Endometriosis – Symptoms, Causes, and Treatment Options

Overview of Endometriosis

Endometriosis is a long-term condition that impacts around 10% of women and people assigned female at birth during their reproductive years (ages 15–49). It occurs when endometrium-like tissue grows in places where it does not belong, such as the ovaries, fallopian tubes, bladder, or intestines. Unlike normal uterine lining, this tissue has no way to leave the body, which can lead to inflammation, scarring, and painful adhesions.

Why is Endometriosis Important?

Endometriosis is more than just “bad period pain.” It can cause:

• Chronic pelvic pain that lasts even outside of menstruation.
• Heavy or irregular periods that disrupt daily activities.
• Difficulty getting pregnant—endometriosis is linked to infertility in up to 50% of cases.
• Emotional and mental health challenges such as depression, anxiety, and fatigue due to ongoing pain and lifestyle disruption.

Impact on Daily Life

Living with endometriosis can affect nearly every part of your life:

• Work and productivity: Many people miss school or work days every month due to pain and fatigue.
• Physical activity and sports: Exercise may trigger or worsen pain, making it harder to stay active.
• Sleep and rest: Pain often disrupts rest, leaving you feeling exhausted and drained.
• Relationships and intimacy: Pain during sex (dyspareunia) is common, which may strain romantic partnerships.
• Mental health: The unpredictable nature of flare-ups contributes to stress and reduced quality of life.

How is Endometriosis Different from Other Conditions?

It is sometimes confused with irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID) because of overlapping symptoms like abdominal pain and bloating. Unlike IBS, however, endometriosis is directly linked to menstrual cycles and reproductive health.

Reference:
World Health Organization (WHO). (2021). Endometriosis: Key facts. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/endometriosis

What Are the Main Symptoms of Endometriosis?

The hallmark symptom of endometriosis is pelvic pain, especially during menstruation. However, symptoms vary widely from person to person. Some may experience severe pain, while others have mild or no symptoms despite having widespread endometriosis.

Common Physical Symptoms

• Painful periods (dysmenorrhea): Severe cramping that worsens over time.
• Chronic pelvic pain: Pain lasting beyond the menstrual cycle.
• Pain during sex (dyspareunia).
• Pain with bowel movements or urination—especially during menstruation.
• Heavy or irregular bleeding.
• Infertility or difficulty getting pregnant.

How Endometriosis Symptoms Affect Daily Life

• Work & school: Missing days due to pain can limit career growth and learning opportunities.
• Sports & hobbies: Activities may be reduced or stopped due to pain flare-ups.
• Sleep: Chronic pain and bloating often make it hard to rest.
• Relationships: Painful intimacy and fatigue may create emotional distance.
• Mood & mental health: Anxiety and depression are more common in people with endometriosis.

Red Flag Signs to Seek Help

You should see a doctor if you experience:

• Severe pelvic pain that interrupts daily activities.
• Pain that worsens over time instead of improving.
• Heavy bleeding or bleeding between periods.
• Inability to get pregnant after trying for 12 months.

Symptom Severity Spectrum

Endometriosis symptoms exist on a spectrum—from mild discomfort to debilitating pain that limits normal function. The level of pain is not always linked to the amount of endometrial tissue growth, meaning even small lesions can cause severe symptoms.

Reference:
American College of Obstetricians and Gynecologists (ACOG). (2021). Endometriosis: Frequently Asked Questions. Retrieved from: https://www.acog.org/womens-health/faqs/endometriosis

Causes and Risk Factors for Endometriosis

The exact cause of endometriosis is not fully understood, but researchers believe it involves a mix of biological, genetic, and environmental factors.

Theories About What Causes Endometriosis

1. Retrograde menstruation: Menstrual blood flows backward into the pelvic cavity instead of leaving the body.
2. Cell transformation: Cells outside the uterus change into endometrial-like cells.
3. Immune system problems: The body fails to recognize and destroy misplaced endometrial tissue.
4. Genetics: Endometriosis often runs in families, suggesting inherited risk.
5. Surgical spread: After procedures like C-sections, endometrial tissue may implant in scars.

Who Is at Higher Risk?

You may be more likely to develop endometriosis if you:

• Have a family history (mother, sister, or daughter with endometriosis).
• Started menstruation at an early age.
• Have short menstrual cycles (less than 27 days).
• Experience heavy menstrual bleeding lasting more than 7 days.
• Never gave birth.
• Have other reproductive tract conditions.

