View source for Endometriosis

{{Short description|Disease of the female reproductive system}}
{{Distinguish|Endometritis}}
{{Use dmy dates|date=November 2025}}
{{cs1 config |name-list-style=vanc |display-authors=6}}
{{Infobox medical condition
| name = Endometriosis
| image = Blausen 0349 Endometriosis.png
| caption = 
| field = [[Gynecology]]
| symptoms = [[Pelvic pain]], [[endometriosis and infertility|infertility]]<ref name=Bulletti2010/>
| complications = 
| onset = Unknown. The first symptoms appear before the age of 20–30 years old.<ref name="Horne2022">{{cite journal |author1-link=Andrew W. Horne | vauthors = Horne AW, Missmer SA | title = Pathophysiology, diagnosis, and management of endometriosis | journal = BMJ | volume = 379 | article-number = e070750 | date = November 2022 | pmid = 36375827 | doi = 10.1136/bmj-2022-070750 | hdl-access = free | hdl = 20.500.11820/a2c07717-cf08-4119-b0f4-b7f8aa50193e }}</ref><ref name=WH2014/><ref name="Mc2013">{{cite book| vauthors = McGrath PJ, Stevens BJ, Walker SM, Zempsky WT |title=Oxford Textbook of Paediatric Pain|date=2013|publisher=OUP Oxford|isbn=978-0-19-964265-6|page=300|url=https://books.google.com/books?id=xWyrAAAAQBAJ&pg=PA300|url-status=live|archive-url=https://web.archive.org/web/20170910181816/https://books.google.com/books?id=xWyrAAAAQBAJ&pg=PA300|archive-date=10 September 2017}}</ref>
| duration = Long term<ref name=Bulletti2010/>
| causes = Unknown<ref name=Bulletti2010/>
| risks = Family history<ref name=WH2014/>
| diagnosis = Based on symptoms, [[medical imaging]], [[tissue biopsy]]<ref name=WH2014/>
| differential = [[Pelvic inflammatory disease]], [[irritable bowel syndrome]], [[interstitial cystitis]], [[fibromyalgia]]<ref name=Bulletti2010/>
| prevention = None<ref name="WHO Fact Sheet" />
| treatment = [[NSAID]]s, continuous birth control pills, [[intrauterine device with progestogen]], surgery<ref name=WH2014/>
| medication = 
| prognosis = 
| frequency = 10–15% of all women of reproductive age<ref name="pmid29276652">{{cite journal| vauthors=Parasar P, Ozcan P, Terry KL| title=Endometriosis: Epidemiology, Diagnosis and Clinical Management |journal=Curr Obstet Gynecol Rep |year=2017 |volume=6 |issue=1 |pages=34–41 |pmid=29276652 |doi=10.1007/s13669-017-0187-1 |pmc=5737931}}</ref>
| deaths = ≈100 (0.0 to 0.1 per 100,000, 2015)<ref name=GBD2015Pre/><ref name=GBD2015De>{{cite journal |vauthors=Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal |collaboration=GBD 2015 Mortality and Causes of Death Collaborators |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |date=October 2016 |pmid=27733281 |pmc=5388903 |doi=10.1016/S0140-6736(16)31012-1}}</ref>
| alt = 
}}
<!-- Definition and symptoms -->

'''Endometriosis''' is a disease in which [[Tissue (biology)|tissue]] similar to the [[endometrium|lining of the uterus]] grows elsewhere in the body.<ref>{{cite web|url=https://www.nichd.nih.gov/health/topics/endometri/conditioninfo|title=About endometriosis|url-status=live|date=21 February 2020|archive-url=https://web.archive.org/web/20250925181242/https://www.nichd.nih.gov/health/topics/endometri/conditioninfo|archive-date=25 September 2025|publisher = [[Eunice Kennedy Shriver National Institute for Child Health and Human Development]]}}</ref> It occurs in humans and a limited number of other mammals that have a menstruation cycle, notably primates.<ref>
{{cite journal | vauthors = Braundmeier AG, Fazleabas AT | title = The non-human primate model of endometriosis: research and implications for fecundity | journal = 
Molecular Human Reproduction | volume = 15 | issue = 10 | pages = 577–586| date = 24 July 2009 |publication-date=October 2009| pmid = 19633013 | pmc = 2744471 | doi = 
10.1093/molehr/gap057|url=https://academic.oup.com/molehr/article-abstract/15/10/577/1090283?redirectedFrom=fulltext|others=The European Society of Human Reproduction and Embryology}}</ref> The tissue most often grows on or around the [[ovaries]] and [[fallopian tube]]s, on the outside surface of the uterus, or the [[peritoneum|tissues surrounding the uterus and the ovaries]].<ref name="WH2014">{{cite web |date=13 February 2017 |title=Endometriosis |url=https://www.womenshealth.gov/a-z-topics/endometriosis |url-status=live |archive-url=https://web.archive.org/web/20170513091846/https://www.womenshealth.gov/a-z-topics/endometriosis |archive-date=13 May 2017 |access-date=20 May 2017 |website=Office on Women's Health}}</ref> It can also grow on other organs in the pelvic region like the [[Gastrointestinal tract|bowels]], [[stomach]] or [[bladder]].<ref>{{cite web |title=Endometriosis |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis |access-date=11 January 2025 |website=Johns Hopkins Medicine}}</ref> Rarely, it can also occur in other parts of the body.<ref name="WH2014" />

Symptoms can be very different from person to person, varying in range and intensity. About 25% of individuals have no symptoms,<ref name="Bulletti2010" /> while for some it can be a debilitating disease.<ref>{{cite web |title=What is endometriosis? |url=https://www.endometriosis-uk.org/what-endometriosis |access-date=11 January 2025 |website=Endometriosis UK}}</ref> Common symptoms include [[pelvic pain]], [[Heavy menstrual bleeding|heavy]] and [[Dysmenorrhea|painful periods]], pain with bowel movements, [[Dysuria|painful urination]], [[Dyspareunia|pain during sexual intercourse]], and [[infertility]].<ref name="Bulletti2010">{{cite journal |vauthors=Bulletti C, Coccia ME, Battistoni S, Borini A |date=August 2010 |title=Endometriosis and infertility |journal=Journal of Assisted Reproduction and Genetics |volume=27 |issue=8 |pages=441–7 |doi=10.1007/s10815-010-9436-1 |pmc=2941592 |pmid=20574791}}</ref><ref>{{cite web |title=Endometriosis Is More Than Just 'Painful Periods' |url=https://www.yalemedicine.org/news/endometriosis-is-more-than-painful-periods |access-date=12 October 2023 |website=Yale Medicine }}</ref> Nearly half of those affected have [[chronic pelvic pain]], while 70% feel pain during [[menstruation]].<ref name="Bulletti2010" /> Up to half of affected individuals are infertile.<ref name="Bulletti2010" /> Besides physical symptoms, endometriosis can affect a person's mental health and social life.<ref name="Cul2013">{{cite journal |vauthors=Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, Raine-Fenning N |title=The social and psychological impact of endometriosis on women's lives: a critical narrative review |journal=Human Reproduction Update |volume=19 |issue=6 |pages=625–39 |date=1 November 2013 |pmid=23884896 |doi=10.1093/humupd/dmt027 |doi-access=free |title-link=doi |hdl=2086/8845 |hdl-access=free}}</ref>

<!-- Diagnosis -->
Diagnosis is usually based on symptoms and [[medical imaging]];<ref name="WH2014" /> however, a definitive diagnosis is made through [[laparoscopy]] (keyhole surgery).<ref name="WH2014" /> Other causes of similar symptoms include [[pelvic inflammatory disease]], [[irritable bowel syndrome]], [[interstitial cystitis]], and [[fibromyalgia]].<ref name="Bulletti2010" /> Endometriosis is often misdiagnosed and many patients report being incorrectly told their symptoms are trivial or normal.<ref name="Cul2013" /> Patients with endometriosis see an average of seven physicians before receiving a correct diagnosis.<ref>{{cite journal | vauthors = Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT | title = Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries | journal = Fertility and Sterility | volume = 96 | issue = 2 | pages = 366–373.e8 | date = August 2011 | pmid = 21718982 | pmc = 3679489 | doi = 10.1016/j.fertnstert.2011.05.090 }}</ref>

<!-- Epidemiology and cause -->
Worldwide, around 10% of the female population of reproductive age (190 million women) are affected by endometriosis.<ref name="WHO Fact Sheet">{{cite web |title=Endometriosis |url=https://www.who.int/news-room/fact-sheets/detail/endometriosis |access-date=11 January 2025 |website=[[World Health Organization]] (WHO) }}</ref> Asian women are more likely than [[White people|White]] women to be diagnosed with endometriosis.<ref name="zondervan32212520" /><ref name="Velarde">{{cite journal |vauthors=Velarde MC, Bucu ME, Habana MA |date=November 2023 |title=Endometriosis as a highly relevant yet neglected gynecologic condition in Asian women |journal=Endocrine Connections |volume=12 |issue=11 |pages=e230169 |doi=10.1530/EC-23-0169 |pmc=10563646 |pmid=37676242 |doi-access=free}} "Compared with Caucasian women, Asian women are more likely to be diagnosed with endometriosis (odds ratio (OR) 1.63, 95% CI 1.03–2.58) (14). Filipinos, Indians, Japanese, and Koreans are among the top Asian ethnicities who are more likely to have endometriosis than Caucasian women (17)."</ref> The exact cause of endometriosis is not known. Possible causes include problems with menstrual period flow, genetic factors, hormones, and problems with the immune system.<ref name="WH2014" /> <!-- Treatment -->

While there is no cure for endometriosis, several treatments may improve symptoms.<ref name="Bulletti2010" /> This includes [[pain medication]], hormonal treatments or surgery. The recommended pain medication is usually a [[non-steroidal anti-inflammatory drug]] (NSAID), such as [[naproxen]]. Taking the [[Combined oral contraceptive pill|birth control pill]] continuously or using a [[Hormonal intrauterine device|hormonal IUD]] (coil) is another first-line treatment. Other types of hormonal treatment can be tried if the pill or IUD are not effective.{{sfn|Solnik|Sanders|2025|p=14-15}} Surgical removal of endometriosis may be used to treat those whose symptoms are not manageable with other treatments, or to treat infertility.<ref name="WH2025" />

{{TOC limit}}

== Subtypes ==
[[File:Perforierte Endometriosezyste.jpg|thumb|Endoscopic image of a ruptured endometrioma (''chocolate cyst'') in left ovary]]
Endometriosis can be subdivided into four categories:<ref name=":7" />

Superficial peritoneal endometriosis
: Small spots of endometriosis grow on the surface layer that covers the organs inside the abdomen or pelvis (the [[peritoneum]])
Deep infiltrating endometriosis
: Lesions grow into the tissue beneath the lining of the pelvis or into the muscle layers of pelvic organs like the bowel, bladder, or ureter
Endometriomas (ovarian)
: Cysts that grow in the ovaries
Extrapelvic endometriosis
: Lesions outside of the pelvic regions, such as in the lungs or [[Thoracic diaphragm|diaphragm]]

Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as [[endometrioma]]s or "chocolate cysts"; "chocolate" because they contain a thick brownish fluid, mostly old blood.<ref name="pmid20436318">{{cite journal |vauthors=Hsu AL, Khachikyan I, Stratton P |date=June 2010 |title=Invasive and noninvasive methods for the diagnosis of endometriosis |journal=Clin Obstet Gynecol |volume=53 |issue=2 |pages=413–9 |doi=10.1097/GRF.0b013e3181db7ce8 |pmc=2880548 |pmid=20436318}}</ref>

Endometriosis most commonly affects the [[Ovary|ovaries]], the [[fallopian tube]]s between the ovaries and the womb, the outer surface of the [[Uterus|womb]] and the tissues that hold the womb in place. Less common pelvic sites are the [[rectum]], [[bladder]], [[bowel]], [[vulva]], [[vagina]] and [[cervix]]<ref name="WH2025">{{cite web |date=24 October 2025 |title=Endometriosis |url=https://www.womenshealth.gov/a-z-topics/endometriosis |url-status=live |archive-url=https://web.archive.org/web/20250926224728/https://womenshealth.gov/a-z-topics/endometriosis |archive-date=26 September 2025 |access-date=31 October 2025 |website=Office on Women's Health}}</ref> Deep infiltrating endometriosis occurs when endometriosis grows more than 5&nbsp;mm beneath the peritoneal surface.<ref name="Van den Bosch Van Schoubroeck 2018 pp. 16–24" /> It can infiltrate the muscles around organs.<ref name=":7" /> The prevalence of deep infiltrating endometriosis is estimated to be 1–2% in women of reproductive age.<ref name="Van den Bosch Van Schoubroeck 2018 pp. 16–24">{{cite journal |vauthors=Van den Bosch T, Van Schoubroeck D |date=August 2018 |title=Ultrasound diagnosis of endometriosis and adenomyosis: State of the art |url=https://lirias.kuleuven.be/handle/123456789/621035 |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=51 |pages=16–24 |doi=10.1016/j.bpobgyn.2018.01.013 |pmid=29506961 |s2cid=3759091 |url-access=subscription}}</ref> Deep endometriosis often looks like nodules, and can include [[fibrosis]] and [[Adhesion (medicine)|adhesions]].<ref name=":7" />

Rarely, endometriosis appears in outside of the pelvis, such as the lungs, brain, and [[skin]].<ref name="WH2025" /> Diaphragmatic endometriosis is rare, almost always on the right hemidiaphragm, and may cause the cyclic pain of the right shoulder or neck during a menstrual period.<ref name="Andres2020p373">{{cite journal |vauthors=Andres MP, Arcoverde FV, Souza CC, Fernandes LF, Abrão MS, Kho RM |date=February 2020 |title=Extrapelvic Endometriosis: A Systematic Review |journal=[[Journal of Minimally Invasive Gynecology]] |volume=27 |issue=2 |pages=373–389 |doi=10.1016/j.jmig.2019.10.004 |pmid=31618674 |doi-access=free |title-link=doi}}</ref> Scar endometriosis can rarely form on the abdominal wall as a complication of [[surgery]], most often following a [[Caesarean section|ceasarean section]] or other pelvic surgery.<ref>{{cite journal |last=Gruber |first=T. M. |last2=Lange |first2=K. |last3=Ebeling |first3=G. S. |last4=Henrich |first4=W. |last5=Mechsner |first5=S. |date=2025 |title=Scar endometriosis, a form of abdominal wall endometriosis–a neglected obstetrical complication? |journal=Archives of Gynecology and Obstetrics |volume=312 |issue=1 |pages=1–8 |doi=10.1007/s00404-024-07834-2 |issn=1432-0711 |pmc=12176990 |pmid=39607442}}</ref>

==Signs and symptoms==
Pain and infertility are common symptoms, although 20–25% of affected women are asymptomatic.<ref name=Bulletti2010/> The presence of pain symptoms is associated with the type of endometrial lesions, as 50% of women with typical (peritoneal) lesions, 10% of women with cystic ovarian lesions, and 5% of women with deep endometriosis do not have pain.<ref name="Koninckx Ussia Mashiach Vilos 2021 pp. 1035–1036">{{cite journal | vauthors = Koninckx PR, Ussia A, Mashiach R, Vilos G, Martin DC | title = Endometriosis Can Cause Pain at a Distance | journal = Journal of Obstetrics and Gynaecology Canada | volume = 43 | issue = 9 | pages = 1035–1036 | date = September 2021 | pmid = 34481578 | doi = 10.1016/j.jogc.2021.06.002 | publisher = Elsevier BV | s2cid = 237422801 | doi-access = free | title-link = doi }}</ref>

