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Health condition · Clinically reviewed

Endometriosis, the guide that answers what to do next.

A common, commonly missed condition where womb-like tissue grows outside the uterus. Here is how it is diagnosed, treated, and when a specialist centre is the right next step.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against NICE, RCOG or peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK guidance on symptom-led referral, imaging and specialist surgery.

Key facts

Endometriosis at a glance.

The essentials, in plain English — what it is, how common it is, how it is diagnosed, and how it is treated in the UK today.

  • What it is

    Tissue similar to the lining of the womb growing outside it — typically on ovaries, tubes, pelvic peritoneum or the bowel and bladder.

  • How common

    Around 1 in 10 women of reproductive age. Often takes years to diagnose.

  • Main symptoms

    Painful periods, chronic pelvic pain, pain during sex, and difficulty conceiving.

  • Diagnosis

    Clinical suspicion + specialist ultrasound or MRI. Laparoscopy remains the gold standard when needed.

  • First-line treatment

    Analgesia, hormonal treatment (combined pill, progestogen, hormonal IUS) — stepped up as needed.

  • Specialist care

    Deep or bowel endometriosis is treated in accredited BSGE centres by multidisciplinary teams.

Why this guide matters

Answers that shorten the wait.

Endometriosis is often missed for years. The three points below shape everything else on this page.

  • Pain that stops your day is not normal

    Period pain that stops school, work or activity deserves proper assessment.

  • Imaging has to be specialist

    General ultrasound often misses deep disease. Dedicated pelvic ultrasound or MRI is far more sensitive.

  • Complex cases belong in BSGE centres

    Deep or bowel disease needs a multidisciplinary team — not a general gynae list.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    A pattern of pelvic pain

    Cyclical or constant pelvic pain, painful periods, and pain during sex — often for years before a diagnosis.

  2. 02

    Recognising

    A symptom diary helps

    Two months of daily notes on pain, cycle and function reveals patterns and severity.

  3. 03

    Recognising

    GP examination

    Abdominal and, where appropriate, pelvic examination looks for tenderness and nodules.

  4. 04

    Confirming

    Specialist ultrasound

    Transvaginal ultrasound by someone trained in endometriosis can detect endometriomas and deep disease.

  5. 05

    Confirming

    MRI where needed

    Pelvic MRI maps deep infiltrating disease and helps plan surgery — see our women’s pelvic MRI page.

  6. 06

    Managing

    A stepwise treatment plan

    Pain relief, then hormonal therapy. Surgery is offered when symptoms persist or fertility is affected.

  7. 07

    Managing

    BSGE centre referral

    Deep or bowel endometriosis is managed in an accredited multidisciplinary centre.

Typical timeline: weeks to months from first appointment to a settled plan, longer when surgery is planned.

Symptoms

What endometriosis actually feels like.

More than a bad period — often a pattern of cyclical pain that touches many parts of daily life. Here is the shape of typical symptoms.

  • Chronic pelvic pain

    Constant or cyclical pain that interferes with daily life — the most common symptom.

  • Painful periods

    Pain that stops you going to work or school — not the normal cramps friends brush off.

  • Pain during sex

    Deep pain during or after intercourse — a distinctive symptom of endometriosis.

  • Bowel symptoms

    Painful bowel movements, especially around periods; sometimes rectal bleeding.

  • Urinary symptoms

    Painful urination or blood in the urine, cyclical with the period.

  • Fatigue

    Very common, especially in the days before a period.

  • Difficulty conceiving

    Endometriosis can affect fertility, though many with the condition conceive naturally.

  • When to escalate

    Sudden severe pelvic pain, heavy bleeding with fainting, or fever — urgent assessment.

Treatment

How endometriosis is treated in the UK.

A stepwise plan — pain relief, hormonal treatment, and surgery when needed — matched to symptoms, fertility plans and disease extent.

  • Analgesia

    Paracetamol and NSAIDs as a first step — taken early, at full dose, on a schedule during a flare.

  • Combined hormonal pill

    Continuous or back-to-back cycles reduce painful periods.

  • Progestogens

    Oral (norethisterone, dienogest) or depot progestogens quieten endometrial tissue.

  • Hormonal IUS

    A Mirena releases progestogen locally — highly effective and long-acting.

  • GnRH analogues

    Short-term “pause” of ovarian function, usually with add-back HRT, in specialist care.

  • Excision surgery

    Laparoscopic removal of endometriotic tissue — often better outcomes than ablation.

