Endometriosis

Endometriosis is also bigger than cramps. It can affect relationships, mental health, fertility planning, work, and long-term wellbeing. The good news is that care has evolved: imaging is better, guidelines are clearer, and more clinicians recognize that symptom relief isn’t a luxury—it’s healthcare.

This guide covers what endometriosis is, what it can feel like, how it’s diagnosed, and what treatment options are supported by current clinical guidance.

What is endometriosis?

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing pain and complications.

This misplaced tissue responds to hormonal changes, thickening and bleeding with each menstrual cycle. However, unlike normal menstrual flow, this blood has no way to exit the body, leading to inflammation, cysts, and scar tissue. Common symptoms include severe menstrual cramps, chronic pelvic pain, painful intercourse, and fertility issues. Endometriosis can affect the ovaries, fallopian tubes, and surrounding pelvic organs. Diagnosis often requires imaging or laparoscopy.

Where does occur?

it typically develops on the pelvic structures including the ovaries, fallopian tubes, bladder, and bowels (intestines).

It is also common for it to develop on the top of the vagina (anterior cul-de-sac) and in the peritoneal cavity between the rectum and the posterior wall of the uterus (posterior cul-de-sac).

In rare cases, it can spread to the diaphragm, lungs, kidney, appendix, and, surprisingly, the gastrocnemius (calf muscles).

What are the stages of endometriosis?

The American Society of Reproductive Medicine classifies endometriosis according to severity.

Stages	American Society of Reproductive Medicine Severity Classifications
Stage I	Minimal
Stage II	Mild
Stage III	Moderate
Stage IV	Severe

Classifications

Because the four stages of endometriosis do not necessarily have any correlation to a patient’s symptoms or the nature of the infiltration itself, we often use a more descriptive system:

Dr.Seckin’s Preferred Classification	Description
Early peritoneal	Infiltration of the lining of the abdomen (peritoneum)
Ovarian endometriomas	Large, fluid-filled “chocolate” cysts that form on, and even encapsulate, the ovaries
Cul-de-sac obliteration	Infiltration of the tissue lining the back wall of the uterus and rectum (posterior cul-de-sac), an extension of the peritoneum
Deep infiltrating endometriosis (DIE)	Invasive endo that penetrates the bladder and bowel wall
Frozen pelvis	In this rare condition, deep infiltrative lesions attach to pelvic ligaments, nerves, and muscle tissue. As a result, pelvic organs can be partially or entirely cemented

Causes of endometriosis

The exact cause of endometriosis is unknown, but several factors may contribute, including genetics, hormones, and immune dysfunction.

One theory is retrograde menstruation, where menstrual blood flows backward into the pelvic cavity, allowing endometrial cells to implant. Other possible causes include cellular transformation and surgical scar implantation. Genetics also plays a role, as endometriosis often runs in families. Hormonal imbalances and immune system issues may allow tissue to grow outside the uterus and evade destruction.

Environmental toxins could also influence disease development. Because the cause is complex, treatment often focuses on managing symptoms rather than curing the condition. Early diagnosis helps reduce long-term effects.

Risk factors of endometriosis

While the following risk factors increase a woman’s risk of developing endometriosis, there are many cases in which women are diagnosed without any of the following:

• family history of the disease, especially in the mother or sister
• age (between 25 and 40)
• history of menstrual complications (i.e. long menstrual cycles, frequent periods)
• not having children
• high consumption of fats and red meat
• heavy alcohol intake

How does it affect pregnancy and fertility?

Endometriosis is likely responsible for one-third of infertility cases. The longer a woman has endometriosis, the more risk she has of infertility. However, up to 70% of women with mild to moderate endometriosis are still capable of conceiving

Adhesions on or near the ovaries, uterus, and fallopian tubes impede the transfer of the egg to the fallopian tube and may cause infertility. Moreover, ovarian implants may prevent the release of an egg and cause infertility. Finally, endometriosis can lead to a decrease in the number and quality of healthy eggs.

What is adenomyosis and how is it different from endometriosis?

Adenomyosis is endometriosis strictly within the uterine muscle. However, 50% of adenomyosis patients also have endometriosis.

Adenomyosis is a condition where uterine lining tissue grows into the muscular wall of the uterus, causing pain and heavy bleeding.

While both adenomyosis and endometriosis involve misplaced endometrial tissue, their locations differ. In adenomyosis, the tissue stays within the uterus but invades its muscle layer, leading to an enlarged, tender uterus. Endometriosis, on the other hand, occurs when similar tissue grows outside the uterus, often affecting pelvic organs. Symptoms of adenomyosis include severe menstrual cramps, pressure in the abdomen, and prolonged periods.

What conditions can it be related to?

Part of the reason why endometriosis is such a complex and dangerous condition is that it can lead to several other related conditions, including:

• adenomyosis
• adhesions
• ovarian cysts
• chronic pelvic pain
• infertility

What can it be misdiagnosed as?

Endometriosis can mask a number of conditions. It is often misdiagnosed and mistaken for the following conditions:

• IBS
• appendicitis
• hemorrhagic cysts

Symptoms of endometriosis

Common symptoms of endometriosis include pelvic pain, painful periods, painful sex, heavy bleeding, digestive discomfort, fatigue, and trouble conceiving.

Endometriosis symptoms vary widely, but patterns help you spot the condition early. Many people describe pelvic pain that starts days before a period and peaks during menstruation. Cramps feel deeper or sharper than “typical” period pain and may radiate to the lower back, hips, or legs.

Key signs and symptoms of endometriosis

• Dysmenorrhea (painful periods): intense cramping, throbbing pelvic pain, and pain that doesn’t respond well to usual pain relievers.
  