===Pelvic pain===
A major symptom of endometriosis is recurring pelvic pain. The pain can range from mild to severe cramping or stabbing pain that occurs on both sides of the [[pelvis]], in the lower back and rectal area, and even down the legs. The amount of pain a person feels correlates weakly with the extent or stage (1 through 4) of endometriosis, with some individuals having little or no pain despite having extensive endometriosis or endometriosis with scarring, while others may have severe pain even though they have only a few small areas of endometriosis.<ref name="Stratton2011">{{cite journal | vauthors = Stratton P, Berkley KJ | title = Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications | journal = Human Reproduction Update | volume = 17 | issue = 3 | pages = 327–46 | year = 2011 | pmid = 21106492 | pmc = 3072022 | doi = 10.1093/humupd/dmq050 }}</ref> The most severe pain is typically associated with menstruation. Pain can also start a week before a menstrual period, during, and even a week after a menstrual period, or it can be constant. The pain can be debilitating and result in emotional stress.<ref>{{cite journal|vauthors=Colette S, Donnez J|date=July 2011|title=Are aromatase inhibitors effective in endometriosis treatment?|journal=Expert Opinion on Investigational Drugs|volume=20|issue=7|pages=917–31|doi=10.1517/13543784.2011.581226|pmid=21529311|s2cid=19463907}}</ref> Symptoms of endometriosis-related pain may include:
* [[Dysmenorrhea]] (64%)<ref name="ovarianendo">{{cite journal | vauthors = Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A | title = Ovarian endometrioma - a possible finding in adolescent girls and young women: a mini-review | journal = Journal of Ovarian Research | volume = 12 | issue = 1 | article-number = 104 | date = November 2019 | pmid = 31699129 | pmc = 6839067 | doi = 10.1186/s13048-019-0582-5 | doi-access = free | title-link = doi }}[[File:CC-BY icon.svg|50px]] Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=16 October 2017 }}.</ref> – painful, sometimes disabling cramps during the menstrual period; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
* Chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
* Dyspareunia – painful [[sexual intercourse]]
* [[Dysuria|Painful urination]] during period<ref name="NIH">{{cite web|url=https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms|title=What are the symptoms of endometriosis?|author=<!--Not stated-->|website=National Institutes of Health|access-date=4 October 2018|archive-date=27 January 2021|archive-url=https://web.archive.org/web/20210127204323/https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms|url-status=live}}</ref>
* [[Mittelschmerz]] – pain associated with ovulation<ref>{{cite journal | vauthors = Brown J, Farquhar C | title = Endometriosis: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD009590 | date = March 2014 | volume = 2014 | pmid = 24610050 | doi = 10.1002/14651858.cd009590.pub2 | pmc = 6984415 }}</ref>

Compared with patients with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of their insides being pulled down.<ref name="Ballard">{{cite journal | vauthors = Ballard K, Lane H, Hudelist G, Banerjee S, Wright J | title = Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain | journal = Fertility and Sterility | volume = 94 | issue = 1 | pages = 20–7 | date = June 2010 | pmid = 19342028 | doi = 10.1016/j.fertnstert.2009.01.164 | doi-access = free | title-link = doi }}</ref> Individual pain areas and intensity appear to be unrelated to the surgical diagnosis, and the area of pain is unrelated to the area of endometriosis.<ref name=Ballard/>

===Infertility===
{{Main|Endometriosis and infertility}}

About a third of women with infertility have endometriosis.<ref name=Bulletti2010/> Among those with endometriosis, about 40% are infertile.<ref name=Bulletti2010/> The [[pathogenesis]] of infertility varies by disease stage: in early-stage disease, it is hypothesised to result from an inflammatory response that impairs various aspects of conception, whereas in later stages, distorted pelvic anatomy and adhesions contribute to impaired fertilisation.<ref>{{cite web|url=https://www.uptodate.com/contents/treatment-of-infertility-in-women-with-endometriosis|title=Treatment of infertility in women with endometriosis|website=uptodate.com|access-date=18 December 2017|archive-date=8 August 2020|archive-url=https://web.archive.org/web/20200808155241/https://www.uptodate.com/contents/treatment-of-infertility-in-women-with-endometriosis|url-status=live}}</ref>

===Other===
Bowel endometriosis may include symptoms like [[diarrhea]], [[constipation]], [[Rectal tenesmus|tenesmus]], [[dyschezia]], and, rarely, [[rectal bleeding]]. Other symptoms include [[Fatigue#Chronic|chronic fatigue]], [[nausea]] and [[vomiting]], [[migraines]], low-grade [[fevers]], [[Heavy menstrual bleeding|heavy]] (44%) and/or [[irregular periods]] (60%), and [[hypoglycemia]].<ref name="ovarianendo"/><ref>{{cite journal | vauthors = Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A | title = Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team | journal = World Journal of Gastroenterology | volume = 20 | issue = 42 | pages = 15616–23 | date = November 2014 | pmid = 25400445 | pmc = 4229526 | doi = 10.3748/wjg.v20.i42.15616 | doi-access = free | title-link = doi }}</ref><ref name="NIH" />  Endometriosis may also affect the nearby colon, which in rare situations may progress to partial [[Bowel obstruction|obstruction]], requiring emergency surgery.<ref>{{cite journal | vauthors = Sarofim M, Attwell-Heap A, Trautman J, Kwok A, Still A | title = Unusual case of acute large bowel obstruction: endometriosis mimicking sigmoid malignancy | journal = ANZ Journal of Surgery | volume = 89 | issue = 11 | pages = E542–E543 | date = November 2019 | pmid = 30277298 | doi = 10.1111/ans.14869 | s2cid = 52902719 }}</ref>

[[Thoracic endometriosis]] occurs when endometrium-like tissue implants in the [[lung]]s or [[pleura]] around the lungs. When it occurs in the lungs, common signs and symptoms are [[hemoptysis|blood discharge from the lungs]] during menstruation and nodules which become bigger during menstruation. When it is found in the pleura, symptoms may be a [[pneumothorax|collapsed lung]] during or outside of menstruation and [[hemothorax|bleeding into the pleural space]]. Further symptoms are a cyclical cough and cyclical shoulder pain. Most often, the endometriosis is found in the right lung.{{sfn|ESHRE|2022|p=149}}

Stress may be a contributing factor or a consequence of endometriosis.<ref name=stress>{{cite journal |vauthors=Reis FM, Coutinho LM, Vannuccini S, Luisi S, Petraglia F |title=Is Stress a Cause or a Consequence of Endometriosis? |journal=Reproductive Sciences |volume=27 |issue=1 |pages=39–45 |date=January 2020 |pmid=32046437 |doi=10.1007/s43032-019-00053-0 |s2cid=209896867}}</ref>

===Complications===

==== Physical health ====

Ovarian endometriosis may complicate [[pregnancy]] through [[decidualization]], abscess formation, and/or rupture.<ref name="Ueda">{{cite journal | vauthors = Ueda Y, Enomoto T, Miyatake T, Fujita M, Yamamoto R, Kanagawa T, Shimizu H, Kimura T |date=June 2010 |title=A retrospective analysis of ovarian endometriosis during pregnancy |journal=Fertility and Sterility |volume=94 |issue=1 |pages=78–84 |pmid=19356751 |doi=10.1016/j.fertnstert.2009.02.092 |doi-access=free |title-link=doi}}</ref> Women with endometriosis also face a significantly increased risk of experiencing [[Antepartum bleeding|ante-]] and [[Postpartum bleeding|postpartum hemorrhage]]<ref name="ESHRE2015">{{cite web |date=2015 |title=ESHRE2015: Endometriosis associated with a greater risk of complications in pregnancy |url=https://endometriosis.org/news/congress-highlights/eshre2015-endometriosis-associated-with-a-greater-risk-of-complications-in-pregnancy/#:~:text=After%20adjustments%20for%20age%20and%20previous%20pregnancy%2C%20results,three%20times%20higher%20for%20ectopic%20pregnancy%20%28OR%202.7%29 |url-status=live |archive-url=https://web.archive.org/web/20240213213247/https://endometriosis.org/news/congress-highlights/eshre2015-endometriosis-associated-with-a-greater-risk-of-complications-in-pregnancy/#:~:text=After%20adjustments%20for%20age%20and%20previous%20pregnancy%2C%20results,three%20times%20higher%20for%20ectopic%20pregnancy%20%28OR%202.7%29 |archive-date=13 February 2024 |access-date=14 February 2024 |website=endometriosis.org |publisher=European Society of Human Reproduction and Embryology |vauthors=Saraswat L}}</ref> as well as a 170% increased risk of severe [[pre-eclampsia]]<ref name="PMID28181672" /> during pregnancy. Endometriosis can also impact a woman's [[fetus]] or [[neonate]], increasing the risks for [[congenital malformations]], [[Preterm birth|preterm delivery]], and higher [[Perinatal mortality|neonatal death]] rates.<ref name="PMID28181672">{{cite journal | vauthors = Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø | title = Endometriosis increases the risk of obstetrical and neonatal complications | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 96 | issue = 6 | pages = 751–760 | date = June 2017 | pmid = 28181672 | doi = 10.1111/aogs.13111 }}</ref>

Sciatic endometriosis, also called catamenial or cyclical sciatica, is a rare form where endometriosis affects the sciatic nerve. Diagnosis is usually confirmed through [[Magnetic resonance imaging|MRI]] or [[CT-myelography]].<ref name="Gandhi Wilson Liang Weissbart pp. 3–9">{{cite journal | vauthors = Gandhi J, Wilson AL, Liang R, Weissbart SJ, Khan SA | title=Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition | journal=Journal of Endometriosis and Pelvic Pain Disorders | publisher=SAGE Publications | volume=13 | issue=1 | date=11 November 2020 | issn=2284-0265 | doi=10.1177/2284026520970813 | pages=3–9| s2cid=228834273 }}</ref>

A 20-year study involving 12,000 women with endometriosis found that individuals under 40 are three times more likely to develop heart problems compared to their healthy peers.<ref>{{cite journal |vauthors=Wise J |title=Women with endometriosis show higher risk for heart disease |journal=BMJ |volume=353 |article-number=i1851 |date=April 2016 |pmid=27036948 |doi=10.1136/bmj.i1851 |s2cid=28699291}}</ref>

Endometriosis increases the risk of developing ovarian and thyroid cancers compared to women without the condition, and slightly increases the risk of breast cancer.<ref name="Kvaskoff Mahamat-Saleh Farland Shigesi pp. 393–420">{{cite journal | vauthors = Kvaskoff M, Mahamat-Saleh Y, Farland LV, Shigesi N, Terry KL, Harris HR, Roman H, Becker CM, As-Sanie S, Zondervan KT, Horne AW, Missmer SA | title = Endometriosis and cancer: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 27 | issue = 2 | pages = 393–420 | date = February 2021 | pmid = 33202017 | doi = 10.1093/humupd/dmaa045 | publisher = Oxford University Press (OUP) | hdl = 20.500.11820/fa3c779d-3cc7-4d0d-b93a-d7176fd8244d | hdl-access = free }}</ref>

The mortality rates associated with endometriosis are low, with unadjusted and age-standardized death rates of 0.1 and 0.0 per 100,000, respectively.<ref name="GBD2015Pre">{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | title-link = doi | doi-access = free }}</ref>

==== Mental health ====
"Endometriosis is associated with an elevated risk of developing depression and anxiety disorders".<ref>{{cite journal | vauthors = Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH | title = Health-related quality of life in women with endometriosis: a systematic review | journal = Journal of Ovarian Research | volume = 5 | issue = 1 | article-number = 29 | date = October 2012 | pmid = 23078813 | pmc = 3507705 | doi = 10.1186/1757-2215-5-29 | title-link = doi | doi-access = free }}</ref> Studies suggest this is partially due to the pelvic pain experienced by endometriosis patients. {{blockquote| "It has been demonstrated that pelvic pain has significant negative effects on women's mental health and quality of life; in particular, women who suffer from pelvic pain report high levels of anxiety and depression, loss of working ability, limitations in social activities and a poor quality of life" <ref>{{cite journal | vauthors = Low WY, Edelmann RJ, Sutton C | title = A psychological profile of endometriosis patients in comparison to patients with pelvic pain of other origins | journal = Journal of Psychosomatic Research | volume = 37 | issue = 2 | pages = 111–116 | date = February 1993 | pmid = 8463987 | doi = 10.1016/0022-3999(93)90077-S }}</ref>
}}
Mental health concerns like depression and anxiety can also result due to poor diagnostic procedures related to cultural norms where women's concerns are devalued or ignored, especially by medical professionals.<ref>Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. (1 November 2013). "The social and psychological impact of endometriosis on women's lives: a critical narrative review". Human Reproduction Update. 19 (6): 625–39. doi:10.1093/humupd/dmt027. hdl:2086/8845. PMID 23884896.</ref><ref>Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. (August 2011). "Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries". Fertility and Sterility. 96 (2): 366–373.e8. doi:10.1016/j.fertnstert.2011.05.090. PMC 3679489. PMID 21718982.</ref>

==Risk factors==
===Genetics===
Endometriosis is a [[Genetic disorder|heritable condition]] influenced by both genetic and [[environmental factor]]s,<ref name="Fauser2011">{{cite journal |vauthors=Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, Howles CM |year=2011 |title=Contemporary genetic technologies and female reproduction |journal=Human Reproduction Update |volume=17 |issue=6 |pages=829–47 |doi=10.1093/humupd/dmr033 |pmc=3191938 |pmid=21896560}}</ref> a genetic disorder of [[Quantitative trait locus#Quantitative traits|polygenic/multifactorial inheritance]]<ref name="GOE-2004">{{cite journal | vauthors = Bischoff F, Simpson JL | title = Genetics of endometriosis: heritability and candidate genes | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 18 | issue = 2 | pages = 219–232 | date = April 2004 | pmid = 15157639 | doi = 10.1016/j.bpobgyn.2004.01.004 }}</ref> acquired via affected genes from either [[First-degree relative|a person's father or mother]]. For example, children or siblings of women with endometriosis are at higher risk of developing endometriosis themselves; low [[progesterone]] levels may be genetic, and may contribute to a hormone imbalance.<ref>{{cite web | last=Davila | first=G Willy | title=Endometriosis: Practice Essentials, Background, Pathophysiology | website=Medscape Reference | date=18 July 2023 | url=https://emedicine.medscape.com/article/271899-overview | access-date=3 November 2025}}</ref> Individuals with an affected first-degree relative have an approximate six-fold increase incidence of endometriosis.<ref>{{cite journal | vauthors = Giudice LC, Kao LC | title = Endometriosis | journal = Lancet | volume = 364 | issue = 9447 | pages = 1789–1799 | year = 2004 | pmid = 15541453 | doi = 10.1016/S0140-6736(04)17403-5 | s2cid = 208788714 }}</ref>

Inheritance is significant but not the sole risk factor for endometriosis. Studies attribute 50% of the risk to genetics, the other 50% to environmental factors.<ref name="Montgomery2020">{{cite journal | vauthors = Montgomery GW, Mortlock S, Giudice LC | title = Should Genetics Now Be Considered the Pre-eminent Etiologic Factor in Endometriosis? | journal = [[Journal of Minimally Invasive Gynecology]] | volume = 27 | issue = 2 | pages = 280–286 | date = February 2020 | pmid = 31683028 | pmc = 7863762 | doi = 10.1016/j.jmig.2019.10.020 }}</ref> It has been proposed that endometriosis may result from multiple mutations within target genes, in a mechanism similar to the development of cancer.<ref name=Fauser2011/> In this case, the mutations may be either [[Somatic mutation|somatic]] or [[Heritability|heritable]].<ref name=Fauser2011/>

