What endometriosis is
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows outside the uterus, commonly on the ovaries, the pelvic lining, and the ligaments behind the uterus, and sometimes on the bowel or bladder. That tissue responds to hormonal changes, causing inflammation, pain and sometimes scar tissue (adhesions).
It affects roughly 1 in 10 women and girls of reproductive age worldwide, according to the World Health Organization. The amount of disease doesn’t always match the amount of pain: some people with extensive endometriosis have little pain, and some with small lesions have severe pain.
Symptoms
- Period pain that stops you from going to school, work or living your life, and that painkillers don’t touch
- Pelvic pain between periods, or pain that follows your cycle
- Pain during or after sex
- Painful bowel movements or peeing, especially during your period
- Bloating (“endo belly”), nausea, diarrhea or constipation
- Heavy or irregular bleeding
- Fatigue
- Difficulty getting pregnant
Severe period pain is not “normal”. If pain regularly disrupts your life, that is worth investigating, however many times you’ve been told otherwise.
Why diagnosis takes so long
In many countries, people wait an average of 7 to 10 years between first symptoms and diagnosis. Period pain gets normalized, symptoms overlap with gut and bladder conditions, and imaging can miss smaller lesions.
- Symptoms and history are the starting point, which is why a symptom record helps so much.
- Imaging (transvaginal ultrasound or MRI, ideally by someone experienced with endometriosis) can find ovarian endometriomas and deep endometriosis. A normal scan doesn’t rule it out.
- Laparoscopy, keyhole surgery, lets a surgeon see and often remove lesions, and confirm them with a biopsy.
Current guidelines support starting treatment based on symptoms, without waiting for surgical confirmation. You don’t need a diagnosis to deserve help.
Treatment options
- Pain relief, such as anti-inflammatory medication.
- Hormonal treatments that calm or pause the cycle, like the pill, progestins, a hormonal IUD or GnRH medications.
- Surgery to remove lesions, ideally by an endometriosis specialist (excision surgery).
- Pelvic floor physiotherapy for muscle tension and pain.
- Pain psychology, movement and nutrition support, as part of a whole-person plan.
Most people need a combination. Ask your doctor about the goals of each option, side effects and what happens if it doesn’t work.
The pelvic floor piece
Endometriosis pain is chronic pain. Over time, the nervous system can turn the volume up, and muscles that have been guarding against pain for years can become a pain source of their own. Studies of people with endometriosis-associated pelvic pain have found pelvic floor muscle tension and trigger points to be very common, and they can persist even after surgery.
| It can feel like | It may be coming from |
|---|---|
| “My ovary is cramping” | Tight deep hip flexors (psoas and iliacus) |
| “Sciatica down my leg” | Trigger points in a deep hip muscle that shares fascia with the pelvic floor |
| “I can’t sit, my tailbone hurts” | Tension at the back of the pelvic floor |
| “I’m always running to the toilet” | Tension at the front of the pelvic floor pressing on the bladder |
This doesn’t rule out lesions and isn’t a diagnosis. It’s simply a part of the picture that often goes untreated. In endometriosis the pelvic floor is more often too tight than too weak, which is why Kegels can make things worse.
When to see a doctor first
- Sudden, severe pelvic pain, or pain with fever
- Bleeding heavy enough to soak a pad or tampon every hour
- Blood in your urine or stool that hasn’t been checked
- Pain that could be pregnancy-related
- Shoulder-tip pain that comes with your period
In Quebec, call Info-Santé at 811 for advice, or 911 in an emergency.
Pain that has a pattern can be worked with.
Naba, our Director of Partnerships, lives with stage 4 endometriosis and founded Pelvactiv: 1:1 movement coaching that releases the pelvic floor, syncs movement to your cycle and helps you read your pain. No diagnosis needed to start.
Pelvactiv is Naba’s independent coaching practice. It works alongside, not instead of, medical care and pelvic floor physiotherapy.
Common questions
Can a normal ultrasound rule out endometriosis?
No. Ultrasound can find some forms, like endometriomas and deep endometriosis, especially with an experienced sonographer, but superficial lesions are often not visible. A normal scan doesn’t mean your pain isn’t real.
Does endometriosis mean I can’t get pregnant?
Not necessarily. Endometriosis can make conceiving harder for some people, but many get pregnant naturally or with support. If you’re planning a pregnancy, raise it with your doctor early.
Is endometriosis the same as adenomyosis?
They’re related but different. In adenomyosis, tissue similar to the uterine lining grows into the muscle wall of the uterus. The two often occur together and share symptoms like painful, heavy periods.
Will surgery cure it?
Surgery can remove lesions and reduce pain for many people, but endometriosis can come back and some pain may come from other sources like the pelvic floor or nervous system. Most people do best with a combined plan.
Last updated October 2026. Written by The Cuterus Corner team from lived experience and published research. Clinical review by our professional network is in progress; professionals can join as reviewers. This guide is educational and doesn’t replace advice from your healthcare provider.