Endometriosis happens when tissue that’s supposed to grow inside your uterus begins growing in other areas of your body.

This often painful condition can affect anyone who has ever had a uterus. Early signs often include painful periods, pain during sex, and difficulty getting pregnant.

Typically, endometrial tissue lines the walls of your uterus. Throughout each menstrual cycle, it grows thicker to prepare your body for pregnancy. If you don’t become pregnant, it sloughs off and exits the body during your period.

When endometrial tissue grows in other places, like on the ovaries or fallopian tubes, it still behaves as if it were in your uterus. Each month it grows, sheds, and bleeds. That extra blood and tissue gets trapped inside the pelvic cavity, where it often causes painful inflammation and irritation.

Over time, this can also lead to scarring and adhesions that may interfere with fertility.

Endometriosis can present differently in different people. Some people have no symptoms and only discover the condition if they have trouble getting pregnant. Others experience a great deal of pain.

Since endometriosis is a progressive condition, symptoms usually start off on the milder side and worsen over time.

People often mistake the early signs of endometriosis for period pain. Unfortunately, many medical professionals make the same mistake. It takes the average person about 7 years to be correctly diagnosed with the condition.

Signs and symptoms of endometriosis include:

  • moderate to severe pain on the days around your period
  • pain during ovulation
  • pain during or after sex
  • painful urination or bowel movements during your period
  • chronic pain in your lower back or pelvic area
  • heavy or long periods
  • bleeding or spotting between periods
  • digestive issues like bloating, nausea, diarrhea, or constipation (especially around your period)
  • difficulty getting pregnant

Endometriosis pain can interfere with everyday life. Your pain may be severe enough that you can’t exercise, work, attend school, or participate in other activities.

Endometriosis and infertility

For some people, the first sign of endometriosis is difficulty getting pregnant.

According to the Department of Health and Human Services, endometriosis affects as many as 1 in 2 women with infertility. The reason for this is not entirely clear. It may happen because scar tissue and adhesions alter the pelvic structure, making it harder for a fertilized egg to reach the uterus.

In addition to endometriosis, other factors can play a role in your ability to get pregnant. Most notably, your age. Researchers have found that in people with endometriosis, infertility risk increases twofold after age 35.

Although endometriosis can make it more difficult to get pregnant, with treatment, most people are able to give birth. Treatment often includes laparoscopic surgery to remove scar tissue and adhesions. Many people also benefit from intrauterine insemination (IUI) and in vitro fertilization (IVF).

Anyone who has ever had a uterus can get endometriosis.

You may be more likely to get the condition if you:

  • are in your 30s or 40s
  • have periods that last longer than a week
  • get your period more often than usual
  • have not given birth
  • have a family history of the condition

Endometriosis may continue to affect menopausal people who use hormone therapy. It may also continue to affect transgender men. One study found that 1 in 3 trans men undergoing hysterectomies showed signs of endometriosis.

Researchers are still trying to determine why people develop the condition and who it affects most often. Research on the prevalence and presentation of endometriosis in diverse, non-white populations is particularly limited.

Doctors don’t know exactly what causes endometriosis. Possible causes include:

  • Retrograde menstruation. This reverse menstrual flow brings blood and tissue back up into the pelvic cavity, where endometrial cells can stick to the surface of the pelvic walls and reproductive organs.
  • Cell transformation. Hormones and other factors may prompt certain cells to transform into endometrial cells.
  • Immune system disorder. The immune system may fail to recognize endometrial tissue growing in the wrong place.
  • Extra estrogen production. Estrogen may prompt cell transformation.
  • Surgical scars. Endometrial cells may become attached to a surgical incision after a hysterectomy, C-section, or other surgical procedure.

Talk with a healthcare professional if you suspect you have endometriosis. You can start by talking with your primary care provider or making an appointment with a gynecologist.

To help reach a diagnosis of endometriosis, your doctor may order tests such as:

  • a pelvic exam
  • lab tests
  • imaging tests like an ultrasound or MRI
  • a laparoscopy (a procedure to view the inside of your pelvic area)

Your doctor may classify your endometriosis as minimal, mild, moderate, or severe. This will help them determine the best treatment plan for you.

There is a range of treatment options for endometriosis. Examples include:

This condition may also cause changes to your mental health. Talk with your doctor or find a therapist to help you manage your feelings.

There are many ways to treat endometriosis symptoms at home. Examples include:

  • over-the-counter medications to treat pain and swelling (ibuprofen, naproxen)
  • heat from a heating pad, hot water bottle, or warm bath
  • anti-inflammatory foods
  • pelvic massage
  • exercise
  • rest
  • relaxation techniques (mindfulness meditation, yoga, breathwork)
  • vaginal lubricants

Alternative therapies could also help your symptoms. These are treatments that fall outside the scope of traditional medication. These treatment methods are not as well supported by research, but many people find them effective.

Treatments include:

Talk with your doctor about whether these treatments are right for you.

Endometriosis is a common condition that can cause painful periods and infertility. Talk with your doctor if you experience symptoms of the condition. Symptoms may worsen if you ignore them.

Your diagnosis will include a physical exam and imaging tests to determine the severity of your condition. There are many ways to treat and manage endometriosis, including medications and alternative therapies.