Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, most often on the ovaries, the fallopian tubes and the lining of the pelvis. This tissue responds to the hormones of the menstrual cycle, which leads to inflammation, pain and, over time, scarring that can bind pelvic organs together. On the ovaries it can form cysts called endometriomas.
Periods that hurt enough to make you miss school or work are not something you simply have to live with. Endometriosis is common, yet diagnosis is often delayed for years, partly because painful periods are so often dismissed as normal and partly because confirming the disease has traditionally required surgery. Our women's health team takes these symptoms seriously, and we do not wait for surgical proof before starting treatment that can help.
Symptoms and who it affects
Endometriosis affects people who menstruate, most often diagnosed in their twenties and thirties. According to the NICHD, the most common symptoms are pain and infertility. The pain takes several forms:
- Painful periods, with cramps that may worsen over the years.
- Pelvic or lower abdominal pain outside of periods.
- Pain during or after sex, often deep in the pelvis.
- Painful bowel movements or painful urination during periods.
Some women also have heavy periods, spotting between periods, bloating and fatigue. For others the first sign is trouble getting pregnant. Symptoms do not always match the extent of disease: the NICHD notes that the size and location of lesions are not related to the severity of pain, so a woman with a small amount of endometriosis can hurt a great deal, while another with extensive disease may have few symptoms.
Other conditions can look similar, including ovarian cysts, fibroids, pelvic infection, irritable bowel and bladder pain conditions, which is one reason a careful evaluation matters. For bladder symptoms we coordinate with our urologists, and our chronic pelvic pain page describes that shared approach.
How we evaluate endometriosis at NYMD Center
Evaluation begins with a detailed history of your periods, the timing and character of your pain, sexual and bowel and bladder symptoms, pregnancy plans and family history. A pelvic exam can reveal tenderness, nodules or an ovary that is fixed in place.
A pelvic ultrasound, done in our office as part of our on-site ultrasound services, is the next step. It is very good at finding endometriomas on the ovaries and at ruling out other causes of pain such as fibroids. It cannot see small surface implants or adhesions, as the NICHD explains, so a normal ultrasound does not exclude endometriosis. MRI can be arranged when deeper disease is suspected.
The only way to confirm endometriosis definitively is laparoscopy, a surgical procedure in which a small camera is passed into the pelvis. But you do not need surgery to begin treatment. When your history, exam and imaging point to endometriosis, we can make a clinical diagnosis and start medical therapy right away, reserving surgery for when it is truly needed.
Treatment options, least invasive first
There is no cure for endometriosis, but its symptoms can usually be controlled. The goal is to reduce pain, protect fertility when that matters to you, and find a treatment you can stay on comfortably. We start with the least invasive options and step up only when needed.
Anti-inflammatory pain relievers
Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, taken on a schedule starting just before the period, reduce the prostaglandins that drive menstrual pain. They are a sensible first step and are often combined with hormonal treatment. They relieve pain but do not suppress the disease, and long-term use can irritate the stomach.
Hormonal suppression
Because endometriosis is fed by the monthly hormone cycle, quieting that cycle quiets the disease. Combined birth control pills taken continuously, skipping the placebo week, can stop periods altogether. Progestin-only options, including daily pills, and the levonorgestrel IUD are good choices for women who cannot take estrogen. These treatments are well studied and suitable for years, but they prevent pregnancy while you use them, and some women have irregular spotting or mood changes.
GnRH antagonists and agonists with add-back
When first-line hormones are not enough, medications that act on gonadotropin-releasing hormone lower estrogen levels sharply, creating a temporary, reversible menopause-like state. They are often effective for pain. The trade-off is menopausal side effects such as hot flashes and bone loss, which is why they are usually paired with low-dose "add-back" hormone therapy that protects bone and eases symptoms while keeping the benefit.
Laparoscopic excision
Surgery is reserved for pain that persists despite medical therapy, for large endometriomas, and for some women with infertility. Laparoscopic excision removes endometriosis implants and cysts through small incisions and confirms the diagnosis at the same time. It is arranged with the group's gynecologic surgeons or by referral to a specialist surgeon. Surgery can bring meaningful relief, but endometriosis can return, so most women continue hormonal suppression afterward unless they are trying to conceive.
What to expect at your visit
At your first appointment we listen to your story in detail. It helps to track your pain for a cycle or two before you come, noting when it starts, how severe it is and what makes it better or worse. We perform a pelvic exam and, in most cases, a pelvic ultrasound, then explain what we think is going on and lay out the options in plain terms. If you are planning a pregnancy soon, treatment is tailored to that goal. Follow-up visits let us adjust treatment until your symptoms are under control. For a deeper look at gynecologic conditions and treatments, our partner site EliteGyn offers more detail.
When to seek care urgently
Go to an emergency room if you have sudden, severe pelvic pain, especially with fever, vomiting, fainting or a positive pregnancy test. A ruptured or twisted ovarian cyst and an ectopic pregnancy can mimic an endometriosis flare and need immediate care.
Questions patients ask
Can endometriosis be diagnosed without surgery?
Endometriosis can only be confirmed definitively by laparoscopy, but you do not need surgery to start treatment. When your symptoms, pelvic exam and ultrasound point to endometriosis, we can make a clinical diagnosis and begin medical therapy. Ultrasound can find ovarian cysts called endometriomas but cannot see small implants, so a normal scan does not rule the condition out.
Does endometriosis cause infertility?
It can. Endometriosis is one of the recognized causes of difficulty getting pregnant, through inflammation, scarring around the tubes and ovaries, and ovarian cysts. Many women with endometriosis still conceive naturally. If pregnancy is a goal, tell us early, because it changes which treatments make sense, and surgery or referral to a fertility specialist may be part of the plan.
Is it normal for periods to be very painful?
Some cramping is common, but pain that keeps you from school, work or daily activities, that gets worse over the years, or that does not respond to over-the-counter pain relievers is not something you should accept as normal. Severe period pain is one of the main symptoms of endometriosis and deserves an evaluation, especially with pain during sex or painful bowel movements.
Will endometriosis come back after surgery?
It can. Laparoscopic excision often brings meaningful relief, but endometriosis may return over time, which is why most women continue some form of hormonal suppression after surgery unless they are trying to conceive. Medical therapy is also the main treatment for many women who never need surgery at all.
Does endometriosis go away after menopause?
Symptoms usually ease after menopause, because the disease depends on the hormones of the menstrual cycle. Hormone therapy after menopause can occasionally reactivate symptoms, so we consider your history of endometriosis when discussing menopausal treatment. Until then, the goal is to control symptoms with a treatment you can stay on comfortably.