  • Bowel or bladder surgery

    For deep disease, in an accredited BSGE centre with a multidisciplinary team.

  • Fertility support

    Fertility assessment early; IVF when appropriate; endometriosis surgery has a role in some cases.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynaecologist knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.

  • NICE. Endometriosis: diagnosis and management (NG73).

  • Royal College of Obstetricians and Gynaecologists (RCOG). Green-top guidelines on endometriosis.

  • Endometriosis UK. Patient information and support.

  • British Society for Gynaecological Endoscopy (BSGE). Endometriosis centre network.

Red flags

When pelvic pain needs urgent care.

Most pelvic pain is benign or hormonal. These are the patterns that need urgent assessment — do not push through them.

  • Sudden severe pelvic pain

    With or without fever — urgent assessment to exclude ovarian torsion or a cyst rupture.

  • Heavy bleeding with fainting

    Passing large clots and feeling faint — call 111 or attend A&E.

  • Fever with pelvic pain

    Possible pelvic infection — urgent assessment.

  • Rectal bleeding

    Any new rectal bleeding needs assessment — not always from endometriosis.

  • Difficulty passing urine

    Especially with pain or blood — see a doctor promptly.

  • Pregnancy with severe pain

    Any severe pelvic pain in early pregnancy — urgent assessment to exclude ectopic.

  • Fertility concerns

    Trying to conceive for 6 months and struggling — fertility assessment worthwhile alongside endometriosis review.

  • Painful symptoms in a teenager

    Endometriosis can start early — a persistent pattern deserves specialist referral.

  • Post-op fever or new pain

    After endometriosis surgery, any new fever or worsening pain — contact your team same day.

Living with it

A long-term condition, but a very manageable one.

Four things that make the biggest difference day to day — the pain plan, mental health, fertility conversations and getting to the right centre.

A quiet reminder

Consistency beats intensity, every time.

Small, steady changes — kept up for months — do more than a heroic week that does not last.

  1. 01 Pain plan

    Take pain relief early

    NSAIDs work better started before the pain peaks — full dose, on a schedule, for a few days.

  2. 02 Mental health

    It is not just physical

    Living with chronic pain affects mood. Psychological support alongside physical care matters.

  3. 03 Fertility

    Have the conversation early

    If you may want children, discuss timing and options with your GP or gynaecologist ahead of time.

  4. 04 Specialist care

    Get to the right centre

    Deep or complex endometriosis is best managed in an accredited BSGE centre.

Frequently asked

Everything we get asked about endometriosis.

Quick answers on diagnosis, imaging, BSGE centres, hormonal treatment, surgery, fertility and menopause.

  • What is endometriosis?

    A condition where tissue similar to the lining of the womb grows outside it — most often on the ovaries, tubes and pelvic peritoneum, sometimes on the bowel or bladder.

  • How is endometriosis diagnosed?

    By clinical pattern plus specialist imaging — transvaginal ultrasound or pelvic MRI. Laparoscopy remains the gold standard when imaging is unclear or surgery is planned.

  • Why does it take so long to diagnose?

    Symptoms are often dismissed as normal period pain, and imaging misses subtle disease unless the operator is experienced in endometriosis.

  • Does an MRI show endometriosis?

    A dedicated pelvic MRI can detect endometriomas and deep infiltrating disease well. It is not perfect — superficial disease can still be missed. See our women’s pelvic MRI page for more.

  • What is a BSGE centre?

    A British Society for Gynaecological Endoscopy accredited centre — a multidisciplinary team specialising in complex endometriosis surgery, including bowel and urinary tract involvement.

  • Will hormonal treatment cure it?

    No — but continuous hormonal treatment often reduces symptoms significantly by preventing periods and quietening endometriotic tissue.

  • Do I need surgery?

    Not always. Many people manage well with analgesia and hormonal treatment. Surgery is offered when symptoms persist, fertility is affected, or deep disease is confirmed.

  • Can I still have children with endometriosis?

    Yes — many people with endometriosis conceive naturally. Fertility can be affected in some, and early advice and fertility assessment help make good choices.

  • Does endometriosis get better after menopause?

    Usually, yes — symptoms often ease when hormonal cycling stops. Some people still have discomfort, especially with adhesions from previous surgery.

  • When should I seek urgent care?

    Sudden severe pelvic pain, heavy bleeding with fainting, fever, difficulty passing urine, or severe pain in early pregnancy — urgent assessment.

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