A 2019 [[genome-wide association study]] (GWAS) review enumerated 36 genes with mutations associated with endometriosis development.<ref name="Vassilopoulou2019">{{cite journal | vauthors = Vassilopoulou L, Matalliotakis M, Zervou MI, Matalliotaki C, Krithinakis K, Matalliotakis I, Spandidos DA, Goulielmos GN | title = Defining the genetic profile of endometriosis | journal = Experimental and Therapeutic Medicine | volume = 17 | issue = 5 | pages = 3267–3281 | date = May 2019 | pmid = 30988702 | pmc = 6447774 | doi = 10.3892/etm.2019.7346 }}</ref> Nine [[Locus (genetics)|chromosome loci]] were robustly replicated:<ref>{{cite journal | vauthors = Rahmioglu N, Nyholt DR, Morris AP, Missmer SA, Montgomery GW, Zondervan KT | title = Genetic variants underlying risk of endometriosis: insights from meta-analysis of eight genome-wide association and replication datasets | journal = Human Reproduction Update | volume = 20 | issue = 5 | pages = 702–716 | date = September 2014 | pmid = 24676469 | pmc = 4132588 | doi = 10.1093/humupd/dmu015 }}</ref><ref name="Gene94025">{{cite web|url=https://www.ncbi.nlm.nih.gov/gene/94025|title=MUC16 mucin 16, cell surface associated [Homo sapiens (human)] - Gene - NCBI|website=ncbi.nlm.nih.gov|access-date=13 November 2018|archive-date=13 November 2018|archive-url=https://web.archive.org/web/20181113225150/https://www.ncbi.nlm.nih.gov/gene/94025|url-status=live}}</ref><ref name="Gene2335">{{cite web|url=https://www.ncbi.nlm.nih.gov/gene/2335|title=FN1 fibronectin 1 [Homo sapiens (human)] - Gene - NCBI|website=ncbi.nlm.nih.gov|access-date=13 November 2018|archive-date=8 June 2019|archive-url=https://web.archive.org/web/20190608083214/https://www.ncbi.nlm.nih.gov/gene/2335|url-status=live}}</ref><ref name="Sapkota Steinthorsdottir Morris Fassbender p.">{{cite journal | vauthors = Sapkota Y, Steinthorsdottir V, Morris AP, Fassbender A, Rahmioglu N, De Vivo I, Buring JE, Zhang F, Edwards TL, Jones S, O D, Peterse D, Rexrode KM, Ridker PM, Schork AJ, MacGregor S, Martin NG, Becker CM, Adachi S, Yoshihara K, Enomoto T, Takahashi A, Kamatani Y, Matsuda K, Kubo M, Thorleifsson G, Geirsson RT, Thorsteinsdottir U, Wallace LM, Yang J, Velez Edwards DR, Nyegaard M, Low SK, Zondervan KT, Missmer SA, D'Hooghe T, Montgomery GW, Chasman DI, Stefansson K, Tung JY, Nyholt DR | title = Meta-analysis identifies five novel loci associated with endometriosis highlighting key genes involved in hormone metabolism | journal = Nature Communications | volume = 8 | issue = 1 | article-number = 15539 | date = May 2017 | pmid = 28537267 | pmc = 5458088 | doi = 10.1038/ncomms15539 | publisher = Springer Science and Business Media LLC | bibcode = 2017NatCo...815539S }}</ref>
{| class="wikitable"
|-
!Chromosome
!Gene/cytoband
!Gene Product
!Function
|-
|1
|''[[WNT4]]''/1p36.12
|Wingless-type MMTV integration site family member 4
|Vital for the development of the female reproductive organs
|-
|2
|''[[GREB1]]''/2p25.1
|Growth regulation by [[estrogen]] in [[breast cancer]] 1/Fibronectin 1
|Early response gene in the estrogen regulation pathway/Cell adhesion and migration processes
|-
|2
|''ETAA1''/2p14
|(ETAA1 Activator Of ATR Kinase) is a protein-coding gene.
|Diseases associated with ETAA1 include Adult [[Lymphoma]] and [[Restless legs syndrome|Restless Legs Syndrome]]
|-
|2
|''IL1A''/2q13
|[[Interleukin 1 alpha]] (IL-1α) is encoded by the ''IL1A'' gene.
|Interleukin 1 alpha (IL-1α) is encoded by the ''IL1A'' gene.
|-
|4
|''KDR''/4q12
|''KDR'' is the human gene encoding [[kinase insert domain receptor]], also known as vascular endothelial growth factor receptor 2 (VEGFR-2)
|Primary mediator of [[VEGF receptor|VEGF-induced]] [[Endothelium|endothelial]] proliferation, survival, migration, tubular morphogenesis and sprouting<ref>{{cite web |title=GeneCards®: The Human Gene Database |url=https://www.genecards.org/cgi-bin/carddisp.pl?gene=KDR&keywords=kdr |website=www.genecards.org |publisher=Weizmann Institute of Science |access-date=7 February 2024 |archive-date=7 February 2024 |archive-url=https://web.archive.org/web/20240207163420/https://www.genecards.org/cgi-bin/carddisp.pl?gene=KDR&keywords=kdr |url-status=live }}</ref>
|-
|6
|''[[ID4]]''/6p22.3
|Inhibitor of DNA binding 4
|Ovarian oncogene, biological function unknown
|-
|7
|7p15.2
|[[Transcription factor]]s
|Influence transcriptional regulation of uterine development
|-
|9
|''[[CDKN2BAS]]''/9p21.3
|Cyclin-dependent kinase inhibitor 2B antisense RNA
|Regulation of tumour suppressor genes
|-
|12
|''[[VEZT]]''/12q22
|Vezatin, an adherens junction transmembrane protein
|Tumor suppressor gene
|}
There are many findings of altered [[gene expression]] and [[epigenetics]], but both of these can also be a secondary result of, for example, environmental factors and altered metabolism. Examples of altered gene expression include that of [[miRNA]]s.<ref name=Fauser2011/>

===Environmental toxins===

Some factors associated with endometriosis include:
* Prolonged exposure to naturally synthesized estrogen; for example, from late [[menopause]]<ref name="Clinical practice. Endometriosis">{{cite journal | vauthors = Giudice LC | title = Clinical practice. Endometriosis | journal = The New England Journal of Medicine | volume = 362 | issue = 25 | pages = 2389–98 | date = June 2010 | pmid = 20573927 | pmc = 3108065 | doi = 10.1056/NEJMcp1000274 }}</ref> or early [[menarche]]<ref>{{cite journal | vauthors = Treloar SA, Bell TA, Nagle CM, Purdie DM, Green AC | title = Early menstrual characteristics associated with subsequent diagnosis of endometriosis | journal = American Journal of Obstetrics and Gynecology | volume = 202 | issue = 6 | pages = 534.e1–6 | date = June 2010 | pmid = 20022587 | doi = 10.1016/j.ajog.2009.10.857 }}</ref><ref>{{cite journal | vauthors = Nnoaham KE, Webster P, Kumbang J, Kennedy SH, Zondervan KT | title = Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of&nbsp;case-control studies | journal = Fertility and Sterility | volume = 98 | issue = 3 | pages = 702–712.e6 | date = September 2012 | pmid = 22728052 | pmc = 3502866 | doi = 10.1016/j.fertnstert.2012.05.035 }}</ref>
* Obstruction of menstrual outflow; for example, in [[Müllerian anomalies]]<ref name="Clinical practice. Endometriosis"/>

Potential [[toxin]]s:
* [[Dioxins and dioxin-like compounds|Dioxins]] - Several studies have investigated the potential link between exposure to dioxins and endometriosis, but evidence is equivocal, and potential mechanisms are poorly understood.<ref name="pmid17981650">{{cite journal | vauthors = Anger DL, Foster WG | title = The link between environmental toxicant exposure and endometriosis | journal = Frontiers in Bioscience | volume = 13 | issue = 13| pages = 1578–93 | date = January 2008 | pmid = 17981650 | doi = 10.2741/2782 | s2cid = 12813384 | doi-access = free | title-link = doi }}</ref> A 2004 review of studies of dioxin and endometriosis concluded that "the human data supporting the dioxin-endometriosis association are scanty and conflicting",<ref>{{cite journal | vauthors = Guo SW | title = The link between exposure to dioxin and endometriosis: a critical reappraisal of primate data | journal = Gynecologic and Obstetric Investigation | volume = 57 | issue = 3 | pages = 157–73 | year = 2004 | pmid = 14739528 | doi = 10.1159/000076374 | s2cid = 29701466 }}</ref> and a 2009 follow-up review also found that there was "insufficient evidence" in support of a link between dioxin exposure and developing endometriosis.<ref>{{cite journal | vauthors = Guo SW, Simsa P, Kyama CM, Mihályi A, Fülöp V, Othman EE, D'Hooghe TM | title = Reassessing the evidence for the link between dioxin and endometriosis: from molecular biology to clinical epidemiology | journal = Molecular Human Reproduction | volume = 15 | issue = 10 | pages = 609–24 | date = October 2009 | pmid = 19744969 | doi = 10.1093/molehr/gap075 | doi-access = free | title-link = doi }}</ref>
* [[Endocrine disruptor#Types|Endocrine-disrupting chemicals (EDCs)]]- A wider class of hormonally active agents, to which dioxin belongs, consists of both natural and manmade compounds, e.g., bisphenols, [[phthalates]], pesticides ([[chlorpyrifos]], [[hexachlorobenzene]]) and [[polychlorinated biphenyl]]s (PCBs).<ref name="Ahn-2023">{{cite journal | vauthors = Ahn C, Jeung EB | title = Endocrine-Disrupting Chemicals and Disease Endpoints | journal = International Journal of Molecular Sciences | volume = 24 | issue = 6 | page = 5342 | date = March 2023 | pmid = 36982431 | pmc = 10049097 | doi = 10.3390/ijms24065342 | doi-access = free }}</ref> Dietary uptake represents a significant source of EDC exposure via consumption of food, water and beverages, but exposure can also occur through ingestion of EDC dust and inhalation of its gases or particles in the air.<ref name="Ahn-2023" /> Most EDCs are [[Lipophilicity|lipophilic]], allowing them to [[Bioaccumulation|bioaccumulate]] in [[adipose tissue]] (body fat) and increase in concentration.<ref name="Rumph2020" /> [[Bisphenol A]] (BPA), [[bisphenol S]] (BPS), [[phthalate]]s, [[pesticide]]s and [[Polychlorinated biphenyl|PCBs]] all have a suspected linkage to endometriosis,<ref name="Ahn-2023" /> though have not been definitively proven as being causative.<ref name="Rumph2020">{{cite book | vauthors = Rumph JT, Stephens VR, Archibong AE, Osteen KG, Bruner-Tran KL | chapter = Environmental Endocrine Disruptors and Endometriosis | title = Advances in Anatomy, Embryology, and Cell Biology | volume = 232 | pages = 57–78 | date = 2020 | pmid = 33278007 | pmc = 7978485 | doi = 10.1007/978-3-030-51856-1_4 | isbn = 978-3-030-51855-4 | series = Advances in Anatomy, Embryology and Cell Biology }}</ref>

===Autoimmune and autoinflammatory conditions===
Endometriosis patients show a significantly increased risk of autoimmune, autoinflammatory, and mixed-pattern psoriatic diseases, with two studies in 2025 pointing to the connection. One of the studies suggested that the chances of receiving a diagnosis of at least one of the autoimmune conditions for those with endometriosis was around twice that of a control cohort. The linked conditions include rheumatoid arthritis, multiple sclerosis, coeliac disease, osteoarthritis, and psoriasis. This reinforces the view that there is a genetic correlation between endometriosis and osteoarthritis, rheumatoid arthritis, and multiple sclerosis (MS), and a potential causal link to rheumatoid arthritis. The work suggests a shared biological basis between endometriosis on one side, and autoimmune and autoinflammatory diseases, on the other. This suggests that certain autoimmunne treatment pathways could be repurposed to provided alternative therapy options for those with endometriosis.<ref name="NewScienceClark">{{cite journal |last1=Clark |first1=Lauren |date=22 September 2025 |title=A deeper understanding of endometriosis is suggesting new treatments |url=https://www.newscientist.com/article/2496240-a-deeper-understanding-of-endometriosis-is-suggesting-new-treatments/ |journal=New Scientist |issue=3562 |publisher=New Scientist Ltd |publication-date=27 September 2025|location=London|url-access=subscription
|archive-url=https://web.archive.org/web/20250927134949/https://www.newscientist.com/article/2496240-a-deeper-understanding-of-endometriosis-is-suggesting-new-treatments/
|archive-date=27 September 2025|url-status=live
|issn=0262-4079 |access-date=29 September 2025}}</ref><ref name="Shigesi">
{{cite journal | vauthors = Shigesi N, Harris H, Fang H, Ndungu A, Lincoln M, Cotsapas C, Knight J, Missmer S, Morris A, Becker C, Rahmioglu N, Zondervan, K | title = The phenotypic and genetic association between endometriosis and immunological diseases | journal = Human Reproduction| volume = 40 | issue = 6 | pages = 1195–1209| date = April 2025 | pmid = 40262193 | pmc = 12127507 | doi = 10.1093/humrep/deaf062|others=The International Endometriosis Genome Consortium and the 23andMe Research Team|url=https://academic.oup.com/humrep/article/40/6/1195/8117905?login=false}}
</ref><ref name="AzizBeaton">
{{cite journal | vauthors = Aziz M, Beaton M, Aziz M, Opoku-Anane J, Elhadad N | title = Endometriosis and autoimmunity: a large-scale case-control study of endometriosis and 10 distinct autoimmune diseases | journal = npj Women's Health| volume = 3 | issue = 1 | article-number = 36|date = 18 June 2025|pmid = 40547362 | pmc = 12176652 |doi=10.1038/s44294-025-00086-8 }}</ref>

==Mechanism==
[[File:Characteristics_of_endometriosis.webp|thumb|upright=1.3|Six characteristics of endometriosis: estrogen dependency, retrograde menstruation, angiogenesis, local inflammation, oxidative stress and stem cells]]
While the exact cause of endometriosis remains unknown, many theories have been presented to understand and explain its development. These concepts do not necessarily exclude each other. The [[pathophysiology]] of endometriosis is likely to be [[Multifactorial disease|multifactorial]] and to involve an interplay between several factors.<ref name="Fauser2011" />

===Formation===
The main theories for the formation of the ectopic endometrium-like tissue include retrograde menstruation, Müllerianosis, coelomic metaplasia, vascular dissemination of [[stem cell]]s, and surgical transplantation, which were postulated as early as 1870. Each is further described below.<ref name="zondervan32212520" /><ref name="vanderLinden1996">{{cite journal | vauthors = van der Linden PJ | title = Theories on the pathogenesis of endometriosis | journal = Human Reproduction | volume = 11 | issue = Suppl 3 | pages = 53–65 | date = November 1996 | pmid = 9147102 | doi = 10.1093/humrep/11.suppl_3.53 | doi-access = free | title-link = doi }}</ref><ref name="hufnagelpmc4986990">{{cite journal | vauthors = Hufnagel D, Li F, Cosar E, Krikun G, Taylor HS | title = The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis | journal = Seminars in Reproductive Medicine | volume = 33 | issue = 5 | pages = 333–40 | date = September 2015 | pmid = 26375413 | pmc = 4986990 | doi = 10.1055/s-0035-1564609 }}</ref>

====Retrograde menstruation theory====
During [[menstruation]], some menstrual blood, tissue, and fluid can flow backward through the fallopian tubes into the pelvic area (the [[peritoneal cavity]]). This backward flow (called retrograde menstruation) is thought to be the main reason why endometriosis develops inside the pelvic cavity. However, this explanation alone is not enough, because almost all women have some backward flow of menstrual fluid, but only some of them develop endometriosis.<ref name="Horne2022" />

Evidence in support of the theory are based on retrospective epidemiological studies that an association with endometrial implants attached to the peritoneal cavity, which would develop into endometrial lesions and retrograde menstruation; and the fact that animals like rodents and non-human primates whose endometrium is not shed during the estrous cycle don't produce naturally endometriosis contrary to animals that have a natural menstrual cycle like rhesus monkeys and baboons.<ref name="Malvezzi Marengo Podgaec Piccinato p.">{{cite journal | vauthors = Malvezzi H, Marengo EB, Podgaec S, Piccinato CA | title = Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology | journal = Journal of Translational Medicine | volume = 18 | issue = 1 | article-number = 311 | date = August 2020 | pmid = 32787880 | pmc = 7425005 | doi = 10.1186/s12967-020-02471-0 | publisher = Springer Science and Business Media LLC | doi-access = free | title-link = doi }}</ref>

