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Women's Health Guide

Endometriosis

What you actually need to know

1 in 10
women in the UK live with endometriosis
⚠
Medical disclaimer

This page provides general health information. It is not a substitute for personalised medical advice, diagnosis, or treatment. Every person's situation is different. If you have concerns about your health, please speak to your GP or a qualified healthcare professional.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it - on the ovaries, fallopian tubes, bowel, bladder, or elsewhere in the pelvis. It is not just painful periods. It is a systemic, inflammatory condition that can affect the whole body.

Around 1.5 million people in the UK live with endometriosis, and yet the average time to diagnosis is still around 8 years. That is 8 years of being told it is 'just bad periods', being offered the pill without explanation, or being made to feel as though the pain is exaggerated. It is not.

This page aims to give you the information that should have been offered at a first appointment - what endometriosis actually is, how to get properly investigated, what genuinely helps, and what to push back on.

Symptoms to know

Painful periods (dysmenorrhoea)
Pain that stops you functioning - not just discomfort. If you are regularly taking days off work, school or life because of period pain, that is worth investigating. NICE guidance notes that severe dysmenorrhoea is a key symptom warranting assessment.
Pelvic pain outside of periods
Endometriosis pain does not stop when your period ends. Ongoing pelvic pressure, heaviness or aching throughout the month is a recognised feature of the condition.
Pain during or after sex (dyspareunia)
Deep dyspareunia is a classic endometriosis symptom and is included in the NICE guidelines guideline as a key indicator. It is often under-reported because women feel embarrassed to mention it. Please do mention it.
Painful bowel movements or urination
Particularly around the time of a period. This can suggest endometriosis involving the bowel or bladder (often called deep infiltrating endometriosis) and should prompt referral to a specialist centre.
Cyclical bloating ('endo belly')
Severe bloating that can cause visible abdominal distension. Often worse around the period but can occur throughout the month and is a recognised symptom.
Fatigue
Chronic fatigue is a widely reported symptom in endometriosis. The exact mechanism is not fully understood but is thought to be related to chronic inflammation and the impact of pain on sleep quality.
Difficulty conceiving
Endometriosis affects fertility in some people, depending on the severity and location of disease. If you have been trying to conceive without success, endometriosis should be considered and investigated.

What actually helps

Take NSAIDs correctly
Ibuprofen works best when taken regularly around the time of your period, not just when pain peaks. Starting the day before your period is due (if predictable) and taking it consistently every 6-8 hours with food maintains anti-inflammatory levels rather than playing catch-up. NICE guidelines recommends NSAIDs as first-line for endometriosis-related pain.
Heat has evidence behind it
A heat patch or hot water bottle applied to the lower abdomen can reduce pelvic pain. A Cochrane review found continuous low-level topical heat therapy was effective for primary dysmenorrhoea. It is not a cure, but it is a safe, evidence-informed option.
Consider an anti-inflammatory approach to eating
An anti-inflammatory diet will not cure endometriosis, but some research suggests it may reduce symptom severity. A 2013 systematic review (Parazzini et al.) and subsequent studies have found associations between omega-3 rich diets and reduced endometriosis risk. Focus on oily fish, vegetables, whole grains, and reducing ultra-processed foods. This should complement, not replace, medical treatment.
Ask about hormonal management
The combined contraceptive pill, hormonal IUS (Mirena), or progestogen-only options can significantly reduce endometriosis symptoms by suppressing the cycle. NICE guidelines recommends these as first-line medical management. They do not treat underlying disease, but are a legitimate and effective tool for symptom control.
Ask about pelvic floor physiotherapy
Chronic pelvic pain often involves pelvic floor dysfunction, with muscles becoming hypertonic (tight and overactive) in response to ongoing pain. NICE guidelines recommends referring women with endometriosis to pelvic floor physiotherapy as part of a multidisciplinary approach. This is available through NHS gynaecology pathways.
Push for a BSGE referral if needed
If symptoms are severe, or if initial treatments have not helped, you can ask for a referral to a BSGE-accredited endometriosis centre. These are specialist multidisciplinary centres commissioned by NHS England. The BSGE website lists all accredited centres in the UK.