Lifestyle and Biomechanical Risk Factors

• Age: Most common between 20–40 years old, but can start in teens.
• Posture and activity: Some studies suggest chronic pelvic misalignment or limited mobility may worsen symptoms.
• Occupation: Jobs requiring long hours of standing or heavy lifting may aggravate pelvic pain.
• Obesity: Higher body weight can worsen inflammation and hormonal imbalance.
• Pregnancy and childbirth: Symptoms may temporarily improve during pregnancy, but return afterward.

Why Do Some People Get Endometriosis and Others Don’t?

Endometriosis likely develops from a combination of hormonal, genetic, and immune system influences. Lifestyle factors may increase the severity of symptoms but are not considered the sole cause.

Reference:
Giudice, L. C. (2010). Clinical practice. Endometriosis. New England Journal of Medicine, 362(25), 2389–2398. doi:10.1056/NEJMcp1000274

Diagnosis, Recovery, and Management of Endometriosis

How Do Doctors Test for Endometriosis? (Diagnosis of Endometriosis)

Endometriosis diagnosis is based on your symptoms, physical exams, imaging tests, and sometimes minimally invasive surgery. Because symptoms overlap with other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID), diagnosis often takes time—studies suggest an average delay of 7–10 years between the first symptoms and a confirmed diagnosis.

Clinical History and Physical Examination

The first step is usually a detailed symptom history and pelvic exam. Your doctor will ask about:

• Period history: When symptoms started, how long they last, and how severe the pain is.
• Daily impact: Missed work, sleep problems, pain with sex, bowel changes.
• Family history: Relatives with endometriosis, infertility, or severe menstrual pain.

During a pelvic exam, a doctor may feel for nodules, cysts, or tenderness in the pelvic area. While this exam can give clues, it does not confirm endometriosis on its own.

Imaging and Diagnostic Tools

• Ultrasound: Transvaginal or pelvic ultrasound can detect ovarian cysts (endometriomas), but small lesions may not show up.
• MRI (Magnetic Resonance Imaging): Often used for complex or deep cases, MRI helps identify the size and location of lesions.
• Laparoscopy: This is the gold standard test. A small camera is inserted into the abdomen to directly view and, if needed, biopsy endometriosis tissue. It allows both diagnosis and treatment (removal of lesions).

Functional and Differential Testing

Doctors may also rule out other conditions:

• IBS testing: If bloating, constipation, or diarrhea are dominant.
• PID evaluation: If pain and fever suggest infection.
• Urinary tract assessment: If bladder pain or urgency is a major symptom.

How Do Doctors Find the Root Cause of Your Pain?

Since endometriosis symptoms vary widely, practitioners often use a multidisciplinary evaluation (gynecologist, pain specialist, physiotherapist, mental health support). This helps identify whether pain is from active endometriosis lesions, scar tissue, nerve sensitization, or other conditions that mimic or overlap with endometriosis.

Reference:
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nature Reviews Endocrinology, 15(11), 666–682. https://doi.org/10.1038/s41574-019-0245-z

How Long Does Endometriosis Recovery Take? (Recovery & Prognosis)

Recovery from endometriosis depends on the severity of the condition, the treatments used, and individual lifestyle factors. While endometriosis is a chronic condition with no known cure, many people experience significant relief with treatment.

Recovery Timelines by Severity

• Mild endometriosis: Symptom improvement may occur within weeks to months with pain relief medications, hormonal therapy, and lifestyle changes.
• Moderate endometriosis: Recovery is slower. Treatments such as laparoscopic surgery plus hormone therapy may require 3–6 months to stabilize symptoms.
• Severe endometriosis: Surgery often brings relief, but recovery can take 6–12 months, and repeat interventions may be needed if lesions grow back.

Risk of Recurrence

Endometriosis can recur. Studies show 20–40% recurrence within 5 years after surgery, depending on the completeness of lesion removal and hormonal support. Lifestyle choices such as regular exercise, anti-inflammatory diet, and stress reduction may help lower recurrence risk.

Short-Term vs. Long-Term Outlook

• Short-term: Pain relief and improved mobility are common after treatment. Many people can return to work or school within weeks (depending on treatment type).
• Long-term: Endometriosis may return, requiring ongoing management. Some people develop chronic pain syndromes even after lesion removal due to nerve changes.

Return-to-Work, Sport, and Lifestyle Outcomes

• Work: With effective treatment, most people return to work within 2–6 weeks after laparoscopic surgery, though energy levels may take longer to normalize.
• Sports: Light exercise often resumes within weeks; high-intensity activity may need gradual reintroduction over several months.
• Lifestyle: Daily activities like travel, social events, and intimacy often improve after successful treatment, but some individuals continue to face limitations.