Endometriosis has shown up in people who have never experienced menstruation including men, female fetuses, and prepubescent girls.<ref>{{cite journal |last=Pašalić |first=Elma |last2=Tambuwala |first2=Murtaza M. |last3=Hromić-Jahjefendić |first3=Altijana |date=2023 |title=Endometriosis: Classification, pathophysiology, and treatment options |url=https://www.sciencedirect.com/science/article/pii/S0344033823005484 |journal=Pathology - Research and Practice |volume=251 |article-number=154847 |doi=10.1016/j.prp.2023.154847 |issn=0344-0338|url-access=subscription }}</ref> Further theoretical additions are needed to complement the retrograde menstruation theory to explain why cases of endometriosis show up in the [[brain]]<ref>{{cite journal | vauthors = Thibodeau LL, Prioleau GR, Manuelidis EE, Merino MJ, Heafner MD | title = Cerebral endometriosis. Case report | journal = Journal of Neurosurgery | volume = 66 | issue = 4 | pages = 609–10 | date = April 1987 | pmid = 3559727 | doi = 10.3171/jns.1987.66.4.0609 | doi-access = free | title-link = doi }}</ref> and lungs.<ref>{{cite journal | vauthors = Rodman MH, Jones CW | title = Catamenial hemoptysis due to bronchial endometriosis | journal = The New England Journal of Medicine | volume = 266 | issue = 16 | pages = 805–8 | date = April 1962 | pmid = 14493132 | doi = 10.1056/nejm196204192661604 }}</ref>

Researchers are investigating the possibility that the immune system may be unable to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest in studying the relationship of endometriosis to [[autoimmune disease]], [[allergy|allergic]] reactions, and the impact of toxic materials.<ref name="Lino">{{cite journal|author-link1=Norbert Gleicher | vauthors = Gleicher N, el-Roeiy A, Confino E, Friberg J | title = Is endometriosis an autoimmune disease? | journal = Obstetrics and Gynecology | volume = 70 | issue = 1 | pages = 115–22 | date = July 1987 | pmid = 3110710 }}</ref><ref>{{cite journal | vauthors = Capellino S, Montagna P, Villaggio B, Sulli A, Soldano S, Ferrero S, Remorgida V, Cutolo M | title = Role of estrogens in inflammatory response: expression of estrogen receptors in peritoneal fluid macrophages from endometriosis | journal = Annals of the New York Academy of Sciences | volume = 1069 | pages = 263–7 | date = June 2006 | issue = 1 | pmid = 16855153 | doi = 10.1196/annals.1351.024 | bibcode = 2006NYASA1069..263C | s2cid = 35601442 }}</ref>

Endometriotic lesions differ in their biochemistry, hormonal response, immunology, and inflammatory response compared to the endometrium.<ref name="zondervan32212520" /><ref name="pmid12372441">{{cite journal |vauthors=Redwine DB |title=Was Sampson wrong? |journal=Fertility and Sterility |volume=78 |issue=4 |pages=686–93 |date=October 2002 |pmid=12372441 |doi=10.1016/S0015-0282(02)03329-0 |doi-access=free |title-link=doi}}</ref> This is likely because the cells that give rise to endometriosis are a side population of cells.<ref name="Fauser2011" /> Similarly, there are changes in, for example, the [[mesothelium]] of the peritoneum in people with endometriosis, such as loss of [[tight junction]]s. It is unknown if these are causes or effects of the disorder.<ref name="Young2013">{{cite journal |vauthors=Young VJ, Brown JK, Saunders PT, Horne AW |year=2013 |title=The role of the peritoneum in the pathogenesis of endometriosis |journal=Human Reproduction Update |volume=19 |issue=5 |pages=558–69 |doi=10.1093/humupd/dmt024 |pmid=23720497 |doi-access=free |title-link=doi}}</ref>

In rare cases, when an [[imperforate hymen]] persists to [[menarche]], menstrual outflow can be obstructed, leading to retention of blood within the [[vagina]] and [[uterus]] (hematocolpos/hematometra) and, in some cases, into the [[Fallopian tubes]]. Symptoms (e.g., pelvic or abdominal pain) may be nonspecific, contributing to delayed recognition. Prolonged obstruction can produce retrograde menstruation, a mechanism widely discussed in reviews of endometriosis pathogenesis.<ref name="Lee2019">Lee KH, Hong JS, Jung HJ, et al. "Imperforate Hymen: A Comprehensive Systematic Review." ''J Clin Med''. 2019;8(1):56.</ref><ref name="Bulun2022">Bulun SE, Yilmaz BD, Sison C, et al. "Endometriosis caused by retrograde menstruation." ''Fertil Steril''. 2022;118(4):713–732.</ref><ref name="Lamceva2023">Lamceva J, Popovska S, Jovanovska V, et al. "The Main Theories on the Pathogenesis of Endometriosis." ''Biomedicines''. 2023;11(3):776.</ref>

====Other theories====
* Stem cells: Endometriosis may arise from stem cells from bone marrow and potentially other sources. In particular, this theory explains endometriosis found in areas remote from the pelvis, such as the brain or lungs.<ref name="hufnagelpmc4986990" /> Stem cells may be from local cells such as the peritoneum (see coelomic metaplasia below) or cells disseminated in the bloodstream (see vascular dissemination below) such as those from the [[bone marrow]].<ref name="vanderLinden1996" /><ref name="hufnagelpmc4986990" /><ref name="sampson27ajogdoi">{{cite journal | vauthors = Sampson JA |year= 1927 |title= Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity |journal= Am J Obstet Gynecol |volume= 14 |issue= 4 |pages= 422–469 |doi= 10.1016/S0002-9378(15)30003-X}}</ref>
* Vascular dissemination: Vascular dissemination is a 1927 theory that has been revived with new studies of bone marrow stem cells involved in pathogenesis.<ref name="hufnagelpmc4986990" /><ref name="sampson27ajogdoi" />
* Müllerianosis: A theory supported by foetal autopsy is that cells with the potential to become endometrial, which are laid down in tracts during embryonic development called the female reproductive (Müllerian) tract, as it migrates downward at 8–10 weeks of embryonic life, could become dislocated from the migrating uterus and act like seeds or stem cells.<ref name="vanderLinden1996" /><ref name="signorile2009">{{cite journal | vauthors = Signorile PG, Baldi F, Bussani R, D'Armiento M, De Falco M, Baldi A | title = Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer | journal = Journal of Experimental & Clinical Cancer Research | volume = 28 | article-number = 49 | date = April 2009 | issue = 1 | pmid = 19358700 | pmc = 2671494 | doi = 10.1186/1756-9966-28-49 | doi-access = free | title-link = doi }}</ref>
* Coelomic metaplasia: [[Coelomic]] cells which are the common ancestor of [[endometrial]] and [[peritoneal]] cells may undergo [[metaplasia]] (transformation) from one type of cell to the other, perhaps triggered by inflammation.<ref name="vanderLinden1996" /><ref name="aafp1999">{{cite journal | vauthors = Wellbery C | title = Diagnosis and treatment of endometriosis | journal = American Family Physician | volume = 60 | issue = 6 | pages = 1753–62, 1767–8 | date = October 1999 | pmid = 10537390 | url = https://www.aafp.org/pubs/afp/issues/1999/1015/p1753.html | access-date = 26 July 2011 | publisher = American Academy of Family Physicians | url-status = live | archive-url = https://web.archive.org/web/20110606032508/http://www.aafp.org/afp/991015ap/1753.html | archive-date = 6 June 2011 }}</ref>
* Vasculogenesis: Up to 37% of the microvascular [[endothelium]] of ectopic endometrial tissue originates from [[endothelial progenitor cell]]s, which result in ''de novo'' formation of microvessels by the process of [[vasculogenesis]] rather than the conventional process of [[angiogenesis]].<ref>{{cite journal | vauthors = Laschke MW, Giebels C, Menger MD | title = Vasculogenesis: a new piece of the endometriosis puzzle | journal = Human Reproduction Update | volume = 17 | issue = 5 | pages = 628–36 | year = 2011 | pmid = 21586449 | doi = 10.1093/humupd/dmr023 | doi-access = free | title-link = doi }}</ref>{{clarify|reason=what's the theory here? |date=March 2016}}
* Neural growth: An increased expression of new nerve fibres is found in endometriosis, but does not fully explain the formation of ectopic endometriotic tissue and is not definitely correlated with the amount of perceived pain.<ref name="MorottiVincent2014">{{cite journal | vauthors = Morotti M, Vincent K, Brawn J, Zondervan KT, Becker CM | title = Peripheral changes in endometriosis-associated pain | journal = Human Reproduction Update | volume = 20 | issue = 5 | pages = 717–36 | year = 2014 | pmid = 24859987 | pmc = 4337970 | doi = 10.1093/humupd/dmu021 }}</ref>{{clarify|reason=what's the theory here? |date=March 2016}}
* Autoimmune: [[Graves disease]] is an autoimmune disease characterized by hyperthyroidism, goiter, ophthalmopathy, and dermopathy. People with endometriosis had higher rates of Graves' disease. One of these potential links between Graves disease and endometriosis is [[autoimmunity]].<ref>{{cite journal | vauthors = Yuk JS, Park EJ, Seo YS, Kim HJ, Kwon SY, Park WI | title = Graves Disease Is Associated With Endometriosis: A 3-Year Population-Based Cross-Sectional Study | journal = Medicine | volume = 95 | issue = 10 | article-number = e2975 | date = March 2016 | pmid = 26962803 | doi = 10.1097/MD.0000000000002975 | pmc = 4998884 }}</ref><ref>{{cite journal | vauthors = Giudice LC, Kao LC | title = Endometriosis | journal = Lancet | volume = 364 | issue = 9447 | pages = 1789–99 | date = 2004 | pmid = 15541453 | doi = 10.1016/S0140-6736(04)17403-5 | s2cid = 208788714 }}</ref>
* [[Oxidative stress]]: Influx of iron is associated with the local destruction of the peritoneal mesothelium, leading to the adhesion of [[Ectopic expression|ectopic]] endometriotic cells.<ref name=":3" /> Peritoneal iron overload has been suggested to be caused by the destruction of [[erythrocytes]], which contain the iron-binding protein hemoglobin, or a deficiency in the peritoneal [[Human iron metabolism|iron metabolism system.]]<ref name=":3">{{cite journal | vauthors = Scutiero G, Iannone P, Bernardi G, Bonaccorsi G, Spadaro S, Volta CA, Greco P, Nappi L | title = Oxidative Stress and Endometriosis: A Systematic Review of the Literature | journal = Oxidative Medicine and Cellular Longevity | volume = 2017 | article-number = 7265238 | date = 2017 | pmid = 29057034 | pmc = 5625949 | doi = 10.1155/2017/7265238 | doi-access = free | title-link = doi }}</ref> Oxidative stress activity and [[reactive oxygen species]] (ROS) (such as [[superoxide anion]]s and [[peroxide]] levels) are reported to be higher than normal in people with endometriosis.<ref name=":3" /> Oxidative stress and the presence of excess ROS can damage tissue and induce rapid [[cellular division]].<ref name=":3" /> Mechanistically, there are several cellular pathways by which oxidative stress may lead to or may induce proliferation of endometriotic lesions, including the [[Mitogen-activated protein kinase|mitogen activated protein]] (MAP) kinase pathway and the [[MAPK/ERK pathway|extracellular signal-related kinase]] (ERK) pathway.<ref name=":3" /> Activation of both of the MAP and ERK pathways lead to increased levels of [[c-Fos]] and [[C-jun|c-Jun]], which are [[Proto oncogenes|proto-oncogenes]] that are associated with [[High grade lesion|high-grade lesions]].<ref name=":3" />
* [[Human microbiome|Microbiome]]: Some studies have reported differences in gut microbial composition in individuals with endometriosis compared to healthy controls. These findings have led to suggestions that alterations in the gut microbiome may contribute to the pathophysiology of endometriosis, though further research is needed to clarify this relationship.<ref>{{cite journal |last1=Torraco |first1=Astrid |last2=Di Nicolantonio |first2=Sara |last3=Cardisciani |first3=Martina |last4=Ortu |first4=Eleonora |last5=Pietropaoli |first5=Davide |last6=Altamura |first6=Serena |last7=Del Pinto |first7=Rita |date=14 May 2025 |title=Meta-Analysis of 16S rRNA Sequencing Reveals Altered Fecal but Not Vaginal Microbial Composition and Function in Women with Endometriosis |journal=Medicina |volume=61 |issue=5 |page=888 |doi=10.3390/medicina61050888 |pmid=40428846 |doi-access=free |issn=1648-9144|pmc=12112980 }}</ref>

=== Pain ===
There are multiple causes of pain. Endometriosis lesions react to hormonal stimulation and may "bleed" during menstruation. The blood accumulates locally if not cleared shortly by the immune, circulatory, and lymphatic systems. This accumulation can lead to swelling, which triggers inflammation via [[cytokines]], resulting in pain. Another source of pain is organ dislocation that arises from [[Adhesion (medicine)|adhesion]] binding internal organs together. The ovaries, the uterus, the oviducts, the peritoneum, and the bladder can all be bound together. Pain triggered in this way can last throughout the menstrual cycle, not just during menstrual periods.<ref>{{page needed|date=April 2015}}{{cite book |title=The Encyclopedia of Natural Medicine |vauthors=Murray MT, Pizzorno J |date=2012 |publisher=Simon and Schuster |edition=3rd |location=New York, NY}}</ref>

Additionally, endometriotic lesions can develop an independent nerve supply, creating a direct and two-way interaction between lesions and the [[central nervous system]]. This interaction can produce a variety of individual differences in pain that, in some cases, become independent of the disease itself.<ref name="Stratton2011" /> Nerve fibers and blood vessels are thought to grow into endometriosis lesions by a process known as [[neuroangiogenesis]].<ref>{{cite journal |vauthors=Asante A, Taylor RN |date=2011 |title=Endometriosis: the role of neuroangiogenesis |journal=Annual Review of Physiology |volume=73 |pages=163–82 |doi=10.1146/annurev-physiol-012110-142158 |pmid=21054165}}</ref>

==Diagnosis==
A health history and a physical examination can lead the health care practitioner to suspect endometriosis. Symptoms in combination with [[ultrasound]] or [[MRI imaging]] can lead to a presumed diagnosis of endometriosis. The gold standard for definite diagnosis is via surgery and a biopsy, but there is a shift away from requiring surgical confirmation before starting treatment to prevent delays.<ref name=":7" /> Patients in the UK have an average delay in diagnosis of 8 years and in Norway of 6.7 years.<ref name="ReferenceA">{{cite journal | vauthors = Pugsley Z, Ballard K | title = Management of endometriosis in general practice: the pathway to diagnosis | journal = The British Journal of General Practice | volume = 57 | issue = 539 | pages = 470–6 | date = June 2007 | pmid = 17550672 | pmc = 2078174 }}</ref> A third of women had consulted their GP six or more times before being diagnosed.<ref name="ReferenceA" />

Endometriosis can be classified into four different stages. The American Society of Reproductive Medicine's scale, revised in 1996, gives higher scores to deep, thick lesions or intrusions on the ovaries and dense, enveloping adhesions on the ovaries or fallopian tubes.<ref name="pmid9130884">{{cite journal |last1=American Society For Reproductive |date=May 1997 |title=Revised American Society for Reproductive Medicine classification of endometriosis: 1996 |journal=Fertility and Sterility |volume=67 |issue=5 |pages=817–21 |doi=10.1016/S0015-0282(97)81391-X |pmid=9130884 |doi-access=free |title-link=doi}}</ref>