Myths worth busting

Myth
“Endometriosis can be diagnosed with a scan”
Ultrasound can detect endometriomas (ovarian cysts caused by endometriosis) but cannot rule out the condition. A normal scan does not mean you do not have endometriosis. The ESHRE 2022 guideline confirms that laparoscopy remains the gold standard for definitive diagnosis, though clinical diagnosis based on symptoms is increasingly accepted as sufficient to begin treatment.
Myth
“Getting pregnant will cure endometriosis”
Pregnancy is not a treatment for endometriosis. Symptoms may temporarily reduce during pregnancy due to changes in hormone levels, but endometriosis typically returns after delivery. No clinical guideline recommends pregnancy as a management strategy.
Myth
“It is just bad periods - everyone gets them”
Period pain that disrupts daily functioning is not a normal part of life to simply accept. NICE guidelines specifically states that severe dysmenorrhoea warrants clinical assessment. The average 8-year diagnostic delay in the UK (Endometriosis UK, 2023) reflects a systemic problem with dismissal of symptoms, not a reflection of how common or serious the condition is.
Myth
“Surgery is always the answer”
Laparoscopy is the definitive diagnostic and can be therapeutic (excision or ablation of disease), but it is not always the first or only step. NICE guidelines recommends a staged approach beginning with pain management and hormonal treatment before proceeding to surgery. Recurrence rates after surgery are also significant, so surgery is one tool, not a cure.

Frequently asked questions

What are the first signs of endometriosis?
The most commonly reported early symptoms are period pain that is disproportionately severe, pelvic pain outside of the period, and pain during sex. Many people also experience bloating, fatigue and bowel or bladder symptoms around their period. NICE guidelines recommends clinicians consider endometriosis when these symptoms are present, even without a diagnostic scan to confirm it.
How is endometriosis diagnosed in the UK?
Definitive diagnosis is through laparoscopy - a keyhole surgical procedure. Before this, NICE recommends a detailed history, pelvic examination, and pelvic ultrasound. If symptoms are suggestive of endometriosis, treatment can begin on a clinical basis without waiting for surgical confirmation. Ask for a gynaecology referral if your GP is unsure, and consider requesting a BSGE-accredited centre if your symptoms are complex.
Can endometriosis be cured?
There is currently no cure for endometriosis. However, symptoms can be very effectively managed through a combination of hormonal treatments, pain management, surgery where appropriate, and lifestyle approaches. Research into new treatments is ongoing. The ESHRE Patient Version of the 2022 guideline is a useful, accessible resource for understanding current management options.
Does endometriosis always affect fertility?
No. Many people with endometriosis conceive naturally. The impact on fertility depends on the severity and location of the disease. Moderate to severe endometriosis can affect ovarian reserve and tubal function, but this does not mean pregnancy is impossible. NICE guidelines recommends that fertility implications are discussed with anyone diagnosed with endometriosis.
Is endometriosis hereditary?
There is a genetic component. Research has shown that first-degree relatives of someone with endometriosis are approximately 7 times more likely to have the condition themselves (Coxhead and Thomas, 1993; subsequent GWAS studies have confirmed multiple genetic loci). Having a family history does not mean you will definitely develop it, and not having one does not mean you will not.
What is the difference between endometriosis and adenomyosis?
Adenomyosis is where endometrial-like tissue grows into the muscular wall of the uterus itself, rather than outside of it. The two conditions can co-exist. Adenomyosis typically causes heavy, painful periods and an enlarged uterus. It can be detected on MRI and sometimes on ultrasound, and is more common in women in their 30s and 40s. It is covered in the NICE guidelines heavy menstrual bleeding guideline.

Sources & references

All clinical claims on this page are grounded in current evidence and published guidelines. Links open external websites.

  1. NICE NG73: Endometriosis - diagnosis and management (2017, updated 2024)
  2. Endometriosis UK: About endometriosis
  3. BSGE: Accredited endometriosis centres
  4. NHS: Endometriosis

Last reviewed: July 2026. This page will be updated as guidelines change. If you spot an error or an outdated reference, please get in touch.

Dr Hiba Sher Khan
© 2026 Dr Hiba Sher Khan · drhiba.co.uk