Summary
Read the full fact sheet- Endometriosis can cause the uterus, ovaries, fallopian tubes or bowel to stick to each other at points called ‘adhesions’.
- This can be extremely painful.
- The exact cause is unknown, but research suggests that retrograde (backwards) menstruation and a family history of endometriosis might increase your risk.
- Treatment with medication, surgery or both can help the symptoms of endometriosis.
- Painful periods that impact on your day to day life are not normal, so speak with your GP if you have bad period pain.
On this page
Endometriosis is a condition that affects one in 10 women. It can sometimes cause severe pain and might reduce your fertility. There are many treatment options available, so contact your GP (doctor) for a diagnosis and more information.
What is endometriosis?
Endometriosis is when cells, similar to those that line the uterus, grow in other areas of your body, especially around your ovaries and behind your uterus.
Symptoms of endometriosis
Endometriosis affects everyone differently. Many women with endometriosis experience pain but some don’t have any symptoms. Some women have mild pain when they have their periods and others have severe pain during their whole menstrual cycle.
Endometriosis can cause different types of pain.
For example:
- painful periods
- pain during or after sex
- abdominal, lower back and pelvic pain
- pain during ovulation, including pain in the thighs or legs
- pain when going to the toilet to wee or poo.
Endometriosis might also cause:
- heavy periods
- irregular periods
- longer than normal periods
- bladder and bowel problems
- bloating
- tiredness
- mood changes
- vaginal discomfort
- reduced fertility.
What causes endometriosis?
We don’t know exactly what causes endometriosis but there are some possible causes and risk factors to consider.
Backwards menstruation
Your period can sometimes flow back along your fallopian tubes into your pelvic cavity. The blood, which contains endometrial cells, is normally absorbed by the body but sometimes the cells can stick to areas outside the uterus, leading to endometriosis.
Your immune system
If your immune system doesn’t stop the growth of endometrial tissue outside your uterus, you can develop endometriosis.
Your family history
Research suggests that genetics might play a role in the development of endometriosis. Women who have a close relative with endometriosis are up to 10 times more likely to get endometriosis.
Reducing your risk of endometriosis
Endometriosis can’t be prevented, but some factors might reduce your risk.
For example:
- having children at a younger age
- breastfeeding for a longer period
- hormonal therapy to prevent ovulation, such as the combined oral contraceptive pill (COC)
- a healthy lifestyle.
Getting a diagnosis
It’s not easy to diagnose endometriosis. Most women are diagnosed after having a laparoscopy. A laparoscopy is keyhole surgery, performed under general anaesthetic, to see if there is any endometrial tissue in your pelvis.
If you do not have endometriosis but you have very painful periods, talk to your doctor.
Managing endometriosis
After you are diagnosed with endometriosis, your gynaecologist will explain the different treatment options based on your symptoms and stage of life.
Medications
If you have a mild case of endometriosis, you might be able to manage the symptoms and reduce any pain with medications such as ibuprofen (e.g. Nurofen™).
Hormone therapy
You can use hormone therapy, which suppresses the growth of any remaining endometrial cells and hopefully reduces the pain.
Options for hormone therapy include:
- the combined oral contraceptive pill – to stop your menstrual cycle and reduce pain
- progestogens – to shrink your endometrial tissue and reduce pain
- gonadotrophin-releasing hormone (GnRH) – to suppress ovulation and the growth of endometrial tissue.
Ask your doctor about how they work and the possible side effects of each option.
Surgery
Surgery is the most effective way to remove the endometriosis, repair any damage and reduce the chance of it coming back. Surgery might also increase your chances of becoming pregnant.
The type of surgery you might need will depend on your situation.
For example:
- laparoscopy – a commonly performed keyhole surgery via the abdomen
- laparotomy – open surgery for more severe endometriosis
- bowel surgery – if endometriosis has grown in the bowel
- hysterectomy (removal of the uterus) – in extreme cases.
Make sure you understand the potential benefits and risks of each option before you decide.
Combined treatment
Surgery by laparoscopy is the best treatment for endometriosis. But a combination of surgery and hormone therapy can improve outcomes.
Some studies have shown there is a delay in endometriosis recurring if the surgery is followed by treatment with some types of hormone therapy or the Mirena® intrauterine device (IUD).
Other therapies
Other therapies might help manage some symptoms of endometriosis, such as period pain and inflammation.
For example:
- pelvic floor physiotherapy – to reduce pelvic pain
- exercise – at least 30 minutes per day
- a healthy diet including lots of plant-based foods and fish
- emotional support or counselling – find more information at Endometriosis Australia support groups
- massage
- naturopathy, herbal medicine, acupuncture and yoga.
If you take herbal medicine, tell your doctor which ones you are taking as they may affect other medications.
More information
For more detailed information, related resources, articles and podcasts, visit Jean Hailes for Women’s Health.
Where to get help
- Guideline on the management of women with endometriosis,, European Society of Human Reproduction and Embryology.
- Endometriosis: an overview of Cochrane Reviews, Brown J, Farquhar C 2014, Cochrane Database of Systematic Reviews 2014, vol. 3, no. CD009590.
- ‘Recurrence of endometriosis after hysterectomy’, Rizk B, Fischer AS, Lotfy HA 2014, Facts, Views and Vision in Obgyn, vol. 6, no. 4, pp. 219–227.
- ‘Medical management of endometriosis’, Rafique S, Decherney AH 2017, Clinical Obstetrics and Gynecology, vol. 60, no. 3, pp. 485–496.
- ‘Medical management of endometriosis’, Black K, Fraser IS 2012,, Australian Prescriber, vol. 35, pp. 114–117.
- Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment, Rolla E 2019, F1000 Research 2019, 8 (F1000 Faculty Rev): 529.
- Endometriosis – ABC Health and Wellbeing
- Endometriosis fact sheets - Royal Women's Hospital