Endometriosis: pain that deserves answers

What is endometriosis?

Endometriosis occurs when tissue similar to the endometrium — the lining of the uterus — grows in other places, most commonly on the ovaries, the fallopian tubes and the lining of the pelvis. This tissue responds to the monthly hormonal cycle, causing inflammation, pain and, over time, scar tissue (adhesions) that can bind pelvic organs together.

The World Health Organization estimates that endometriosis affects around 10% of women and girls of reproductive age worldwide. Because period pain is so often normalised, many women live with symptoms for years before they are diagnosed.

Common symptoms

• Period pain that is severe, gets worse over time or isn't relieved by usual painkillers
• Pelvic pain between periods
• Deep pain during or after sex
• Pain when opening the bowels or passing urine, especially during a period
• Heavy or irregular bleeding
• Difficulty getting pregnant
• Fatigue, bloating and low mood

The severity of symptoms does not always match the amount of endometriosis present — some women with extensive disease have few symptoms, and some with small areas have severe pain. That is why a careful assessment matters.

How it's diagnosed

Diagnosis begins with a detailed conversation about your symptoms and cycle, followed — with your consent — by an examination. An ultrasound scan can identify endometriosis cysts on the ovaries (endometriomas) and deeper disease in experienced hands, and MRI is sometimes used. Laparoscopy (keyhole surgery) allows the gynaecologist to see and, where appropriate, treat endometriosis at the same time.

You don't need to wait for a definitive surgical diagnosis before starting treatment: if your symptoms strongly suggest endometriosis, your gynaecologist may recommend beginning medical treatment first.

Treatment options

• Pain relief — the right medication, taken at the right time in your cycle.
• Hormonal treatment — options that quieten the menstrual cycle and reduce pain.
• Laparoscopic surgery — to remove endometriosis or cysts and free adhesions, when appropriate.
• Fertility planning — treatment chosen with your pregnancy plans in mind.
• Pelvic floor physiotherapy — long-term pain often causes the pelvic muscles to tighten and guard; physiotherapy helps them relax.
• Psychological support — living with chronic pain affects mood, sleep and relationships.

At Narika, these aren't separate referrals. Our gynaecologists, physiotherapist and psychologist plan your care together.

Endometriosis and fertility

Many women with endometriosis conceive naturally. For some, endometriosis makes conception harder — by affecting the ovaries, the fallopian tubes or the pelvic environment. If you are planning a pregnancy, it's worth discussing this early so your treatment supports that goal. Dr Vidya Shetty, our fertility and laparoscopy specialist, can assess your situation.

Written by the Narika clinical team. Last reviewed 28 September 2026. This guide is general education; your Narika doctor will tailor advice to you. If you have severe or sudden symptoms, go to the nearest emergency department first — our team will support your follow-up care.