• Pain with sex (dyspareunia): deep pelvic pain during or after intercourse, especially with certain positions.
  
• Bowel or bladder pain: painful bowel movements (dyschezia), constipation/diarrhea, bloating, nausea, or painful urination (dysuria)—often worse during periods.
  
• Heavy or irregular bleeding: heavy flow, clots, or spotting between periods.
  
• Chronic pelvic pain: ongoing pain outside of periods, sometimes with nerve-like burning or shooting sensations.
  
• Fatigue and brain fog: persistent exhaustion that disrupts work, school, or exercise.
  
• Infertility or subfertility: difficulty conceiving can be a first clue, especially with other symptoms.
  
• Ovarian cysts (endometriomas): can cause one-sided pelvic pain, tenderness, or fullness.

Diagnosis of Endometriosis

What is the first step towards diagnosing?

Before pursuing imaging, you should speak with a GYN physician who is familiar with diagnosing endometriosis and can provide a comprehensive pelvic exam. A physical exam and a discussion about your symptoms and medical history will help a physician determine if imaging tests are necessary.

What imaging tests are available?

In order to properly diagnose a patient with endometriosis and determine whether surgery is necessary, one or both of the following imaging tests must be conducted:

• ultrasound/sonogram
• MRI

What procedures and tests help definitively diagnose endometriosis?

In an operating room, a well-trained and experienced GYN surgeon will be able to visualize any anatomical abnormalities or endometriosis lesions through the following procedures:

• hysteroscopy
• laparoscopy

While a physical exam and other imaging tests can give insight into whether or not a patient may have endometriosis, the only way to definitively diagnose endometriosis is through laparoscopic excision surgery. This must be accompanied by a biopsy sample that is sent to a pathology lab in order to confirm a diagnosis of the disease.

Endometriosis Treatment

Endometriosis treatment focuses on relieving pain, reducing tissue growth, and improving fertility through medication or surgery.

Hormonal therapies, like birth control pills or GnRH agonists, help slow endometrial growth and ease symptoms. Pain relief often starts with nonsteroidal anti-inflammatory drugs (NSAIDs). For more severe cases, laparoscopic surgery can remove or destroy endometrial implants. In cases of infertility, assisted reproductive technologies like IVF may be recommended.

Lifestyle changes, such as diet and stress management, can also support symptom control. Treatment plans vary based on age, symptom severity, and fertility goals. Early and personalized care improves quality of life and long-term outcomes.

Treatment options for endometrosis

Management of endometrosis spans medical, surgical, and integrative strategies. Hormonal options can suppress ovulation or modulate hormonal signaling to lessen pain. Non-hormonal pain strategies (topical heat, pelvic floor therapy, neuropathic agents) may complement care.

When surgery is appropriate, approaches range from conservative to excisional techniques aimed at removing lesions and adhesions.

Non-surgical methods to relieve symptoms

It is important to note that the following methods are not treatments for the disease, but rather may help control a patient’s pain and symptoms.

• painkillers
• acupuncture
• birth control pills
• anti-inflammatory diet
• medicated IUD

Surgical procedures

There are a variety of surgical treatments that a patient can undergo to treat endometriosis depending on the severity, stage, and quantity of the lesions.

Technique	Description
Laparoscopic Deep Excision Surgery	The “gold standard” for removing all endometriosis in the body, ranging from lesions on the ovaries to the intestine
Myomectomy	Removal of fibroids, is necessary only when fibroids develop
Hysterectomy	Removal of the uterus, which is only needed in cases of diffuse endometrioma tissue in the uterus such as with adenomyosis

Our approach to endometriosis

Endometriosis is not an easy condition to diagnose. Our practice provides a number of advantages.

• over 20 years of experience identifying, diagnosing, and treating endometriosis
• over 20 years of experience in laparoscopic deep excision surgery
• strong preference for laparoscopic deep excision surgery
• strong preference for excision surgery over robotics or laser ablation
• only performing hysterectomies or oophorectomy as the last resorts
• patented technologies, including the Aqua Blue Contrast technique (ABC)
• high-quality surgical imaging

Your health and well-being come first for us. With decades of experience, we know that this is the most important aspect of treating the disease and every patient is different and therefore every patient’s unique story and symptoms must be heard.

Myths and misconceptions about endometrosis

A common myth about endometriosis is that it’s just bad period pain, but it’s a serious chronic medical condition.

Another misconception is that pregnancy cures endometriosis; while symptoms may ease temporarily, the condition often returns. Many believe it only affects older women, but teens and young adults can also suffer.

Some think a hysterectomy guarantees a cure, yet symptoms can persist if lesions remain. It’s also wrongly assumed that all women with endometriosis are infertile, many can still conceive naturally. Misunderstandings delay diagnosis and treatment, worsening quality of life. Raising awareness helps women seek timely care and manage symptoms effectively.

Building your personal care roadmap for endometrosis

Think of your plan as an evolving document. Start with symptom relief, layer in lifestyle supports, evaluate medical therapies, and revisit surgical discussions as needed. Define checkpoints (three-month and six-month reviews) to assess progress.

Keep copies of key records and a running list of questions. With endometrosis, steady, informed adjustments often outpace drastic, one-time fixes.

Patient story

Menoka M. has been experiencing severe pelvic pain for the past seven years and has not received a diagnosis for nearly five years. After seeing many doctors and having several surgeries, Menoka found us and was soon scheduled for laparoscopic deep excision surgery. Read about Menoka’s journey here, as well as how she is doing now.

You can read more stories of patients with endometriosis in our testimonial section.

Frequently Asked Questions About Endometriosis