As for deep infiltrating endometriosis, TVUS, [[TRUS]], and MRI are the techniques of choice for non-invasive diagnosis with a high sensitivity and specificity.<ref name="Zhang He Shen 2020 p.">{{cite journal | vauthors = Zhang X, He T, Shen W | title = Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta-analysis of diagnostic accuracy studies | journal = Experimental and Therapeutic Medicine | volume = 20 | issue = 4 | pages = 3208–3220 | date = October 2020 | pmid = 32855690 | pmc = 7444323 | doi = 10.3892/etm.2020.9043 | publisher = Spandidos Publications }}</ref>

=== Physical examination ===
A trauma-informed framework is recommended for a physical examination, where the health practioner validates pain and fosters trust. The examination focuses on assessing both general symptoms and those linked to deep endometriosis or endometriosis outside the pelvis. Risk factors are also reviewed. The physical examination can include an abdominal exam, a single digit exam of the vagina and pelvic floor, a bimanual exam and examination with a [[Speculum (medicine)|speculum]].<ref name=":7" />

=== Ultrasound ===
[[File:Endometrioma.jpg|thumb|[[Transvaginal ultrasonography]] showing a 67 x 40 mm [[endometrioma]] as distinguished from other types of [[ovarian cyst]]s by a somewhat grainy and not completely [[anechoic]] content]]
Vaginal ultrasound can be used to diagnose endometriosis or to localize an endometrioma before surgery.<ref name=":0">{{cite web|url=https://www.sbu.se/en/publications/sbu-assesses/endometriosis--diagnosis-treatment-and-patient-experiences/|title=Endometriosis – Diagnosis, treatment and patient experiences|date=4 May 2018|publisher=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|access-date=13 June 2018|archive-date=19 January 2021|archive-url=https://web.archive.org/web/20210119024015/https://www.sbu.se/en/publications/sbu-assesses/endometriosis--diagnosis-treatment-and-patient-experiences/|url-status=live}}</ref> This can be used to identify the spread of disease in individuals with well-established clinical suspicion of endometriosis.<ref name=":0" /> Vaginal ultrasound is inexpensive, easily accessible, has no contraindications, and requires no preparation.<ref name=":0" /> By extending the ultrasound assessment into the posterior and anterior pelvic compartments, a sonographer can evaluate structural mobility and look for deep infiltrating endometriotic nodules.<ref name=":2">{{cite journal |vauthors=Fang J, Piessens S |title=A step-by-step guide to sonographic evaluation of deep infiltrating endometriosis |journal=Sonography |date=June 2018 |volume=5 |issue=2 |pages=67–75 |doi=10.1002/sono.12149 |doi-access=free |title-link=doi}}</ref> Better sonographic detection of deep infiltrating endometriosis could reduce the number of diagnostic laparoscopies, as well as guide disease management and enhance patient quality of life.<ref name=":2" />

Ultrasounds cannot be used to exclude a diagnosis of endometriosis.{{sfn|Solnik|Sanders|2025|p=94}} If a transvaginal ultrasound is not suitable or declined, an alternative is an ultrasound via the lower abdomen.{{sfn|Solnik|Sanders|2025|p=93}}

=== Magnetic resonance imaging ===
[[File:Trichromatic_Color_MRI_of_ovarian_cysts.jpg|thumb|upright=1.3|Trichromatic color MRI of ovarian cysts. The bottom right cyst is endometriosis (a chocolate cyst).]]
MRI is another means of detecting lesions in a non-invasive manner.<ref name="Imaging">{{cite journal |vauthors=Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML |date=February 2016 |title=Imaging modalities for the non-invasive diagnosis of endometriosis |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=2 |doi=10.1002/14651858.cd009591.pub2 |pmc=7100540 |pmid=26919512 |article-number=CD009591}}</ref> MRI is not widely used due to its cost and limited availability.<ref name="Imaging" /> It can reliably detect endometriomas and deep infiltrating endemetriosis. It is sometimes used for planning surgery, for instance if an ultrasound is unclear, or for diagnosis if a transvaginal ultrasound is not appropriate or is declined. The field of view is larger in an MRI compared to an ultrasound, which allows a larger part of the bowel to be assessed.<ref>{{cite journal |last=Quesada |first=Juan |last2=Härmä |first2=Kirsi |last3=Reid |first3=Shannon |last4=Rao |first4=Tanushree |last5=Lo |first5=Glen |last6=Yang |first6=Natalie |last7=Karia |first7=Sonal |last8=Lee |first8=Emmeline |last9=Borok |first9=Nira |date=2023 |title=Endometriosis: A multimodal imaging review |url=https://www.ejradiology.com/article/S0720-048X(22)00460-0/fulltext |journal=European Journal of Radiology |volume=158 |doi=10.1016/j.ejrad.2022.110610 |issn=0720-048X |pmid=36502625}}</ref>

===Laparoscopy===
[[File:Peritoneal endometriosis.jpg|thumb|upright=1.3|[[laparoscopy|Laparoscopic]] image of endometriotic lesions at the peritoneum of the pelvic wall]]
Laparoscopy (keyhole surgery) is a surgical procedure where a camera is used to look inside the abdominal cavity. Laparoscopy with a biopsy is the most accurate way to diagnose endometriosis.<ref name=":7" /> It can be used when endometriosis is suspected, but not visible via medical imaging.<ref name=":12" /> An alternative after negative imaging is to try out treatment and give a presumed diagnosis if that improves symptoms ('empirical treatment').{{sfn|ESHRE|2022|p=30}}

Surgery for diagnosis also allows for surgical treatment of endometriosis at the same time.{{sfn|Solnik|Sanders|2025|p=10}} In nearly 40% of cases, no cause for pelvic pain is discovered during laparoscopy.<ref name=":12" />

The lesions of superficial endometriosis often appear dark blue or black. In the earlier stages of disease, they may be white, red or yellow-brown. Ovarian cysts are typically dark brown. [[Adhesion (medicine)|Adhesions]] are made up of fibrous scar tissue. Deep endometriosis looks like multiple distinct nodules.<ref name=":12" />

A biopsy may be negative even when endometriosis is present, particularly in younger women. As such, it cannot be used to exclude a diagnosis of endometriosis.<ref name=":12" /> For confirmation, biopsy samples should show at least two of the following features:<ref>{{cite web | vauthors = Han L, Garcia R, Busca A, Parra-Herran C | date = November 2023 | veditors = Turashvili G, Skala SL | url = https://www.pathologyoutlines.com/topic/ovarynontumorendometriosis.html | title = Endometriosis | website = Pathology Outlines | access-date = 18 March 2020 | archive-date = 7 August 2020 | archive-url = https://web.archive.org/web/20200807014147/http://www.pathologyoutlines.com/topic/ovarynontumorendometriosis.html | url-status = live }}</ref>
* Endometrial type [[stroma (animal tissue)|stroma]]
* Endometrial [[epithelium]] with glands
* Evidence of chronic hemorrhage, such as [[hemosiderin]] deposits

<gallery mode="packed" heights="175">
File:Endometriosis, abdominal wall.jpg|Endometriosis, abdominal wall
File:Endometriosis of the ovary.jpg|[[Micrograph]] showing endometriosis (right) and ovarian stroma (left)
File:Endometrioma1.jpg|[[Micrograph]] of the wall of an endometrioma. All features of endometriosis are present (endometrial [[gland]]s, endometrial [[stroma (animal tissue)|stroma]] and [[hemosiderin]]-laden [[macrophage]]s).
</gallery>

===Stages===
There are three staging or classification systems commonly used. Fertility is assessed with the Endometriosis Fertility Index (EFI).<ref name=":12">{{Cite journal |last=Horne |first=Andrew W. |last2=Missmer |first2=Stacey A. |date=2022 |title=Pathophysiology, diagnosis, and management of endometriosis |url=https://www.bmj.com/content/379/bmj-2022-070750 |journal=BMJ |language=en |volume=379 |article-number=e070750 |doi=10.1136/bmj-2022-070750 |issn=1756-1833 |pmid=36375827}}</ref> Endometriosis can be classified as stage I–IV by the revised [[American Society of Reproductive Medicine]] (rASRM) staging system. The stages range from minimal (stage I) to severe (stage IV).<ref name="Crump2024">{{cite journal |last=Crump |first=Jessica |last2=Suker |first2=Adriana |last3=White |first3=Louise |date=2024 |title=Endometriosis: A review of recent evidence and guidelines |url=https://www1.racgp.org.au/ajgp/2024/january-february/endometriosis |journal=Australian Journal of General Practice |volume=53 |issue=1-2 |pages=11–18 |doi=10.31128/AJGP/04-23-6805 |doi-access=free}}</ref> The scale uses a point system that assesses lesions and adhesions during surgery. The ENZIAN system focuses more on deep endometriosis compared to rASRM. The rASRM and ENZIAN systems correlate poorly with how much pain women have.<ref name=":12" />

The [[American Association of Gynecologic Laparoscopists]] (AAGL) endometriosis staging system, introduced in 2021, correlates well with complexity of surgery, and captures pain better than rASRM. Like rASRM, it divides endometriosis into four stages.<ref>{{Cite journal |last=Pašalić |first=Elma |last2=Tambuwala |first2=Murtaza M. |last3=Hromić-Jahjefendić |first3=Altijana |date=2023 |title=Endometriosis: Classification, pathophysiology, and treatment options |url=https://www.sciencedirect.com/science/article/pii/S0344033823005484 |journal=Pathology - Research and Practice |volume=251 |article-number=154847 |doi=10.1016/j.prp.2023.154847 |issn=0344-0338|url-access=subscription }}</ref>

==Prevention==
The US Office of Women's Health states that the chance of developing endometriosis can be reduced by lowering the levels of the hormone [[estrogen]] in the body.<ref name="WH2025" /> According to the [[World Health Organization]], there is no known way to prevent endometriosis.<ref name="WHO Fact Sheet" />

==Management==
While there is no cure for endometriosis, there are treatments for pain and endometriosis-associated infertility. Pain can be treated with hormones, painkillers, or, in severe cases, surgery.<ref>{{cite web |date=21 February 2020 |title=What are the treatments for endometriosis? |url=https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment |access-date=12 January 2025 |website=NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development }}</ref> The goal of management is to provide pain relief, to restrict the progression of the process, and to restore or preserve fertility where needed.<ref name="zondervan32212520" />

Treatment with medication for pain management can be initiated based on the presence of symptoms, examination, and ultrasound findings that rule out other potential causes.<ref name="Women's Healthcare 2020">{{cite web |title=Update on pharmacologic treatment for endometriosis- related pain |website=Women's Healthcare |date=7 June 2020 |url=https://www.npwomenshealthcare.com/update-on-pharmacologic-treatment-for-endometriosis-related-pain/ |access-date=3 October 2021 |archive-date=3 October 2021 |archive-url=https://web.archive.org/web/20211003205203/https://www.npwomenshealthcare.com/update-on-pharmacologic-treatment-for-endometriosis-related-pain/ |url-status=live}}</ref> The UK [[National Institute for Health and Care Excellence]] recommends starting initial medication for those with suspected endometriosis, at the same time as referral for investigations such as ultrasound.{{sfn|NICE|2024|pp=11-12}}

In general, the diagnosis of endometriosis is confirmed during surgery, at whih time removal can be performed. Further steps depend on circumstances: someone without infertility can manage symptoms with pain medication and hormonal medication that suppresses the natural cycle, while an infertile individual may be treated expectantly after surgery, with fertility medication, or with [[in vitro fertilisation]] (IVF).

A 2020 Cochrane systematic review found that for all types of endometriosis, "it is uncertain whether laparoscopic surgery improves overall pain compared to diagnostic laparoscopy".<ref name="Bafort Beebeejaun Tomassetti Bosteels p.">{{cite journal |vauthors=Bafort C, Beebeejaun Y, Tomassetti C, Bosteels J, Duffy JM |title=Laparoscopic surgery for endometriosis |journal=The Cochrane Database of Systematic Reviews |volume=2020 |issue=10 |article-number=CD011031 |date=October 2020 |pmid=33095458 |doi=10.1002/14651858.cd011031.pub3 |publisher=Wiley |pmc=8428328}}</ref>

===Hormonal medications===
{{See also|High-dose estrogen}}

* [[Hormonal birth control]] pills: combined estrogren-progestin birth control pills are a first-line treatment. The recommendation is to use the pills continuously to stop periods.<ref name=":7">{{cite journal |last=As-Sanie |first=Sawsan |last2=Mackenzie |first2=Scott C. |last3=Morrison |first3=Leigh |last4=Schrepf |first4=Andrew |last5=Zondervan |first5=Krina T. |last6=Horne |first6=Andrew W. |last7=Missmer |first7=Stacey A. |date=2025 |title=Endometriosis |url=https://jamanetwork.com/journals/jama/article-abstract/2833561 |journal=JAMA  |volume=334 |issue=1 |page=64 |doi=10.1001/jama.2025.2975 |url-access=subscription }}</ref> A 2018 Cochrane systematic review found that there is insufficient evidence to make a judgement on the effectiveness of the combined oral contraceptive pill compared with placebo or other medical treatment for managing pain associated with endometriosis partly because of lack of included studies for data analysis (only two for COCP vs placebo).<ref name="Brown Crawford Datta Prentice p.">{{cite journal | vauthors = Brown J, Crawford TJ, Datta S, Prentice A | title = Oral contraceptives for pain associated with endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 5 | article-number = CD001019 | date = May 2018 | pmid = 29786828 | pmc = 6494634 | doi = 10.1002/14651858.cd001019.pub3 | publisher = Wiley }}</ref>
* [[Progestin]]-only hormonal suppression (progestogen) is another first-line therapy. It come in different forms and includes the [[Hormonal intrauterine device|hormonal coil]] (intrauterine device), the oral [[dienogest]], an injection of [[medroxyprogesterone acetate]] every three months or an implant under the skin.<ref name=":7" /> Dienogest, which may better than injections,<ref name=":10">{{cite journal |last=Chen |first=Innie |last2=Kives |first2=Sari |last3=Zakhari |first3=Andrew |last4=Nguyen |first4=Dong Bach |last5=Goldberg |first5=Hanna R |last6=Choudhry |first6=Abdul J |last7=Le |first7=Ai-Lien |last8=Kowalczewski |first8=Emilie |last9=Schroll |first9=Jeppe Bennekou |date=2025 |editor-last=Cochrane Central Editorial Service |title=Progestagens for pain symptoms associated with endometriosis |journal=Cochrane Database of Systematic Reviews |volume=2025 |issue=10 |doi=10.1002/14651858.CD002122.pub3}}</ref> is not available on its own in the US.<ref name=":7" /> Oral progestins likely reduce overall pain and period pain compared to placebo, and may also help with pelvic pain. It is unclear how well they work compared to other hormonal therapies.<ref name=":10" />
* [[Gonadotropin-releasing hormone modulator|Gonadotropin-releasing hormone (GnRH) modulator]]s are second-line treatments: These drugs include [[GnRH agonist]]s such as [[leuprorelin]], and [[GnRH antagonist]]s such as [[elagolix]] and decrease estrogen levels.<ref name=":7" /> GnRH agonists mimic the effects of menopause, and seem more effective than placebo or oral progestin at reducing pain.<ref name=":11">{{cite journal |last=Veth |first=Veerle B |last2=van de Kar |first2=Majorie MA |last3=Duffy |first3=James MN |last4=van Wely |first4=Madelon |last5=Mijatovic |first5=Velja |last6=Maas |first6=Jacques WM |date=2023 |editor-last=Cochrane Gynaecology and Fertility Group |title=Gonadotropin-releasing hormone analogues for endometriosis |journal=Cochrane Database of Systematic Reviews |volume=2023 |issue=6 |doi=10.1002/14651858.CD014788.pub2}}</ref> They come with side effects of [[hot flash]]es and [[decreased bone density]]. GnRHs can be prescribed with hormonal 'add-back' therapy or with calcium-regulating agents to reduce the amount of bone loss.<ref name=":7" /><ref name=":11" />
* [[Aromatase inhibitor]]s are third-line treatments and block estrogen production throughout the body. Examples of aromatase inhibitors include [[anastrozole]] and [[letrozole]]. Common side effects are hot flashes, night sweats and functional cysts.<ref name=":7" /><ref name="Garzon Laganà Barra Casarin 2020 pp. 1377–1388">{{cite journal |vauthors=Garzon S, Laganà AS, Barra F, Casarin J, Cromi A, Raffaelli R, Uccella S, Franchi M, Ghezzi F, Ferrero S |date=December 2020 |title=Aromatase inhibitors for the treatment of endometriosis: a systematic review about efficacy, safety and early clinical development |journal=Expert Opinion on Investigational Drugs |publisher=Informa UK Limited |volume=29 |issue=12 |pages=1377–1388 |doi=10.1080/13543784.2020.1842356 |pmid=33096011 |s2cid=225058751}}</ref> In premenopausal women, these should be taken with other hormones (such as the combined pill) to prevent ovarian stimulation and to prevent menopause symptoms. They can be a option for post-menopausal women who still have endometriosis symptoms, as their action is not limited to suppressing estrogen from ovaries. Evidence is limited.<ref name=":7" />
* Progesterone receptor modulators like [[mifepristone]] and [[gestrinone]] have the potential (based on only one [[randomized controlled trial]] each) to be used as a treatment to manage pain caused by endometriosis.<ref name="Fu Song Zhou Zhu p.">{{cite journal | vauthors = Fu J, Song H, Zhou M, Zhu H, Wang Y, Chen H, Huang W | title = Progesterone receptor modulators for endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 7 | article-number = CD009881 | date = July 2017 | pmid = 28742263 | pmc = 6483151 | doi = 10.1002/14651858.cd009881.pub2 | publisher = Wiley }}</ref>

