Endometriosis is more than just “bad periods.” It’s a common but sometimes misunderstood condition affecting millions of women, most often in their 20s or 30s. It occurs when tissue similar to the lining of the uterus grows outside it — typically on the ovaries, fallopian tubes or the tissue lining the pelvis. 

The misplaced tissue thickens, breaks down and bleeds each month but has no way to exit the body. This can lead to pain, inflammation and scarring.

“Endometriosis can present in different ways, so symptoms don’t always match the extent of the disease,” says Nebraska Medicine OB-GYN Nicholas Jesse, MD. 

Symptoms of endometriosis

Endometriosis symptoms can vary, but common signs include:

• Severe cramping and painful periods that disrupt daily life.

• Chronic pelvic pain that may occur outside of menstrual cycles.

• Discomfort or pain during intercourse.

• Painful bowel movements, bloating or urinary discomfort. 

• Difficulty getting pregnant. 

“Everyone experiences endometriosis differently,” Dr. Jesse says. “Some patients with significant disease may have few symptoms, while others are severely affected.”

How endometriosis is diagnosed

Because symptoms may overlap with other conditions, diagnosing endometriosis typically requires a combination of approaches. Doctors will ask detailed questions about menstrual cycles, pain patterns and family history. 

Early recognition can prevent progression and help with fertility. A pelvic exam may be recommended to detect nodules, tenderness or endometriosis-related abnormalities. Ultrasound or MRI can help identify lesions and larger cysts called endometriomas. Smaller lesions may not appear on imaging. 

The best way to diagnose endometriosis is through minimally invasive surgery. A surgeon can visually inspect the pelvis and remove any abnormal tissue.

“We want to make sure surgery is thorough,” says Dr. Jesse. “It’s important that the surgeon looks everywhere in the abdomen and treats all visible disease, not just what’s easy to see.”

Treatment options

Treatment for endometriosis depends on symptoms, age and whether the patient wants to have children.

Along with surgery, hormonal medications are often first-line treatments because endometriosis is hormonally responsive:

• Progesterone-only treatments: Pills, injections or IUDs help suppress endometriosis tissue growth.

• Combined hormonal contraceptives: Pills, patches or vaginal rings with estrogen and progesterone can reduce pain and limit lesion growth.

• GnRH agonists: These medications create temporary menopause by blocking hormones from the brain to the ovaries, providing powerful symptom relief.

“Hormonal suppression can reduce symptoms and slow disease progression,” Dr. Jesse says. “We always weigh benefits versus side effects for each patient.”

Surgery and other options

Excision surgery removes visible endometriosis tissue. It’s minimally invasive, helps relieve pain and improves fertility. Recovery is typically two to four weeks, depending on severity and health.

“Surgery is often necessary when other treatments haven’t worked, or fertility is a concern,” Dr. Jesse explains. “Even if patients have had surgery before, we can often treat recurrent disease safely.”

For patients who still experience symptoms, these strategies may help:

• Physical therapy: Specialized pelvic exercises can relieve muscle tension and improve pain.

• Dietary changes: Anti-inflammatory diets, fiber-rich food, plant-based foods and limiting red meat and processed sugars may reduce symptoms.

• Exercise: Gradual, regular activity can improve overall pain scores and pelvic health.

• Pain management: Medications or targeted injections, including Botox or steroids, may reduce localized pain.

“Adjunct treatments can make a big difference, especially for patients who continue to experience pain after surgery or hormonal therapy,” Dr. Jesse notes.

Living with endometriosis

Even with treatment, endometriosis symptoms may return. Because it’s a chronic and often progressive condition, ongoing care for endometriosis is important. Dr. Jesse explains that patients benefit from a multidisciplinary approach that involves pain specialists, gynecologists, physical therapists and sometimes urologists. 

“This is a journey we take with each patient,” he says. “Frequent check-ins help us understand how they’re feeling and what the next step should be. Early intervention and a stepwise approach are key to improving quality of life.”

Contact your health care provider if you experience severe menstrual cramps, pain during intercourse, fertility challenges or painful bowel movements or urination.