Endometriosis

Endometriosis can cause severe pelvic pain, especially during your menstrual cycle. Left untreated, endometriosis can cause problems with fertility.

The SLUCare Physician Group's endometriosis specialty clinic is leading research to improve endometriosis treatment options. Recent studies show that complete surgical removal by skilled specialists can eliminate the disease without long-term hormone therapy.

Endometriosis affects an estimated 176 million women worldwide.1
 

What is endometriosis?

Endometriosis occurs when the endometrium, the uterus's inner lining, grows outside the uterus. It can show up on the ovaries, fallopian tubes, pelvic walls, bowel, or bladder. This condition can cause severe pelvic pain, especially during your menstrual cycle, and infertility. It affects 15-80% of women with chronic pelvic pain and 21-65% of women with infertility.1

What are the signs and symptoms of endometriosis?

The main symptoms of endometriosis are pelvic pain, adhesions, and infertility. Endometriosis pain usually happens during menstrual periods. Women with endometriosis can feel lower abdominal pain at other times too. This pain might worsen during intercourse or bowel movements.

Endometriosis may also cause:

  • Diarrhea
  • Constipation
  • Abdominal bloating
  • Irregular or excessive menstrual bleeding
  • Fatigue

Endometriosis can cause scar tissue and adhesions. This can distort a woman's internal anatomy. In advanced stages, this can become quite severe. Organs such as the uterus, ovaries, and bowel might end up attached to one another.

How is endometriosis diagnosed?

Diagnosing endometriosis can be hard. There’s no simple test for it. The best way to test endometriosis is through a surgical biopsy of the tissue.

Gynecologists can use various diagnostic tools. These include ultrasounds, MRI scans, and pelvic exams. These methods can’t confirm or rule out endometriosis. These methods can’t confirm or rule out endometriosis but they can offer clues that suggest it might be present.

How is endometriosis treated?

Endometriosis treatment includes pain medications, hormone suppression, or surgery. Pain medications and hormone therapy can ease endometriosis symptoms. Surgery is the only option that can cure the disease and return the anatomy to normal.

Our team provides surgical care for endometriosis.

At the SLUCare Physician Group endometriosis specialty clinic at SSM Health St. Mary's Hospital - St. Louis, the goal of surgery is to remove all visible endometriosis. This method can offer a cure for the disease and halt its progression. It works best when done by an experienced surgeon. Surgery for endometriosis uses a minimally invasive method called laparoscopy. This technique reduces pain after surgery, speeds up recovery, and improves cosmetic results.

Our doctors perform "see and treat" laparoscopy. This method helps us diagnose and treat endometriosis in one procedure, if we can. After surgery, several techniques help stop adhesions or scarring. These issues can cause pain and hurt your fertility.

Removal may not be better than ablation techniques, but it has several advantages:

  • The surgeon the lesion down to normal tissue, ensuring its complete removal.
  • Fewer areas can lead to adhesions.
  • The material removed is sent to pathology for a definitive diagnosis.

Common questions about endometriosis:

Many women with endometriosis can conceive, although the condition may reduce fertility. It relates to challenges in becoming pregnant. Approximately 30–40% of women with endometriosis experience infertility issues.2 Endometrial lesions can block fallopian tubes or impact ovarian function. However, with the right treatment, pregnancy is still possible.

The exact cause of endometriosis remains unknown, though hormones, genetics, immune dysfunction, and anatomical factors are likely involved.

It’s not exclusively caused by excess estrogen, but endometrial growths are hormone-sensitive—responding to estrogen and progesterone, which drive inflammation and lesion growth.1

Endometriosis is generally benign and not life-threatening. However, it can impair quality of life and cause significant health issues. Severe forms, such as deep infiltrating and ovarian endometriomas, can slightly raise the risk of ovarian cancer. However, the overall mortality remains low.2

More research is necessary to fully understand the genetic characteristics of endometriosis. If someone in your family, like a mother, sister, or daughter, has endometriosis, your risk of having it goes up.

For many women, the pain of endometriosis is debilitating and affects their lives in significant ways. For others, the pain of endometriosis is milder.

Patients with endometriosis commonly report:

  • Very painful menstrual cramps that may worsen over time
  • Chronic pain in the lower back and pelvic area
  • Deep pain during or after intercourse
  • Painful bowel movements or urination—especially during periods
  • Digestive issues including diarrhea, bloating, constipation, or nausea around menstruation
  • Pain intensity varies—some experience debilitating pain, while others have milder symptoms
  1. Pettersson, A., & Berterö, C. M. (2020). How Women with Endometriosis Experience Health Care Encounters. Women S Health Reports, 1(1), 529–542. https://doi.org/10.1089/whr.2020.0099
  2. Girard, E., Mazloum, A., Navarria-Forney, I., Pluchino, N., Streuli, I., & Cedraschi, C. (2023). Women’s lived experience of endometriosis-related fertility issues. PLoS ONE, 18(11), e0293531. https://doi.org/10.1371/journal.pone.0293531

Page reviewed by: K.Michael Schraff, MD, February 2026