===Other medicines===
* [[Pentoxifylline]], an immunomodulating agent, has been theorized to improve pain as well as improve pregnancy rates in individuals with endometriosis. There is not enough evidence to support the effectiveness or safety of either of these uses.<ref>{{cite journal|vauthors=Grammatis AL, Georgiou EX, Becker CM|date=August 2021|title=Pentoxifylline for the treatment of endometriosis-associated pain and infertility|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=8|article-number=CD007677|doi=10.1002/14651858.CD007677.pub4|pmid=34431079|pmc=8407096|s2cid=237294362}}</ref>
* NSAIDs are anti-inflammatory medications commonly used for endometriosis patients despite unproven efficacy and unintended adverse effects.<ref>{{cite journal | vauthors = Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A | title = Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD004753 | date = January 2017 | pmid = 28114727 | pmc = 6464974 | doi = 10.1002/14651858.CD004753.pub4 }}</ref>

===Surgery===
{{See also|Endometrioma#Surgery}}

Clinical guidelines recommend surgery when medical treatment does not work sufficiently, has unacceptable side effects or is [[contraindicated]]. Large endometriomas can only effectively be treated with surgery. Surgery is also recommended when deep endometriosis causes problems in the bowels or [[urinary tract]], such as obstruction. It is unclear what the effect of surgery is for pain relief in cases of superficial periteneal endometriosis.<ref name=":7" />

Laparoscopy (keyhole surgery) is the standard surgical approach. Treatment consists of the removal of endometriosis and the restoration of pelvic anatomy via the division of [[adhesions]].{{sfn|EHSRE|2022|p=48}} The removal takes place via [[Surgery#Types_of_surgery|excision]] (cutting out) or [[electrosurgery]] (coagulation or ablation/vaporisation).{{sfn|EHSRE|2022|pp=48, 51}}{{sfn|Solnik|Sanders|2025|p=27}} When laparoscopic surgery is used, small instruments are inserted through the incisions to remove the endometriosis tissue and adhesions. Because the incisions are tiny, there will only be small scars on the skin after the procedure, and most individuals recover from surgery quickly and have a reduced risk of adhesions.<ref>{{cite web |year=2008 |title=Endometriosis and Infertility: Can Surgery Help? |url=http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endometriosis_infertility.pdf |url-status=live |archive-url=https://web.archive.org/web/20101011155943/http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endometriosis_infertility.pdf |archive-date=11 October 2010 |access-date=31 October 2010 |publisher=American Society for Reproductive Medicine}}</ref> A 2017 literature review found that excision improved some outcomes over ablation.<ref>{{cite journal |vauthors=Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P |date=2017 |title=Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis |journal=[[Journal of Minimally Invasive Gynecology]] |volume=24 |issue=5 |pages=747–756 |doi=10.1016/j.jmig.2017.04.008 |pmid=28456617}}</ref> In the United States, some specialists trained in excision for endometriosis do not accept health insurance because insurance companies do not reimburse the higher costs of this procedure over ablation.<ref>{{cite news |date=16 July 2023 |title=Endometriosis, a painful and often overlooked disease, gets attention in a new film |url=https://www.npr.org/sections/health-shots/2023/07/16/1186533247/endometriosis-a-painful-and-often-overlooked-disease-gets-attention-in-a-new-fil |url-status=live |archive-url=https://web.archive.org/web/20230717173453/https://www.npr.org/sections/health-shots/2023/07/16/1186533247/endometriosis-a-painful-and-often-overlooked-disease-gets-attention-in-a-new-fil |archive-date=17 July 2023 |access-date=17 July 2023 |publisher=[[NPR]] |vauthors=Muraskin A}}</ref>

Endometriomas are usually excised (removed completely). Compared to drainage and coagulation of the cyst, excision makes it less likely the cysts and pain symptoms come back. However, excision may damage fertility, as it can affect the [[ovarian reserve]], the amount of [[Egg cell|egg cells]] that can be fertilised.<ref name=":12" /><ref name=":7" />

For deep endometriosis, surgery improves quality of life and pain symptoms.{{Sfn|EHSRE|2022|p=55}} However, the procedure can be complicated, especially if the lesions are in or near the bowel, [[ureter]] of the urinary system or the chest, and requires a interdisciplinary surgical team in those cases. For instance, for [[rectovaginal]] endometriosis, 7% of surgeries had complications.<ref name=":7" /> Sometimes, a part of the bowel is removed.{{sfn|EHSRE|2022|pp=54-55}}

Historically, a [[hysterectomy]] (removal of the uterus) was thought to be a cure for endometriosis in individuals who do not wish to conceive. Removal of the uterus may be beneficial as part of the treatment if the uterus itself is affected by adenomyosis. However, this should only be done in combination with the removal of the endometriosis by excision. If endometriosis is not also removed at the time of hysterectomy, pain may persist.<ref name="John2013">{{cite journal |vauthors=Johnson NP, Hummelshoj L |date=June 2013 |title=Consensus on current management of endometriosis |journal=Human Reproduction |volume=28 |issue=6 |pages=1552–68 |doi=10.1093/humrep/det050 |pmid=23528916 |doi-access=free |title-link=doi}}</ref> 

[[Presacral neurectomy]] may be performed where the nerves to the uterus are cut. However, this technique is not usually used due to the high incidence of associated complications, including presacral hematoma and irreversible problems with urination and constipation.<ref name="John2013" />

====Recurrence====
The underlying process that causes endometriosis may not cease after a surgical or medical intervention. Even though surgery can improve symptoms, the resurgence of pain is common.<ref name=":9">{{cite journal |date=4 December 2024 |title=Endometriosis, fibroids and heavy periods: long-term research supports treatment decisions |url=https://evidence.nihr.ac.uk/collection/endometriosis-fibroids-and-heavy-periods-long-term-research-supports-treatment-decisions/ |journal=NIHR Evidence |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_64953 |doi-access=free}}</ref> A study has shown that dysmenorrhea recurs at a rate of 30 percent within a year following laparoscopic surgery. Resurgence of lesions tends to appear in the same location if the lesions were not completely removed during surgery. It has been shown that laser ablation resulted in higher and earlier recurrence rates when compared with endometrioma cystectomy, and recurrence after repetitive laparoscopy was similar to that after the first surgery. Endometriosis has a 10% recurrence rate after hysterectomy and bilateral salpingo-oophorectomy.<ref name="updateonrecur">{{cite journal |vauthors=Selçuk İ, Bozdağ G |date=2013 |title=Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature |journal=J Turk Ger Gynecol Assoc |volume=14 |issue=2 |pages=98–103 |doi=10.5152/jtgga.2013.52385 |pmc=3881735 |pmid=24592083}}</ref>

Endometriosis recurrence following conservative surgery is estimated as 21.5% at 2 years and 40–50% at 5 years.<ref>{{cite journal |vauthors=Guo SW |year=2009 |title=Recurrence of endometriosis and its control |journal=Human Reproduction Update |volume=15 |issue=4 |pages=441–61 |doi=10.1093/humupd/dmp007 |pmid=19279046 |doi-access=free |title-link=doi}}</ref>

===Comparison of interventions===
A 2021 meta-analysis found that GnRH analogs and combined hormonal contraceptives were the best treatment for reducing dyspareunia and menstrual and non-menstrual pelvic pain.<ref name="Samy Taher Sileem Abdelhakim 2021 p=101798">{{cite journal | vauthors = Samy A, Taher A, Sileem SA, Abdelhakim AM, Fathi M, Haggag H, Ashour K, Ahmed SA, Shareef MA, AlAmodi AA, Keshta NH, Shatat HB, Salah DM, Ali AS, El Kattan EA, Elsherbini M | title = Medical therapy options for endometriosis-related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials | journal = Journal of Gynecology Obstetrics and Human Reproduction | volume = 50 | issue = 1 | article-number = 101798 | date = January 2021 | pmid = 32479894 | doi = 10.1016/j.jogoh.2020.101798 | publisher = Elsevier BV | s2cid = 219173190 }}</ref> A 2018 Swedish systematic review found several studies but a general lack of scientific evidence for most treatments.<ref name=":0" /> There was only one study of sufficient quality and relevance comparing the effect of surgery and non-surgery.<ref name=":1">{{cite web|url=https://www.sbu.se/sv/publikationer/SBU-utvarderar/endometrios--diagnostik-behandling-och-bemotande/|title=Endometrios – diagnostik, behandling och bemötande|date=4 May 2018|website=sbu.se|publisher=Statens beredning för medicinsk och social utvärdering (SBU); [[Swedish Agency for Health Technology Assessment and Assessment of Social Services]]|page=121|language=sv|access-date=13 June 2018|archive-date=13 June 2018|archive-url=https://web.archive.org/web/20180613134401/https://www.sbu.se/sv/publikationer/SBU-utvarderar/endometrios--diagnostik-behandling-och-bemotande/|url-status=live}}</ref> Cohort studies indicate that surgery is effective in decreasing pain.<ref name=":1" /> Most complications occurred in cases of low intestinal anastomosis, while the risk of fistula occurred in cases of combined abdominal or vaginal surgery, and urinary tract problems were common in intestinal surgery.<ref name=":1" /> The evidence was found to be insufficient regarding surgical intervention.<ref name=":1" />

The advantages of physical therapy techniques are decreased cost, absence of major side effects, it does not interfere with fertility, and a near-universal increase in sexual function.<ref name="JOEPPD">{{primary source inline|date=April 2015}} {{cite journal | vauthors =Wurn BF, Wurn LJ, Patterson K, King CR, Scharf ES | title =Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual physical therapy: Results from two independent studies | journal =Journal of Endometriosis and Pelvic Pain Disorders | volume =3 | issue = 4| pages =188–196 | year =2011 | doi =10.5301/JE.2012.9088 | pmc =6154826 }}</ref> Disadvantages are that there are no large or long-term studies of its use for treating pain or infertility related to endometriosis.<ref name="JOEPPD"/>

===Treatment of infertility===
{{Main|Endometriosis and infertility}}

[[File:InVitroFertilization.jpg|thumb|Assistive reproductive technology like IVF can help with fertility in endometriosis.]]
Infertility can be treated with [[assistive reproductive technology]] (ART) such as [[In vitro fertilisation|in vitro fertilization]] (IVF) or surgery.{{sfn|Solnik|Sanders|2025|p=28-29}} IVF procedures are effective in improving fertility in many individuals with endometriosis. IVF is increasingly recommended over surgery for older women or for those where there might be multiple reasons why they struggle to conceive.{{sfn|Solnik|Sanders|2025|p=29}} It does not increase recurrence of endometriosis.{{sfn|ESHRE|2022|p=118}} The Endometriosis Fertility Index can help guide decisions on treatment of infertility.{{sfn|ESHRE|2022|p=12}} Surgery is typically not recommended before starting ART.{{sfn|ESHRE|2022|p=13}}

In terms of surgery, endometriomas can be cut out (a cystectomy), or drained and destroyed (ablation). The ablation technique may be better able to preserve the number of remaining viable eggs (the [[ovarian reserve]]), compared to cutting out the endometrioma.{{sfn|NICE|2024|pp=18-19}} On the other hand, cutting out the endometrioma may help more with pain.{{sfn|Solnik|Sanders|2025|p=29}} Surgery likely also helps with infertility in the case of superficial peritoneal endometriosis.<ref name=":7" /> Receiving hormonal suppression therapy after surgery might be help with endometriosis recurrence and pregnancy.<ref>{{cite journal | vauthors = Chen I, Veth VB, Choudhry AJ, Murji A, Zakhari A, Black AY, Agarpao C, Maas JW | title = Pre- and postsurgical medical therapy for endometriosis surgery | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 12 | article-number = CD003678 | date = November 2020 | pmid = 33206374 | pmc = 8127059 | doi = 10.1002/14651858.CD003678.pub3 }}</ref> but evidence for pregancy outcomes is mixed{{sfn|NICE|2024|p=19, 28}} and the both NICE and the [[European Society of Human Reproduction and Embryology]] recommend against hormonal suppression to improve fertility.{{sfn|NICE|2024|p=19, 28}}{{sfn|ESHRE|2022|p=83}}

==Epidemiology==
Determining how many people have endometriosis is challenging because a definitive diagnosis requires surgical visualization through laparoscopic surgery.<ref name="Risk">{{cite journal |vauthors=Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA |date=August 2018 |title=Risk for and consequences of endometriosis: A&nbsp;critical epidemiologic review |url=https://ora.ox.ac.uk/objects/uuid:39cf959c-3942-4d04-b99f-7be23c31217f |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=51 |pages=1–15 |doi=10.1016/j.bpobgyn.2018.06.001 |pmid=30017581 |s2cid=51679656 |archive-date=23 October 2020 |access-date=23 August 2020 |archive-url=https://web.archive.org/web/20201023011153/https://ora.ox.ac.uk/objects/uuid:39cf959c-3942-4d04-b99f-7be23c31217f |url-status=live }}</ref> Criteria that are commonly used to establish a diagnosis include pelvic pain, infertility, surgical assessment, and in some cases, magnetic resonance imaging. An ultrasound can identify large clumps of tissue as potential endometriosis lesions and ovarian cysts, but it is not effective for all patients, especially in cases with smaller, superficial lesions.<ref>{{cite web |title=Endometriosis Ultrasound: Procedure, Diagnosis, & Follow Up |url=https://my.clevelandclinic.org/health/diagnostics/21814-endometriosis-ultrasound |access-date=7 March 2022 |website=Cleveland Clinic |archive-date=7 March 2022 |archive-url=https://web.archive.org/web/20220307193518/https://my.clevelandclinic.org/health/diagnostics/21814-endometriosis-ultrasound |url-status=live }}</ref>

Ethnic differences in endometriosis have been observed. The condition is more common in women of [[East Asian people|East Asian]] and [[Southeast Asia]]n descent than in White women.<ref name=zondervan32212520/>

