Overview

Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus — on ovaries, fallopian tubes, and pelvic lining. It affects ~190 million women worldwide and is found in up to 50% of women with fertility difficulties.

Symptoms

• Pelvic pain, worse before and during periods
• Severe, cramping period pain (dysmenorrhoea)
• Deep pain during or after intercourse
• Heavy menstrual bleeding or spotting between periods
• Pain with bowel movements or urination
• Bloating and fatigue
• Difficulty conceiving

Causes & Risk Factors

• Retrograde menstruation — most widely accepted theory
• Immune system dysfunction
• Genetics — first-degree relative increases risk 7–10×
• Early onset of menstruation; short cycles
• High oestrogen environment

Complications

• Infertility — responsible for 30–50% of female infertility
• Ovarian endometriomas damaging egg reserve
• Adhesions blocking fallopian tubes
• Chronic pelvic pain and reduced quality of life

Diagnosis

• Transvaginal ultrasound — identifies endometriomas and deep disease
• MRI — maps extent of disease
• Laparoscopy with biopsy — gold standard

Treatment

• NSAIDs for pain management
• Hormonal therapy — OCP, progesterone, hormonal IUD
• GnRH agonists/antagonists for moderate-to-severe cases
• Laparoscopic surgery — removes lesions and adhesions
• IVF — most effective for moderate-to-severe disease
• Egg freezing — to preserve fertility before reserve declines

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