What Leads To Endometriosis Diagnosis And Treatment
Learn what leads to an endometriosis diagnosis, key symptoms, risk factors, imaging and lab tests, treatment options, fertility planning, and daily management strategies.
Written by Dr. Mohammed Kamran
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 24th Oct, 2025
Endometriosis is a chronic, estrogen‑dependent inflammatory condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity—most often on the ovaries, fallopian tubes, pelvic peritoneum, bowel, or bladder. These lesions respond to menstrual cycle hormones, leading to local bleeding, inflammation, scarring, and nerve growth that can cause significant pain and, for some, difficulty conceiving. It is not an infection or cancer, although rare malignant transformations of endometriomas can occur post‑menopause.
Prevalence estimates suggest around 10% of reproductive‑age individuals have endometriosis, with a higher burden among those with severe period pain or infertility. Global health bodies like WHO and clinical guidelines from ESHRE and NICE stress that endometriosis is common but underdiagnosed, partly because symptoms overlap with other pelvic disorders and the condition presents differently from one person to another. Family history increases risk; first‑degree relatives of someone with endometriosis have several-fold higher odds of having the condition.
Myths persist. “Normal” period pain should not keep you from school, work, or life. Sexual pain is not “in your head.” Hysterectomy is not a universal cure—endometriosis is outside the uterus, and pain may persist if lesions remain. Pregnancy may temporarily lessen symptoms for some, but it is not a treatment. Understanding these basics empowers timely diagnosis and informed treatment decisions. Related terms include adenomyosis (endometrium‑like tissue in the uterine muscle), deep infiltrating endometriosis (DIE), and endometriomas (ovarian cysts formed by endometriosis).
What Leads to an Endometriosis Diagnosis?
Doctors suspect endometriosis based on a pattern of symptoms and exam findings. The hallmark is cyclical pelvic pain that worsens around menstruation, though pain can also be constant. Common symptoms include:
- Dysmenorrhea: severe period pain that limits activities or requires strong pain relief.
- Dyspareunia: pain during or after penetrative sex.
- Dyschezia: pain with bowel movements, especially during periods, sometimes with bloating or alternating constipation/diarrhoea.
- Dysuria or urinary frequency/urgency, particularly if the bladder is involved.
- Subfertility: difficulty conceiving after 6–12 months of trying.
- Heavy menstrual bleeding and spotting between periods, especially if adenomyosis coexists.
Risk factors include early menarche, shorter cycles, heavy bleeding, low BMI, obstructive reproductive tract anomalies, and family history. People with autoimmune conditions may be overrepresented, though causation is not established. Red flags prompting evaluation include pain causing missed work/school, bowel or urinary pain with bleeding, painful sex, pelvic masses on exam, and pain not relieved by over‑the‑counter medication.
Symptom severity does not always correlate with disease extent. Careful clinical evaluation and targeted imaging—like transvaginal ultrasound for endometriomas or MRI for deep lesions—support diagnosis without immediately resorting to invasive surgery. If pain persists beyond two menstrual cycles or new red flags appear, consult a doctor online with Apollo 24|7 for guidance.
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Why Diagnosis Takes Years?
Average diagnostic delay ranges from 7–10 years due to:
- Normalisation of pain: Severe period pain is often dismissed.
- Symptom overlap: IBS, bladder pain syndrome, pelvic floor dysfunction, and adenomyosis may confuse diagnosis.
- Variability in presentation: Symptoms may be gastrointestinal, back pain, or neuropathic.
- Historical reliance on laparoscopy: Waiting for surgical confirmation prolonged diagnosis.
Fast‑track strategies:
- Maintain a symptom diary documenting pain patterns, bowel/urinary symptoms, triggers, and daily life impact.
- Request focused imaging: transvaginal ultrasound for ovarian endometriomas; MRI for deep infiltrating lesions.
- Discuss empiric therapy: Hormonal suppression can begin without laparoscopy if fertility is not an immediate concern.
- Engage multidisciplinary care: Pain specialists, physiotherapists, and gastro/urology colleagues can address comorbidities.
- Advocate for timely referral to an endometriosis specialist if first-line treatment fails.