Estimates of prevalance vary. One source estimates that between 6 and 10% of the general female population have endometriosis.<ref name="Bulletti2010" /> Another estimates that between 2 and 11% of asymptomatic women are affected.<ref name="zondervan32212520" /> In addition, 11% of women in a general population have undiagnosed endometriosis that can be seen on magnetic resonance imaging (MRI).<ref name="bucklewis21719000">{{cite journal |vauthors=Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, Chen Z, Fujimoto VY, Varner MW, Trumble A, Giudice LC |date=August 2011 |title=Incidence of endometriosis by study population and diagnostic method: the ENDO study |journal=Fertil. Steril. |volume=96 |issue=2 |pages=360–5 |pmc=3143230 |pmid=21719000 |doi=10.1016/j.fertnstert.2011.05.087}}</ref><ref name="Risk" /> Globally, around 176 girls and women are effected, with roughly 22 million having a diagnosis confirmed surgically as of 2021.<ref>{{cite journal |last1=Li |first1=Ruijie |last2=Zhang |first2=Ling |last3=Liu |first3=Yi |date=7 June 2025 |title=Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021 |journal=Reproductive Biology and Endocrinology |volume=23 |issue=1 |page=88 |doi=10.1186/s12958-025-01421-z |doi-access=free |issn=1477-7827 |pmc=12144762 |pmid=40483411}}</ref>

Endometriosis is most common in those in their thirties and forties; however, it can begin in girls as early as eight years old.<ref name="WH2014" /><ref name="Mc2013" /> It results in few deaths with unadjusted and age-standardized death rates of 0.1 and 0.0 per 100,000.<ref name="GBD2015Pre" /> Endometriosis was first determined to be a separate condition in the 1920s.<ref name="Bro2012">{{cite book |url=https://books.google.com/books?id=Wu0gfwFUfz8C&pg=PA3 |title=Endometriosis: Science and Practice |vauthors=Brosens I |date=2012 |publisher=John Wiley & Sons |isbn=978-1-4443-9849-6 |page=3}}</ref> Before that time, endometriosis and [[adenomyosis]] were considered together.<ref name="Bro2012" />

It chiefly affects adults from premenarche to postmenopause, regardless of race or ethnicity or whether or not they have had children, and is estimated to affect over 190 million women in their reproductive years.<ref name="Nothnick">{{cite journal | vauthors = Nothnick WB | title = The emerging use of aromatase inhibitors for endometriosis treatment | journal = Reproductive Biology and Endocrinology | volume = 9 | page = 87 | date = June 2011 | pmid = 21693036 | pmc = 3135533 | doi = 10.1186/1477-7827-9-87 | doi-access = free | title-link = doi }}</ref> Incidences of endometriosis have occurred in postmenopausal individuals,<ref name="Medscape">{{cite journal | vauthors = Bulun SE, Zeitoun K, Sasano H, Simpson ER | title = Aromatase in aging women | journal = Seminars in Reproductive Endocrinology | volume = 17 | issue = 4 | pages = 349–58 | year = 1999 | pmid = 10851574 | doi = 10.1055/s-2007-1016244 | s2cid = 25628258 }}</ref> and in less common cases, individuals may have had endometriosis symptoms before they even reach menarche.<ref>{{cite journal | vauthors = Batt RE, Mitwally MF | title = Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and pedagogy | journal = Journal of Pediatric and Adolescent Gynecology | volume = 16 | issue = 6 | pages = 337–47 | date = December 2003 | pmid = 14642954 | doi = 10.1016/j.jpag.2003.09.008 }}</ref><ref name="Marsh EE 2004">{{cite journal |vauthors=Marsh EE, Laufer MR |date=March 2005 |title=Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly |journal=Fertility and Sterility |volume=83 |issue=3 |pages=758–60 |doi=10.1016/j.fertnstert.2004.08.025 |pmid=15749511 |doi-access=free |title-link=doi}}</ref>

The rate of recurrence of endometriosis is estimated to be 40-50% for adults over five years.<ref name=":4">{{cite journal | vauthors = Guo SW | title = Recurrence of endometriosis and its control | journal = Human Reproduction Update | volume = 15 | issue = 4 | pages = 441–61 | date = 11 March 2009 | pmid = 19279046 | doi = 10.1093/humupd/dmp007 | doi-access = free | title-link = doi }}</ref> The rate of recurrence has been shown to increase with time from surgery and is not associated with the stage of the disease, initial site, surgical method used, or post-surgical treatment.<ref name=":4" />

==History==
Endometriosis was first discovered microscopically by [[Carl von Rokitansky|Karl von Rokitansky]] in 1860,<ref name="batt">{{cite book| vauthors = Batt RE |title=A history of endometriosis|year=2011|publisher=Springer|location=London|isbn=978-0-85729-585-9|pages=13–38|doi=10.1007/978-0-85729-585-9}}</ref> although the earliest antecedents may have stemmed from concepts published almost 4,000 years ago.<ref name="nezhat">{{cite journal | vauthors = Nezhat C, Nezhat F, Nezhat C | title = Endometriosis: ancient disease, ancient treatments | journal = Fertility and Sterility | volume = 98 | issue = 6 Suppl | pages = S1-62 | date = December 2012 | pmid = 23084567 | doi = 10.1016/j.fertnstert.2012.08.001 | doi-access = free | title-link = doi }}</ref> The [[Hippocratic Corpus]] outlines symptoms similar to endometriosis, including uterine ulcers, adhesions, and infertility.<ref name=nezhat/> Historically, women with these symptoms were treated with [[leech]]es, [[straitjacket]]s, [[bloodletting]], chemical [[douche]]s, [[Female genital mutilation|genital mutilation]], pregnancy (as a form of treatment), hanging upside down, surgical intervention, and even killing due to suspicion of [[demonic possession]].<ref name=nezhat/> Hippocratic doctors recognized and treated chronic pelvic pain as a true organic disorder 2,500 years ago, but during the Middle Ages, there was a shift into believing that women with pelvic pain were mad, immoral, imagining the pain, or simply misbehaving.<ref name=nezhat/> The symptoms of inexplicable chronic pelvic pain were often attributed to imagined madness, female weakness, promiscuity, or [[hysteria]].<ref name=nezhat/> The historical diagnosis of hysteria, which was thought to be a psychological disease, may have indeed been endometriosis in many cases.<ref name=nezhat/> The idea that chronic pelvic pain was related to mental illness influenced modern attitudes regarding individuals with endometriosis, leading to delays in correct diagnosis and indifference to the patients' true pain throughout the 20th and into the 21st century.<ref name=nezhat/>

Hippocratic doctors believed that delaying childbearing could trigger diseases of the uterus, which caused endometriosis-like symptoms. Women with dysmenorrhea were encouraged to marry and have children at a young age.<ref name=nezhat/> The fact that Hippocratics were recommending changes in marriage practices due to an endometriosis-like illness implies that this disease was likely common.<ref name=nezhat/>

The theory of retrograde menstruation as a cause of endometriosis was first proposed by [[John A. Sampson]].<ref name="vanderLinden1996" /><ref name="sampson27ajppmcid">{{cite journal |vauthors=Sampson JA |date=March 1927 |title=Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation |journal=Am. J. Pathol. |volume=3 |issue=2 |pages=93–110.43 |pmc=1931779 |pmid=19969738}}</ref>

The early treatment of endometriosis was [[surgery|surgical]] and included [[oophorectomy]] (removal of the ovaries) and hysterectomy (removal of the uterus).<ref name="pmid17857917">{{cite journal | vauthors = Meigs JV | title = Endometriosis—Its Significance | journal = Ann. Surg. | volume = 114 | issue = 5 | pages = 866–74 | date = November 1941 | pmid = 17857917 | pmc = 1385984 | doi = 10.1097/00000658-194111000-00007 }}</ref> In the 1940s, the only available hormonal therapies for endometriosis were high-dose [[testosterone (medication)|testosterone]] and [[high-dose estrogen]] therapy.<ref name=barbieri1992>{{cite journal | vauthors = Barbieri RL | title = Hormonal therapy of endometriosis | journal = Infertility and Reproductive Medicine Clinics of North America | volume = 3 | issue = 1 | pages = 187–200 | date = January 1992 | quote = The hormonal therapy of endometriosis continues to evolve. In the 1940s and 1950s, high-dose testosterone and diethylstilbestrol regimens were the only hormonal agents available in the treatment of endometriosis. These agents, although efficacious, were associated with intolerable side effects. The current armamentarium of hormonal GnRH analogues, danazol, and synthetic progestins is efficacious and has fewer side effects.}}</ref> High-dose estrogen therapy with [[diethylstilbestrol]] for endometriosis was first reported by Karnaky in 1948 and was the main [[medication|pharmacological]] treatment for the condition in the early 1950s.<ref name="Aiman2012">{{cite book | vauthors = Aiman J |title=Infertility: Diagnosis and Management|url=https://books.google.com/books?id=D4_TBwAAQBAJ&pg=PA261|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-1-4613-8265-2|pages=261–}}</ref><ref name="Josimovich2013">{{cite book| vauthors = Josimovich JB |title=Gynecologic Endocrinology|url=https://books.google.com/books?id=9vv2BwAAQBAJ&pg=PA387|date=11 November 2013|publisher=Springer Science & Business Media |isbn=978-1-4613-2157-6|pages=387–}}</ref><ref name="Kistner1995">{{cite book| vauthors = Kistner RW |title=Kistner's Gynecology: Principles and Practice|url=https://books.google.com/books?id=WAdtAAAAMAAJ|year=1995|publisher=Mosby|isbn=978-0-8151-7479-0|page=263}}</ref> [[Pseudopregnancy]] (high-dose estrogen–progestogen therapy) for endometriosis was first described by Kistner in the late 1950s.<ref name="Aiman2012" /><ref name="Josimovich2013" /> Pseudopregnancy, as well as progestogen monotherapy, dominated the treatment of endometriosis in the 1960s and 1970s.<ref name="Kistner1995" /> These agents, although efficacious, were associated with intolerable side effects. [[Danazol]] was first described for endometriosis in 1971 and became the main therapy in the 1970s and 1980s.<ref name="Aiman2012" /><ref name="Josimovich2013" /><ref name="Kistner1995" /> In the 1980s, [[GnRH agonist]]s gained prominence for the treatment of endometriosis and by the 1990s had become the most widely used therapy.<ref name="Josimovich2013" /><ref name="Kistner1995" /> Oral GnRH antagonists such as [[elagolix]] were introduced for the treatment of endometriosis in 2018.<ref name="pmid30763525">{{cite journal | vauthors = Barra F, Grandi G, Tantari M, Scala C, Facchinetti F, Ferrero S | title = A comprehensive review of hormonal and biological therapies for endometriosis: latest developments | journal = Expert Opin Biol Ther | volume = 19 | issue = 4 | pages = 343–360 | date = April 2019 | pmid = 30763525 | doi = 10.1080/14712598.2019.1581761 | s2cid = 73455399 | hdl = 11380/1201437 | hdl-access = free }}</ref>

