Understanding Endometriosis

What Is Endometriosis?

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. These areas of endometriosis may cause inflammation, irritation, scar tissue, and changes to the surrounding reproductive anatomy.

Endometriosis most commonly affects structures within the pelvis, including:

• Ovaries
• Fallopian tubes
• Pelvic lining
• Ligaments supporting the uterus
• Areas between the uterus, bladder, and rectum

Endometriosis affecting an ovary may form a cyst called an endometrioma. The location, extent, and symptoms of endometriosis vary considerably, and the severity of pain does not always correspond with the extent of disease.

Some patients experience significant symptoms, while others first learn they may have endometriosis during an evaluation for infertility or another pelvic health concern.

Common Endometriosis Symptoms

Endometriosis symptoms vary from patient to patient. Some people experience severe or persistent pain, while others have mild symptoms or no noticeable symptoms.

Common symptoms may include:

• Painful menstrual periods
• Chronic pelvic pain
• Pain during or after intercourse
• Painful bowel movements, particularly during menstruation
• Painful urination during menstruation
• Heavy menstrual bleeding or bleeding between periods
• Abdominal bloating or digestive discomfort
• Difficulty becoming pregnant

Pelvic pain and menstrual symptoms can have many possible causes. Symptoms alone cannot confirm endometriosis, but their timing, severity, and effect on daily life can help clinicians determine whether further evaluation is appropriate.

Patients may wish to speak with a healthcare provider when menstrual or pelvic pain disrupts work, school, relationships, physical activity, sleep, or other aspects of daily life.

What Causes Endometriosis?

The exact cause of endometriosis is not fully understood. Researchers continue to study how hormonal, immune, genetic, inflammatory, anatomical, and environmental factors may contribute to the condition.

Several theories have been proposed, including:

• Menstrual tissue moving backward through the fallopian tubes into the pelvis
• Transformation of cells outside the uterus into endometrial-like tissue
• Movement of endometrial-like cells through blood vessels or the lymphatic system
• Genetic or inherited susceptibility
• Changes in immune or inflammatory responses

No single theory explains every case of endometriosis. The condition may develop through a combination of biological processes that differ from one patient to another.

Having a close biological relative with endometriosis may be associated with a greater likelihood of developing the condition, but endometriosis can also occur without a known family history.

Endometriosis & Fertility

Endometriosis may affect fertility in several ways, although many patients with endometriosis conceive without fertility treatment.

Depending on the location and extent of disease, endometriosis may be associated with:

• Inflammation within the reproductive environment
• Scar tissue or adhesions that alter pelvic anatomy
• Blocked or impaired fallopian tubes
• Endometriomas involving the ovaries
• Changes that may affect egg release, fertilization, or embryo transport
• Reduced ovarian reserve in some patients
• Possible effects on implantation or embryo development

The relationship between endometriosis and fertility is complex. A patient’s ability to conceive may also be influenced by age, ovarian reserve, sperm health, tubal function, prior surgery, reproductive history, and other medical factors.

For this reason, fertility specialists evaluate the complete reproductive picture rather than assuming that endometriosis is the only factor contributing to difficulty conceiving.

How Endometriosis Is Evaluated

Evaluation for possible endometriosis often begins with a detailed review of symptoms, menstrual history, medical history, prior pregnancies, fertility history, and previous pelvic procedures or surgeries.

Evaluation may include:

• Discussion of the location, timing, and severity of pain
• Pelvic examination when appropriate
• Transvaginal or pelvic ultrasound
• Magnetic resonance imaging (MRI) in selected situations
• Ovarian reserve testing when fertility is a concern
• Evaluation of the fallopian tubes and uterine cavity
• Semen analysis when applicable

Ultrasound and MRI may identify ovarian endometriomas or certain forms of deeper endometriosis, but normal imaging does not necessarily rule out the condition.

In some cases, clinicians may make a working or clinical diagnosis based on symptoms, examination, and imaging before surgery is considered. Laparoscopy is a minimally invasive surgical procedure that can allow a physician to directly view and, when appropriate, treat areas of suspected endometriosis.