Decision Pathway (Mild, Moderate, Severe Cases)

• If symptoms are mild: Pain medication, lifestyle changes, and monitoring may be enough.
• If symptoms are moderate: Hormonal therapy and/or surgery may be recommended.
• If symptoms are severe: Surgery is often combined with long-term hormone therapy and lifestyle management.

This if/then approach helps tailor care to your condition, ensuring you receive neither undertreatment nor overtreatment.

Reference:
Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology, 10(5), 261–275. https://doi.org/10.1038/nrendo.2013.255

What’s the Best Way to Manage Endometriosis at Home? (Management of Endometriosis)

Managing endometriosis involves a combination of medical treatments, lifestyle strategies, and self-help techniques. Because endometriosis is chronic, management focuses on reducing pain, improving function, and preventing recurrence.

Evidence-Based Management Strategies

• Medical management: Pain relievers (NSAIDs), hormonal therapies (birth control pills, IUDs, injections).
• Surgical management: Laparoscopic removal of lesions or hysterectomy in severe cases.
• Lifestyle management: Exercise, nutrition, sleep hygiene, and stress management.
• Multidisciplinary care: Physiotherapy, counseling, pain clinics, and support groups.

Self-Help & Relief Tips (Step-by-Step)

1. Track your symptoms – Use an app or journal to log pain patterns, period dates, and triggers.
2. Use heat therapy – A heating pad or warm bath can relax muscles and reduce cramping.
3. Practice gentle stretching – Yoga and pelvic stretches improve flexibility and reduce tension.
4. Improve posture – Sitting upright with support reduces pelvic strain.
5. Stay active – Light walking or swimming can help circulation and lower inflammation.
6. Adjust your diet – Many people find relief with anti-inflammatory foods (fruits, vegetables, omega-3s) and reduced red meat or processed food intake.
7. Prioritize rest – Create a regular sleep routine, and allow rest breaks during flare-ups.
8. Seek support – Talking to others with endometriosis through community groups can improve mental health and coping.

Each of these tips has been shown to ease pain and improve daily function, though they work best alongside medical treatment.

Lifestyle and Long-Term Management

• Posture & ergonomics: Avoid sitting for long periods; use supportive chairs.
• Core strength & flexibility: Pilates and yoga help stabilize the pelvis.
• Habit formation: Small daily practices—hydration, stress management, regular movement—reduce flare-ups over time.
• Community and support: Support groups and counseling reduce isolation and improve resilience.

Comparisons with Similar Conditions

Unlike PCOS (Polycystic Ovary Syndrome), which primarily affects hormone regulation and ovulation, endometriosis is marked by pain and abnormal tissue growth. Unlike fibroids, which are solid growths, endometriosis involves misplaced tissue that reacts to hormones.

Reference:
Practice Committee of the American Society for Reproductive Medicine. (2014). Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertility and Sterility, 101(4), 927–935. https://doi.org/10.1016/j.fertnstert.2014.02.012

Multidisciplinary Care for Endometriosis at CARESPACE

At CARESPACE, endometriosis care goes beyond pain relief. Our approach combines evidence-based therapies across multiple disciplines to address the physical, emotional, and lifestyle challenges of this condition. By coordinating chiropractic, physiotherapy, massage therapy, kinesiology, psychotherapy, nutrition, naturopathic medicine, acupuncture, and more, we help you recover faster, manage flare-ups, and prevent recurrence.

How Does CARESPACE Treat Endometriosis Differently?

CARESPACE treats endometriosis with a team approach that looks at the whole person, not just the symptoms. Instead of isolated treatments, your care is guided by a coordinated plan where each provider communicates with the others.

The CARESPACE Difference

• Integrated assessments: You may begin with a physiotherapist to assess pelvic alignment and core stability while also consulting with a psychotherapist to manage pain-related stress.
• Team-based care: If muscle tension worsens your pain, massage therapy or acupuncture may be added. If fatigue or diet play a role, nutrition and naturopathic medicine provide targeted support.
• Mental health support: Because endometriosis often leads to anxiety, depression, and sleep problems, our psychotherapy and coaching services are built into the care pathway.

By treating both the body and the mind, CARESPACE creates better long-term outcomes than single-discipline approaches.

Why Does a Team Approach Help Endometriosis Recovery Faster?