A practical tip: create a “flare snapshot” noting your worst symptoms, peak timings, and top three improvement goals to guide your clinician.
The Diagnostic Pathway: Exams, Imaging, And Laparoscopy
Diagnosis begins with medical history and pelvic exam, assessing menstrual patterns, pain timing, sexual and
bowel/urinary symptoms, fertility goals, and prior surgeries. Pelvic tenderness, nodules in uterosacral ligaments, fixed uterus, or adnexal masses suggest endometriosis.
Imaging:
- Transvaginal ultrasound (TVUS): First-line for endometriomas; identifies nodules when performed by experienced
operators. - MRI pelvis: Maps deep infiltrating lesions, especially in bowel, bladder, or uterosacral ligaments.
- Transrectal ultrasound: Occasionally used for bowel involvement.
Laparoscopy: No longer mandatory for all; considered when medical therapy fails, imaging is inconclusive, pelvic masses require surgery, deep disease affects bowel/bladder, or infertility work-up suggests surgical intervention.
CA‑125 and blood tests: CA‑125 is nonspecific and not diagnostic; blood tests mainly evaluate anemia from heavy bleeding.
Interpreting results: staging, differential diagnosis, and comorbidities
Staging guides treatment:
- rASRM I–IV: Based on lesion size, depth, adhesions; correlates poorly with pain but informs fertility planning.
- Enzian: Describes deep infiltrating endometriosis compartments; aids surgical planning.
Differential diagnoses include adenomyosis, IBS, IBD, celiac disease, bladder pain syndrome, pelvic floor myalgia, and neuropathic pain. Comorbidities are common, and holistic management addresses all contributors.
Evidence-based Treatments: Medicines, Devices And Surgery
Here are the treatments for endometriosis:
Analgesics and supportive care: NSAIDs, heat, gentle movement, and TENS units; manage comorbidities like IBS or
bladder dysfunction.
Hormonal therapies:
- Combined oral contraceptives (COCs), patch, or ring for continuous or cyclical suppression.
- Progestin-only options: oral progestins, depot medroxyprogesterone, etonogestrel implant, LNG‑IUD.
- GnRH agonists/antagonists (e.g., leuprolide, elagolix) with add-back therapy for hypoestrogenic side effects.
- Aromatase inhibitors in refractory cases.
Surgical options:
- Conservative laparoscopic excision/ablation and adhesiolysis.
- Cystectomy for ovarian endometriomas.
- Advanced surgery for deep infiltrating endometriosis (bowel, bladder) in specialised centres.
- Hysterectomy with/without oophorectomy for refractory pain in select cases.
Layered care—symptom suppression, mechanistic targeting, structural correction, and neuromuscular/psychosocial modulation—often yields optimal outcomes.
Fertility and Endometriosis: Planning, Preservation And Pregnancy
Endometriosis may impair fertility through inflammation, adhesions, and anatomical distortion. Many conceive
naturally:
- Under 35, trying <12 months: optimise timing and manage pain; fertility evaluation if no conception after 12 months.
- Mild–moderate disease: surgical excision may improve conception rates.
- Moderate–severe disease or older age: consider ART (IUI, IVF) with or without prior surgery.
Plan around ovarian reserve and endometrioma surgery; consider fertility preservation if needed. Pregnancy may relieve or shift symptoms, but most outcomes are healthy.
Daily Management: Pain Strategies, Nutrition And Mental Health
Multimodal strategies improve day-to-day life:
- Pelvic floor physiotherapy: Down-training, breathing, manual therapy to reduce pain.
- Graded movement: Gentle activity (walking, yoga, pilates) supports endorphins; micro-sessions during flare days help maintain momentum.
- Diet: Anti-inflammatory patterns, omega-3s, fruits, vegetables, whole grains; low-FODMAP trials for IBS overlap. Track personal flare triggers.
- Sleep and stress: Consistent schedule, wind-down routines, mindfulness, CBT, or pain reprocessing therapy.
- Flares toolkit: Heat pads, TENS, scheduled NSAIDs, hydration, gentle stretches, pre-planned rest. Cycle-aware planning helps schedule demanding tasks during lower-pain windows.