Surgery is not required for every patient before symptoms can be treated or fertility care can begin. Whether laparoscopy is appropriate depends on symptoms, imaging findings, fertility goals, prior treatment, and the potential benefits and risks of surgery.

Endometriosis Treatment Options

Endometriosis treatment is individualized based on symptoms, disease location, age, medical history, reproductive goals, and whether a patient is currently trying to become pregnant.

Possible approaches may include:

• Pain-relief medications
• Hormonal medications intended to suppress ovulation or menstruation
• Minimally invasive surgery to remove or treat endometriosis
• Fertility evaluation and treatment
• Supportive care for pelvic pain and related symptoms

Hormonal treatment may help manage endometriosis-related pain, but it generally prevents or delays attempts to conceive while being used. It is therefore not a fertility treatment for patients actively trying to become pregnant.

Surgery may be considered for severe pain, endometriomas, distorted anatomy, suspected organ involvement, or selected fertility circumstances. However, surgery involving the ovaries may also affect ovarian reserve, so its potential benefits and risks should be carefully evaluated when future fertility is important.

Some patients benefit from coordinated care involving a reproductive endocrinologist, gynecologic surgeon, pelvic pain specialist, or other clinicians depending on their symptoms and goals.

Endometriosis & IVF

IVF may be considered when endometriosis contributes to infertility, when the fallopian tubes are damaged, when other fertility factors are present, or when lower-intervention treatment has not resulted in pregnancy.

During IVF, eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. Because fertilization occurs outside the body, IVF can bypass some reproductive barriers associated with tubal damage or altered pelvic anatomy.

Whether IVF is recommended depends on factors such as:

• Age
• Ovarian reserve
• Location and extent of endometriosis
• Presence and size of endometriomas
• Fallopian tube function
• Sperm health
• Previous surgery or fertility treatment
• Desired family size and reproductive timeline

Surgery before IVF is not automatically recommended for every patient with endometriosis or an endometrioma. In some circumstances, surgery may help address pain, improve access to the ovaries, or evaluate concerning findings. In others, ovarian surgery could reduce ovarian reserve without clearly improving the likelihood of pregnancy.

A fertility specialist can help assess whether expectant management, surgery, IUI, IVF, or another approach is most appropriate based on the patient’s complete clinical circumstances.

Common Endometriosis Questions

Can you become pregnant with endometriosis?
Yes. Many patients with endometriosis conceive naturally, while others may benefit from fertility treatment. Pregnancy chances depend on age, ovarian reserve, tubal function, sperm health, disease location, and other reproductive factors.

Does severe pain mean endometriosis is severe?
Not necessarily. Some patients with limited disease experience substantial pain, while others with more extensive endometriosis have mild symptoms or no symptoms.

Can endometriosis be seen on an ultrasound?
Ultrasound may identify ovarian endometriomas and some forms of deeper endometriosis, but superficial disease may not appear on imaging. Normal imaging does not always exclude endometriosis.

Is surgery always required to diagnose endometriosis?
No. Clinicians may begin treatment based on symptoms, examination, and imaging without requiring surgery in every case. Laparoscopy may still be considered when diagnosis remains uncertain, symptoms persist, or surgical treatment may be beneficial.

Does endometriosis always cause infertility?
No. Endometriosis may make conception more difficult for some patients, but many people with the condition become pregnant without fertility treatment.

Does endometriosis mean IVF is necessary?
No. Treatment recommendations vary. Some patients may continue trying naturally, consider surgery, pursue IUI, or move to IVF depending on age, fertility testing, symptoms, disease extent, and reproductive goals.

Learn More About Endometriosis & Fertility

If you have endometriosis, symptoms that may suggest endometriosis, or concerns about how the condition could affect your fertility, an individualized evaluation can help clarify your reproductive health and treatment options.

At Spring Fertility, board-certified reproductive endocrinologists evaluate endometriosis alongside age, ovarian reserve, reproductive anatomy, sperm health, medical history, and family-building goals to develop personalized, evidence-based recommendations.

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