Endometriosis
A chronic disease affecting about 10% of women of reproductive age, still diagnosed with a multi-year delay on average — despite pain severe enough to significantly disrupt daily functioning.
Number of studies
1
Safety
Moderate
Time to effects
Improvement in symptoms with hormonal treatment is usually visible within a few menstrual cycles.
Who it's for
Table of contents
TL;DR
A chronic disease affecting about 10% of women of reproductive age, still diagnosed with a multi-year delay on average — despite pain severe enough to significantly disrupt daily functioning.
| Type | Chronic disease — presence of endometrial tissue outside the uterine cavity |
|---|---|
| Evidence level | Strong — well-characterized epidemiology and mechanisms, less clear single cause |
| Prevalence | About 10% of women of reproductive age worldwide |
| Average time to diagnosis | Several to more than a dozen years from first symptoms in many countries |
| Diagnostics | Gynecological exam, ultrasound, definitive confirmation usually via laparoscopy |
| Status | Chronic disease requiring long-term management |
Understand
Overview
Endometriosis is a chronic disease in which tissue similar to the uterine lining (endometrium) grows outside the uterine cavity — most often on the ovaries, the pelvic peritoneum, or, less commonly, in other locations. This abnormally located tissue responds to cyclical hormonal changes much like normal endometrium, leading to local inflammation, scarring and chronic pain.
A review by Zondervan and colleagues, published in Nature Reviews Disease Primers, highlights that endometriosis affects about 10% of women of reproductive age worldwide, yet the average time from first symptoms to diagnosis is several to more than a dozen years in many countries — partly because severe menstrual pain is often mistakenly normalized as 'just' period discomfort instead of being recognized as a potential symptom of a disease requiring investigation.
What actually helps: hormonal treatment (birth control pills, progestins, GnRH analogs) limits the cyclical hormonal stimulation of endometrial lesions and forms the basis of conservative treatment. Surgical treatment (laparoscopic removal of endometriosis lesions) is sometimes used for severe pain unresponsive to pharmacological treatment or for fertility problems. Nonsteroidal anti-inflammatory drugs help control pain on an as-needed basis, and pelvic floor physiotherapy can be helpful as a supportive therapy in some patients.
Mechanism of action
The exact cause of endometriosis isn't fully established, but the leading theory involves so-called retrograde menstruation — the backward flow of some menstrual blood along with fragments of endometrium through the fallopian tubes into the peritoneal cavity, where these cells can implant and grow outside the uterus. This doesn't fully explain the disease, however, since retrograde menstruation occurs in most women, while endometriosis develops in only some of them — suggesting the involvement of additional immunological and genetic factors.
Endometriosis lesions outside the uterus respond to cyclical hormonal changes (estrogen and progesterone) much like normal endometrium, going through a cycle of growth and shedding, which, in the absence of a natural outflow route (as during menstruation), leads to local bleeding, chronic inflammation and progressive scarring of the surrounding tissue — this scarring and chronic inflammation explain both the characteristic pain and the possible fertility problems linked to disrupted pelvic anatomy.
Retrograde menstruation
Backward flow of menstrual blood with fragments of endometrium through the fallopian tubes into the peritoneal cavity.
Implantation of tissue outside the uterus
Endometrial fragments can implant and grow on the ovaries or the pelvic peritoneum.
Cyclical hormonal response of lesions
Endometriosis lesions respond to estrogen and progesterone much like normal endometrium, leading to local inflammation.
Chronic scarring
The repeating cycle of bleeding and inflammation leads to progressive scarring of tissue.
Evidence: strong — based on 1 study in this database.
Benefits
Common myths
MythSevere menstrual pain is a 'normal' part of a period you have to live with.
FactPain severe enough to disrupt daily functioning is not 'normal' and can be a symptom of endometriosis or another condition requiring investigation — normalizing such pain is one of the reasons for the years-long delay in diagnosing this disease.
MythEndometriosis always prevents pregnancy.
FactEndometriosis can make conceiving harder, but many women with the disease conceive naturally or with treatment support — the degree of impact on fertility depends on the extent and location of the lesions.
Practice
Frequently asked questions
Severe menstrual pain, chronic pelvic pain not limited to the period, pain during intercourse, and, in some women, difficulty conceiving.
In many countries, the average time from first symptoms to diagnosis is several to more than a dozen years, partly due to normalizing severe menstrual pain as a 'typical' period symptom.
There's no single method that completely eliminates the disease, but available hormonal and surgical treatment effectively controls symptoms in a significant proportion of patients.
What actually helps
Birth control pills and progestins
Strong evidenceLimit the cyclical hormonal stimulation of endometriosis lesions, reducing pain and disease progression.
GnRH analogs
Strong evidenceInduce a temporary hypoestrogenic state, more strongly suppressing the activity of endometriosis lesions; usually used short-term.
Surgical treatment (laparoscopy)
Strong evidenceRemoval of endometriosis lesions, used for severe pain unresponsive to pharmacological treatment or for fertility problems.
Nonsteroidal anti-inflammatory drugs
Moderate evidenceHelp control menstrual pain associated with endometriosis on an as-needed basis.
Pelvic floor physiotherapy
Early-stage evidenceCan be helpful as a supportive therapy in easing chronic pelvic pain in some patients.
What to combine with
Good combinations
Polycystic Ovary Syndrome (PCOS) — Endometriosis and PCOS are distinct gynecological conditions, sometimes confused due to partly overlapping pain-related and hormonal symptoms
Safety
Side effects & contraindications
Possible side effects
Untreated endometriosis can lead to chronic pelvic pain and fertility problems
Contraindications
No significant contraindications at typical doses.
Interactions
Hormonal treatment of endometriosis requires coordination with other hormonal medications if used concurrently
Is it worth taking?
Who it's for
- Women with menstrual pain that is severe and beyond typical discomfort
- Women with chronic pelvic pain or difficulty conceiving
Not for
- No significant contraindications at typical doses.
Evidence
Worth knowing
Endometriosis affects about 10% of women of reproductive age worldwide.
Definitive confirmation of an endometriosis diagnosis usually requires laparoscopy, though ultrasound and the clinical picture can strongly suggest the diagnosis earlier.
Studies
Endometriosis affects about 10% of women of reproductive age, and the average time from first symptoms to diagnosis remains troublingly long in many countries.
Zondervan KT et al., Nature Reviews Disease Primers, 2018
Endometriosis
Strong evidenceZondervan KT, Becker CM, Missmer SA · Nature Reviews Disease Primers · 2018
A comprehensive review of the epidemiology, mechanisms, diagnostics and treatment of endometriosis.
View studySources & bibliography
Citations are illustrative for this demo version and require full bibliographic verification by the editorial team before production publication.
Compare with similar entries
About the authors of this entry
Author
dr Anna KowalczykEditor-in-Chief, Molecular Biology
Anna oversees the editorial process and scientific review of every publication in the knowledge base. She previously researched autophagy and mitochondrial biology.
50 publications on this site
Medical review
Julia WiśniewskaEditor, Neurohacking & Sleep
Julia writes about nootropics, chronobiology and recovery protocols.
45 publications on this site
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Comments (2)
- KW
Kasia W. 2 weeks ago
Very clearly explained, especially the interactions section — I hadn't seen it laid out this well anywhere else.
- MT
Marek T. a month ago
Are you planning to update this with the newest study from this year? I saw an interesting meta-analysis.