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Care pathways, costs, and getting help in India
Efficient care reduces delays and cost:
- Start with a gynecologist experienced in chronic pelvic pain; consider co-management with gastroenterology or urology.
- Request targeted imaging and discuss empiric therapy options.
- Telehealth via Apollo 24|7 for online assessment, medication refills, or imaging interpretation; book in-person follow-up if needed.
- Home lab collection for CBC and iron studies is available.
- Costs vary: continuous hormonal therapy is cost-effective; MRI and surgery are higher cost but may be necessary. Discuss staged approaches, generic options, and insurance coverage.
Questions to ask your doctor include likelihood of endometriosis, imaging choice, empiric therapy suitability, fertility impact, and surgical team experience.
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Dr. Rupam Manna
Radiation Specialist Oncologist
4 Years • MBBS MD(RADIO THERAPY)
Barasat
Diab-Eat-Ease, Barasat
Dr. Sreeparna Roy
Obstetrician and Gynaecologist
8 Years • MBBS , MS (OBSTETRICS & GYNAECOLOGY), Fellowship in Infertility, Endoscopy & Ultrasonography), Fellowship in Laparoscopy & Hysteroscopy,DRM
Kolkata
Dr Utsa Basu Clinic, Kolkata
Dr Bhawna Garg
Gynaecological Oncologist
26 Years • MBBS, MS, (PGI MS ROHTAK) FELLOWSHIP GYNECOLOGY ONCOLOGY, (CANCER INSTITUTE CHENNAI)
Delhi
Apollo Hospitals Indraprastha, Delhi
Dr. B Shravanthi Reddy
Radiation Specialist Oncologist
8 Years • MBBS, DNB(Radiation Oncology)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
Dr Shaikat Gupta Director Surgical Onco
Surgical Oncologist
34 Years • MBBS (University Gold Medalist), MS, FRCSEd
Kolkata
Apollo Multispeciality Hospitals , Kolkata, Kolkata
(250+ Patients)
Consult Top Specialists Here
Dr. Rupam Manna
Radiation Specialist Oncologist
4 Years • MBBS MD(RADIO THERAPY)
Barasat
Diab-Eat-Ease, Barasat
Dr. Sreeparna Roy
Obstetrician and Gynaecologist
8 Years • MBBS , MS (OBSTETRICS & GYNAECOLOGY), Fellowship in Infertility, Endoscopy & Ultrasonography), Fellowship in Laparoscopy & Hysteroscopy,DRM
Kolkata
Dr Utsa Basu Clinic, Kolkata
Dr Bhawna Garg
Gynaecological Oncologist
26 Years • MBBS, MS, (PGI MS ROHTAK) FELLOWSHIP GYNECOLOGY ONCOLOGY, (CANCER INSTITUTE CHENNAI)
Delhi
Apollo Hospitals Indraprastha, Delhi
Dr. B Shravanthi Reddy
Radiation Specialist Oncologist
8 Years • MBBS, DNB(Radiation Oncology)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
Dr Shaikat Gupta Director Surgical Onco
Surgical Oncologist
34 Years • MBBS (University Gold Medalist), MS, FRCSEd
Kolkata
Apollo Multispeciality Hospitals , Kolkata, Kolkata
(250+ Patients)
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Frequently Asked Questions
1) How is endometriosis diagnosed without laparoscopy?
Probable diagnosis is often based on symptoms, pelvic exam, and imaging (TVUS ± MRI). Empiric therapy may start if fertility is not immediately desired.
2) Can CA‑125 diagnose endometriosis?
No; it is nonspecific and not recommended for diagnosis.
3) What is the best birth control for endometriosis pain?
Continuous COCs or progestin-only methods (dienogest, LNG‑IUD) are effective. Choice depends on symptoms and preferences.
4) Do I need surgery to get pregnant?
Not always; mild-moderate disease may allow natural conception. Surgery may help in select cases. IVF may be preferable for others.
5) How long does surgery recovery take?
Most laparoscopic procedures take 2–4 weeks for routine activities, longer for advanced disease. Pain improvement may continue over months.