A team approach works because endometriosis impacts many systems at once—muscles, hormones, digestion, mental health, and daily function. Coordinated care addresses these layers simultaneously instead of leaving you to manage them separately.

Physical Recovery

• Physiotherapy & chiropractic care: Improve pelvic stability, posture, and movement patterns to reduce flare-ups.
• Massage therapy: Relieves muscle tension caused by chronic pain and compensatory movement.
• Acupuncture: Supports pain relief and hormone balance.

Mental & Emotional Support

• Psychotherapy & coaching: Teach coping strategies for stress, anxiety, and insomnia caused by chronic pain.
• Mental performance coaching: Helps you maintain focus at work or school despite flare-ups.

Lifestyle & Prevention

• Nutrition & naturopathic medicine: Target inflammation with anti-inflammatory diets and supplement guidance.
• Fitness & kinesiology: Create safe, progressive exercise plans to rebuild strength and energy.

By combining these supports, you avoid the frustration of fragmented care and instead follow a coordinated pathway to improvement.

What Does Multidisciplinary Endometriosis Care Look Like at CARESPACE?

Your care journey at CARESPACE follows three key phases—acute, subacute, and maintenance—designed to meet your needs at every stage.

Acute Phase (Managing Flare-Ups)

• Focus: Pain relief and symptom stabilization.
• Example: You might start with acupuncture and physiotherapy while also using psychotherapy to manage stress and insomnia.

Subacute Phase (Restoring Function)

• Focus: Building strength, improving mobility, addressing emotional health.
• Example: A physiotherapist designs core stability exercises while a nutritionist adjusts your diet to reduce bloating and fatigue.

Maintenance Phase (Preventing Recurrence)

• Focus: Long-term management, lifestyle optimization, relapse prevention.
• Example: Regular check-ins with chiropractic or physiotherapy, combined with fitness training and ongoing counseling.

This phase-based approach ensures your care evolves with you, whether you’re managing daily life or planning long-term wellness goals.

How Does CARESPACE Support the Mental Health Side of Endometriosis?

CARESPACE recognizes that endometriosis is not only physical—it affects mental health, sleep, and relationships. Chronic pain can trigger stress hormones, disrupt sleep cycles, and increase the risk of depression or anxiety.

Coordinated Mental Health Care

• Psychotherapy: Offers tools to manage pain-related stress and emotional strain.
• Nutrition & naturopathy: Improve mood and energy through balanced diet and supplementation.
• Exercise & fitness coaching: Helps release endorphins, reduce inflammation, and restore confidence.
• Coaching for coping strategies: Supports better sleep habits, workplace performance, and personal resilience.

By coordinating these services, CARESPACE ensures your emotional health is addressed alongside your physical recovery.

Why Choose CARESPACE for Endometriosis?

Most clinics treat endometriosis from one angle. CARESPACE treats it from every angle.

• Faster results: Multiple therapies working together reduce recovery times.
• Lower recurrence risk: Coordinated prevention strategies keep flare-ups under control.
• Personalized plans: Your care is unique, adapting to your symptoms, lifestyle, and goals.
• Whole-person care: Physical, mental, and lifestyle factors are all addressed under one roof.

This integrated model means you don’t have to juggle multiple clinics, referrals, or conflicting advice. Instead, you receive streamlined, evidence-based care from a team that works together.

Related Conditions, FAQs, and Disclaimer for Endometriosis

Related Conditions for Endometriosis

Endometriosis shares symptoms with several other conditions, making diagnosis challenging. Understanding these overlaps helps you recognize when to seek further evaluation.

Conditions That Can Mimic Endometriosis

• Irritable Bowel Syndrome (IBS): Both conditions cause abdominal pain, bloating, and bowel changes. Unlike endometriosis, IBS is not linked to the menstrual cycle.
• Polycystic Ovary Syndrome (PCOS): PCOS primarily affects ovulation and hormone balance, while endometriosis is defined by tissue growth outside the uterus. Both may cause infertility.
• Uterine Fibroids: These are benign growths in the uterus that can lead to heavy bleeding and pelvic pain, similar to endometriosis.
• Pelvic Inflammatory Disease (PID): PID causes chronic pelvic pain but is triggered by infection, unlike endometriosis.
• Chronic Pelvic Pain Syndrome: Persistent pain in the pelvis can have multiple causes, with endometriosis being one possible factor.

These conditions often overlap, which is why a multidisciplinary assessment is important for accurate diagnosis and tailored treatment.

Explore the full Conditions List at CARESPACE to see related conditions.

Looking for information on a different condition? Visit our full Conditions List.