is a long-term condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. It is most often found on the ovaries, the fallopian tubes, the lining of the pelvis, and sometimes the bowel or bladder.
This tissue responds to the monthly hormone cycle. It can cause inflammation, scarring, and areas where organs stick together (adhesions). Sometimes it forms cysts on the ovaries, called endometriomas or "chocolate cysts".
Endometriosis is common. It is also often missed for years, because period pain is easily dismissed as normal.
Common symptoms
Symptoms vary a lot from person to person. Some people have severe pain with only small areas of endometriosis; others have extensive disease and few symptoms.
- period pain that stops you doing everyday things, or that painkillers don't help
- pain during or after sex
- pelvic pain at other times of the month
- pain when passing stools or urine, especially during a period
- tiredness, and sometimes heavy periods
- difficulty getting pregnant
Good to know. Period pain that disrupts school, work or daily life is not something you simply have to put up with. It is a valid reason to see a doctor, whether or not you are trying to conceive.
How it may affect fertility
Endometriosis can make conceiving harder in several ways, though not everyone with it has fertility problems. It may:
- distort or block the fallopian tubes through scarring and adhesions
- affect the ovaries, especially when there are endometriomas
- create an inflamed environment in the pelvis that may affect eggs, sperm or early embryos
- make sex painful, so it happens less often
How much it matters depends on where the endometriosis is, how extensive it is, your age, and other factors for both partners.
How it is diagnosed
For many years, keyhole surgery (laparoscopy) was the only way to confirm endometriosis. That has changed. The European Society of Human Reproduction and Embryology (ESHRE) 2022 guideline says imaging, such as a transvaginal ultrasound or an MRI scan, can be used to diagnose endometriosis, particularly endometriomas and deeper disease.
A normal scan does not rule endometriosis out, because small surface patches may not show up. Laparoscopy is still used when imaging is normal but symptoms continue, or when surgery may also be part of treatment.
A diagnosis usually starts with a careful history and examination. Don't be put off if a first scan is normal and your symptoms persist.
Treatment options when you want to conceive
There is no single plan that suits everyone. Doctors usually weigh up your age, how long you have been trying, your symptoms, the location and extent of endometriosis, ovarian reserve, previous surgery, and the male partner's results.
| Option | When it may be considered | Things to discuss |
|---|---|---|
| Surgery (laparoscopy) | To remove or treat endometriosis, especially when pain is significant | Possible benefit for natural conception in some cases; surgery on the ovaries can lower egg reserve |
| IUI with ovarian stimulation | Sometimes, for milder disease with open tubes | Needs at least one healthy tube |
| IVF | When tubes are affected, after other steps, or depending on age | Often discussed sooner for more extensive disease |
| Surgery, then assisted reproduction | Case by case | The order and timing should be explained to you |
Our guide to how doctors choose between IUI and IVF explains these options in more detail.
Hormonal medicines that suppress endometriosis can help pain, but most of them stop ovulation, so they are not a way to improve fertility while trying.
Caution. Repeated surgery on the ovaries can reduce the number of eggs remaining. Before any operation, ask how it may affect your ovarian reserve and your fertility plans.
Pain matters too
Fertility is only one part of living with endometriosis. Pain, fatigue and the strain on relationships and work deserve attention in their own right. A good plan considers how you feel day to day, not only whether you conceive.
It may help to keep a simple diary of pain, periods and how symptoms affect your life. Bring it to appointments. If you are single, or in a same-sex relationship, the same principles apply when planning a pregnancy.
When to see a doctor
- Period or pelvic pain affects daily life, or painkillers don't help.
- Sex is painful.
- You have been trying for 12 months (under 35) or 6 months (35 and over), or sooner if you already know you have endometriosis.
- You have endometriosis and want to plan for a future pregnancy.
Sudden severe pelvic pain, pain with fever, or fainting needs urgent care: call 112 or go to the nearest hospital.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.