==Society and culture==
===Public figures===
Several public figures have spoken about their experience with endometriosis, including:
{{div col |colwidth=20em}}
* [[RuthAnne]]<ref>{{cite web |vauthors=Gallagher K |date=31 March 2021 |title=Irish songwriter Ruth Anne opens up on her debilitating fight with endometriosis |url=https://www.irishmirror.ie/showbiz/irish-songwriter-ruthanne-opens-up-23831453 |access-date=11 April 2023 |website=Irish Mirror |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411192710/https://www.irishmirror.ie/showbiz/irish-songwriter-ruthanne-opens-up-23831453 |url-status=live }}</ref>
* [[Emma Barnett]]<ref>{{cite web|url=https://www.theguardian.com/commentisfree/2020/oct/22/endometriosis-women-pain-diagnosis-report-mps|title=Endometriosis showed me we need better ways to talk about women's pain &#124; Emma Barnett|website=[[TheGuardian.com]]|date=22 October 2020}}</ref>
* [[Emma Bunton]]<ref>{{cite web |url=https://www.her.ie/entertainment/nearly-broke-spice-girls-emma-bunton-describes-struggling-conceive-endometriosis-491098 |title='Nearly broke me' Spice Girls' Emma Bunton describes struggling to conceive with endometriosis |work=[[Her.ie]] |date=11 May 2020 |access-date=28 May 2021 | vauthors = Hayden J }}</ref>
* [[Alexa Chung]]<ref>{{cite web |date=18 July 2019 |title=Alexa Chung Reveals Her Battle With Endometriosis—And Taps Into an Empowering Online Community |url=https://www.vogue.com/article/alexa-chung-endometriosis-battle-instagram-community |access-date=11 April 2023 |website=Vogue |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411192807/https://www.vogue.com/article/alexa-chung-endometriosis-battle-instagram-community |url-status=live }}</ref>
* [[Danielle Collins]]<ref>{{cite news|url=https://www.wtatennis.com/news/2211449/champions-corner-collins-unleashes-the-best-tennis-of-her-career-after-life-changing-surgery|title=Champions Corner: Collins unleashes the best tennis of her career after life-changing surgery|website=Women's Tennis Association|access-date=3 March 2022|archive-date=2 February 2022|archive-url=https://web.archive.org/web/20220202222551/https://www.wtatennis.com/news/2211449/champions-corner-collins-unleashes-the-best-tennis-of-her-career-after-life-changing-surgery|url-status=live}}</ref>
* [[Olivia Culpo]]<ref>{{cite magazine |title=Watch: Olivia Culpo Shares Emotional Details of Her Endometriosis Journey |url=https://lifestyle.si.com/wellness/olivia-culpo-shares-endometriosis-journey |magazine=Sports Illustrated}}</ref>
* [[Lena Dunham]]<ref>{{cite web |title=Lena Dunham Gives Health Update Following Battle with Endometriosis |website=People |url=https://people.com/celebrity/lena-dunham-gives-health-update-following-battle-with-endometriosis/ |access-date=11 April 2023 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191944/https://people.com/celebrity/lena-dunham-gives-health-update-following-battle-with-endometriosis/ |url-status=live }}</ref>
* [[Diana Falzone]]
* [[Abby Finkenauer]]<ref>{{cite web|date=5 March 2020 |title=Congresswoman Abby Finkenauer Opens Up About Her Struggle With Endometriosis |website=Glamour |url=https://www.glamour.com/story/abby-finkenauer-endometriosis-caucus|access-date=17 December 2021}}</ref>
* [[Bethenny Frankel]]<ref>{{cite web |title=EXCLUSIVE: Bethenny Frankel in Tears Over Recent Health Scare: 'I Really Tried to Hold It All Together' |website=Entertainment Tonight |url=https://www.etonline.com/news/191621_bethenny_frankel_tears_over_recent_health_scare_i_really_tried_to_hold_it_all_together |access-date=11 April 2023 |date=22 June 2016 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191944/https://www.etonline.com/news/191621_bethenny_frankel_tears_over_recent_health_scare_i_really_tried_to_hold_it_all_together |url-status=live }}</ref>
* [[Whoopi Goldberg]]<ref>{{cite web |url=https://www.endofound.org/blossom-ball-2009-whoopi-goldberg/ |title=Blossom Ball 2009 – Whoopi Goldberg |publisher=[[Endometriosis Foundation of America]] |date=27 November 2007 |access-date=21 January 2021}}</ref>
* [[Mel Greig]]<ref>{{cite news |title=Radio presenter Mel Greig's shocking photo shows reality of living with endometriosis |url=https://www.news.com.au/lifestyle/health/health-problems/radio-presenter-mel-greigs-shocking-photo-shows-reality-of-living-with-endometriosis/news-story/4638a8c8899928d4ebb8dfd82ef820a7 |work=[[News.com.au]] |date=28 March 2018 |access-date=21 January 2021 |archive-date=13 November 2018 |archive-url=https://web.archive.org/web/20181113210524/https://www.news.com.au/lifestyle/health/health-problems/radio-presenter-mel-greigs-shocking-photo-shows-reality-of-living-with-endometriosis/news-story/4638a8c8899928d4ebb8dfd82ef820a7 |url-status=live }}</ref>
* [[Halsey (singer)|Halsey]]<ref>{{cite magazine |url=https://www.billboard.com/articles/news/7647866/halsey-surgery-endometriosis/ |title=Halsey undergoes surgery to treat endometriosis |magazine=[[Billboard (magazine)|Billboard]] |date=7 January 2017 |access-date=27 November 2018 | vauthors = Iasimone A }}</ref>
* [[Emma Hayes]]<ref>{{cite web |title=Emma Hayes: Chelsea manager has emergency hysterectomy because of endometriosis |url=https://www.bbc.co.uk/sport/football/63246126 |website=BBC Sport |publisher=BBC |access-date=28 December 2022 |date=13 October 2022 |archive-date=28 December 2022 |archive-url=https://web.archive.org/web/20221228162245/https://www.bbc.co.uk/sport/football/63246126 |url-status=live }}</ref>
* [[Julianne Hough]]<ref>{{cite web |url=https://www.today.com/health/julianne-hough-endometriosis-i-just-thought-it-was-normal-t116059 |title=Julianne Hough opens up about endometriosis: 'I just thought it was normal' |work=[[Today (American TV program)|Today]] |date=9 September 2017 |access-date=21 January 2021 |vauthors=Murray R |archive-date=13 November 2018 |archive-url=https://web.archive.org/web/20181113210750/https://www.today.com/health/julianne-hough-endometriosis-i-just-thought-it-was-normal-t116059 |url-status=live }}</ref><ref>{{cite web |date=23 April 2018 |title=Julianne Hough Won't Let Endometriosis Stop Her From Having a Family With Brooks Laich: "We've Discussed Options" |url=https://www.endofound.org/julianne-hough-wont-let-endometriosis-stop-her-from-having-a-family-with-brooks-laich-weve-discussed |access-date=31 December 2023 |website=Endometriosis : Causes - Symptoms - Diagnosis - and Treatment |archive-date=31 December 2023 |archive-url=https://web.archive.org/web/20231231012944/https://www.endofound.org/julianne-hough-wont-let-endometriosis-stop-her-from-having-a-family-with-brooks-laich-weve-discussed |url-status=live }}</ref><ref>{{cite web |vauthors=Olya G |date=24 March 2017 |title=Julianne Hough Opens Up About Her Struggle with Endometriosis |url=https://people.com/health/julianne-hough-endometriosis/ |access-date=31 December 2023 |website=Peoplemag |archive-date=31 December 2023 |archive-url=https://web.archive.org/web/20231231012944/https://people.com/health/julianne-hough-endometriosis/ |url-status=live }}</ref>
* [[Bridget Hustwaite]]<ref>{{cite web |url=https://www.abc.net.au/triplej/programs/hack/pain-of-endometriosis-sucks-but-so-does-just-getting-a-diagnosis/10119888/ |title=Endometriosis: The pain sucks, but so does just getting a diagnosis |work=[[Hack (radio program)|Hack]] on [[Triple J]] |date=14 August 2018 |access-date=21 January 2021 |vauthors=Hustwaite B |author-link=Bridget Hustwaite |archive-date=18 August 2018 |archive-url=https://web.archive.org/web/20180818073027/https://www.abc.net.au/triplej/programs/hack/pain-of-endometriosis-sucks-but-so-does-just-getting-a-diagnosis/10119888/ |url-status=live }}</ref>
* [[Bindi Irwin]]<ref>{{cite news |url=https://www.abc.net.au/news/2023-03-08/bindi-irwin-reveals-struggle-with-endometriosis/102066858 |title=On International Women's Day, Bindi Irwin reveals 10-year struggle with endometriosis |vauthors=Dye J |website=Australian Broadcasting Corporation News |date=8 March 2023 |access-date=10 March 2023 |archive-date=9 March 2023 |archive-url=https://web.archive.org/web/20230309213705/https://www.abc.net.au/news/2023-03-08/bindi-irwin-reveals-struggle-with-endometriosis/102066858 |url-status=live }}</ref>
* [[Jaime King]]<ref>{{cite web |date=24 April 2022 |title=Why Jaime King Decided It Was Time to Talk About Her Years-Long Fertility Struggle |url=https://www.eonline.com/news/1327944/why-jaime-king-decided-it-was-time-to-talk-about-her-years-long-fertility-struggle |access-date=11 April 2023 |website=E! Online}}</ref>
* [[Padma Lakshmi]]<ref>{{cite web |url=https://www.youtube.com/watch?v=Gfixp0jUjKg |title=Padma Lakshmi shares her struggle with endometriosis |work=[[Redbook]] |via=[[YouTube]] |date=17 October 2011 |access-date=9 March 2021 |archive-url=https://web.archive.org/web/20201102201459/https://www.youtube.com/watch?v=Gfixp0jUjKg |archive-date=2 November 2020 |url-status=live}}</ref>
* [[Cyndi Lauper]]<ref>{{cite news |vauthors=Hajdu D |date=30 November 2012 |title='80s Pop |work=[[The New York Times]] |url=https://www.nytimes.com/2012/12/02/books/review/cyndi-lauper-a-memoir.html |access-date=11 April 2023 |issn=0362-4331 |archive-date=29 June 2017 |archive-url=https://web.archive.org/web/20170629020918/https://www.nytimes.com/2012/12/02/books/review/cyndi-lauper-a-memoir.html |url-status=live }}</ref>
* [[Jillian Michaels]]<ref>{{cite web |title=No Kidding: Jillian Michaels is Not "Doing That" to Her Body |url=https://www.bitchmedia.org/post/no-kidding-jillian-michaels-is-not-doing-that-to-her-body |access-date=11 April 2023 |website=Bitch Media |date=7 February 2011 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191944/https://www.bitchmedia.org/post/no-kidding-jillian-michaels-is-not-doing-that-to-her-body }}</ref>
* [[Monica (singer)|Monica]]<ref>{{cite web |date=9 June 2021 |title=Monica's Second Surgery For Her Endometriosis Was 'Very Hard' And She 'Ended Up Having Multiple Blood Transfusions' |url=https://madamenoire.com/1230703/monica-endometriosis-2/ |access-date=11 April 2023 |website=MadameNoire |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191944/https://madamenoire.com/1230703/monica-endometriosis-2/ |url-status=live }}</ref>
* [[Marilyn Monroe]]<ref>{{cite web |vauthors=Wilson-Beevers H |date=28 September 2022 |title=Marilyn Monroe's battle with endometriosis is often ignored – but it's a vital part of her story |website=Cosmopolitan |url=https://www.cosmopolitan.com/uk/body/health/a41419168/marilyn-monroe-endometriosis/ |access-date=11 April 2023 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411195217/https://www.cosmopolitan.com/uk/body/health/a41419168/marilyn-monroe-endometriosis/ |url-status=live }}</ref>
* [[Tia Mowry]]<ref>{{cite web |vauthors=Henderson W |date=14 June 2017 |title=Tia Mowry Releases a Cookbook for Women With Endometrosis |url=https://endometriosisnews.com/2017/06/14/tia-mowry-introduces-cookbook-for-women-with-endometriosis/ |access-date=11 April 2023 |website=Endometriosis News |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191944/https://endometriosisnews.com/2017/06/14/tia-mowry-introduces-cookbook-for-women-with-endometriosis/ |url-status=live }}</ref>
* [[Sinéad O'Connor]]<ref>{{cite web |vauthors=Devereux N |url=https://vipmagazine.ie/sinead-oconnor-tells-of-illness-hell/ |title=Sinead O'Connor tells of illness hell: "I'm in a bad way" |date=19 August 2015 |access-date=5 August 2023 |archive-date=5 August 2023 |archive-url=https://web.archive.org/web/20230805193756/https://vipmagazine.ie/sinead-oconnor-tells-of-illness-hell/ |url-status=live }}</ref>
* [[Dolly Parton]]<ref>{{cite web| vauthors = Vargas A |title=12 celebrities who have opened up about having endometriosis |url=https://www.insider.com/celebrities-with-endometriosis-2019-3 |access-date=6 August 2021|website=Insider}}</ref>
* [[Florence Pugh]]<ref>{{cite web|last1=Shultz|first1=Cara Lynn|title=Florence Pugh Says It Was a 'Mind-Boggling Realization' to Learn She Had to Freeze Her Eggs at 27|url=https://people.com/florence-pugh-froze-eggs-27-pcos-endometriosis-she-md-podcast-8746962|website=People|date=19 November 2024|access-date=19 November 2024|archive-date=19 November 2024|archive-url=https://web.archive.org/web/20241119154617/https://people.com/florence-pugh-froze-eggs-27-pcos-endometriosis-she-md-podcast-8746962|url-status=live}}</ref>
* [[Daisy Ridley]]<ref>{{cite web |vauthors=Scott E |url=https://www.cosmopolitan.com/uk/entertainment/news/a43962/daisy-ridley-opened-up-about-her-struggle-with-endomitriosis/ |title=Daisy Ridley opened up about her struggle with endometriosis |work=[[Cosmopolitan (magazine)|Cosmopolitan]] |date=12 June 2016 |access-date=29 June 2021 |archive-date=8 August 2016 |archive-url=https://web.archive.org/web/20160808102649/http://www.cosmopolitan.co.uk/entertainment/news/a43962/daisy-ridley-opened-up-about-her-struggle-with-endomitriosis/ |url-status=live }}</ref>
* [[Emma Roberts]]<ref>{{cite web | publisher = Condé Nast |url=https://www.self.com/story/emma-roberts-endometriosis-pregnancy/ |title=Emma Roberts shares how her undiagnosed endometriosis affected her pregnancy journey |work=[[Self (magazine)|Self]] |date=11 November 2020 |access-date=15 July 2021}}</ref>
* [[Susan Sarandon]]<ref>{{cite web |title=EFA2011: Susan Sarandon speaks up about endometriosis |work=Endometriosis.org |url=https://endometriosis.org/news/congress-highlights/susan-sarandon-speaks-up-about-endometriosis/ |access-date=11 April 2023 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411191946/https://endometriosis.org/news/congress-highlights/susan-sarandon-speaks-up-about-endometriosis/ |url-status=live }}</ref>
* [[Amy Schumer]]<ref>{{cite web |title=Amy Schumer 'feeling good' after endometriosis surgery and liposuction |url=https://independenttribune.com/entertainment/amy-schumer-feeling-good-after-endometriosis-surgery-and-liposuction/video_b81d1935-b96d-5726-999a-83464d9cb89b.html |access-date=11 April 2023 |website=The Independent Tribune |date=20 January 2022 |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411192345/https://independenttribune.com/entertainment/amy-schumer-feeling-good-after-endometriosis-surgery-and-liposuction/video_b81d1935-b96d-5726-999a-83464d9cb89b.html |url-status=live }}</ref>
* [[Kirsten Storms]]<ref>{{cite web|date=25 December 2012|title='General Hospital': Kirsten Storms opens up about return – The TV Guy – Orlando Sentinel|url=http://blogs.orlandosentinel.com/entertainment_tv_tvblog/2012/08/general-hospital-kirsten-storms-opens-up-about-return.html|access-date=18 October 2021|archive-url=https://web.archive.org/web/20121225185503/http://blogs.orlandosentinel.com/entertainment_tv_tvblog/2012/08/general-hospital-kirsten-storms-opens-up-about-return.html|archive-date=25 December 2012}}</ref>
* [[Gabrielle Union]]<ref>{{cite web | vauthors = Haller S |title=Gabrielle Union says she probably can't get pregnant because of adenomyosis. What exactly is that? |website=USA Today |url=https://www.usatoday.com/story/life/allthemoms/2018/08/15/gabrielle-union-explains-infertility-type-endometriosis-called-adenomyosis/999052002/ |access-date=11 April 2023}}</ref>
* [[Lacey Schwimmer]]<ref>{{cite web |vauthors=((Staff Writer)) |title=Another victim of the 'Dancing With The Stars' curse |url=https://www.dispatch.com/story/news/2008/10/30/another-victim-dancing-with-stars/24005782007/ |access-date=31 December 2023 |website=The Columbus Dispatch |archive-date=19 January 2024 |archive-url=https://web.archive.org/web/20240119032448/https://www.dispatch.com/story/news/2008/10/30/another-victim-dancing-with-stars/24005782007/ |url-status=live }}</ref><ref>{{cite web |vauthors=Richenthal M |date=30 October 2008 |title=Lacey Schwimmer is Also Sick |url=https://www.tvfanatic.com/2008/10/lacey-schwimmer-is-also-sick/ |access-date=31 December 2023 |website=TV Fanatic |archive-date=31 December 2023 |archive-url=https://web.archive.org/web/20231231012944/https://www.tvfanatic.com/2008/10/lacey-schwimmer-is-also-sick/ |url-status=live }}</ref><ref>{{cite web |date=23 March 2017 |title=Lena Dunham, Julianne Hough and More Who've Opened Up About Endometriosis Battles: "You Don't Have to Ignore Pain" |website=E! Online |url=https://www.eonline.com/news/838260/lena-dunham-julianne-hough-and-more-who-ve-opened-up-about-endometriosis-battles-you-don-t-have-to-ignore-pain |access-date=31 December 2023 |archive-date=31 December 2023 |archive-url=https://web.archive.org/web/20231231012944/https://www.eonline.com/news/838260/lena-dunham-julianne-hough-and-more-who-ve-opened-up-about-endometriosis-battles-you-don-t-have-to-ignore-pain |url-status=live }}</ref>
* [[Chrissy Teigen]]<ref>{{cite web |vauthors=Mazziotta J |url=https://people.com/health/chrissy-teigen-endometriosis-surgery-better-than-pain/ |title=Chrissy Teigen says endometriosis surgery was 'a toughie' but better than 'the pain of endo' |work=[[People (magazine)|People]] |date=5 February 2021 |access-date=15 July 2021 |archive-date=15 July 2021 |archive-url=https://web.archive.org/web/20210715053905/https://people.com/health/chrissy-teigen-endometriosis-surgery-better-than-pain/ |url-status=live }}</ref>
* [[Emma Watkins]]<ref>{{cite web |url=https://www.perthnow.com.au/entertainment/yellow-wiggle-emma-watkins-opens-up-about-the-agony-of-endometriosis-ng-b881137647z |title=Yellow Wiggle Emma Watkins opens up about the agony of endometriosis |work=[[PerthNow]] |date=16 March 2019 |access-date=21 January 2021 |archive-date=6 February 2020 |archive-url=https://web.archive.org/web/20200206010025/https://www.perthnow.com.au/entertainment/yellow-wiggle-emma-watkins-opens-up-about-the-agony-of-endometriosis-ng-b881137647z |url-status=live }}</ref>
* [[Mae Whitman]]<ref>{{cite web |date=21 May 2020 |title=Mae Whitman: 'Endometriosis Is Like Being Shot With a Cannonball in the Stomach' |url=https://www.glamour.com/story/mae-whitman-on-navigating-a-hollywood-career-while-battling-endometriosis |access-date=11 April 2023 |website=Glamour |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411192952/https://www.glamour.com/story/mae-whitman-on-navigating-a-hollywood-career-while-battling-endometriosis |url-status=live }}</ref>
* [[Jessica Williams (actress)|Jessica Williams]]<ref>{{cite web |date=12 April 2022 |title=Jessica Williams on the 'Debilitating' Symptom That Led to Her Endometriosis Diagnosis |url=https://www.self.com/story/jessica-williams-endometriosis |access-date=11 April 2023 |website=Self |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411192859/https://www.self.com/story/jessica-williams-endometriosis |url-status=live }}</ref>
* [[Leah Williamson]]<ref>{{cite web |vauthors=Dervish-O'Kane R |title=Leah Williamson, captain of the Lionesses, is our January cover star |url=https://www.womenshealthmag.com/uk/health/a42306525/leah-williamson-january-2023/ |website=Women's Health |publisher=Hearst UK |access-date=28 December 2022 |date=27 December 2022 |archive-date=28 December 2022 |archive-url=https://web.archive.org/web/20221228000326/https://www.womenshealthmag.com/uk/health/a42306525/leah-williamson-january-2023/ |url-status=live }}</ref>
{{div col end}}

===Economic burden===
The economic burden of endometriosis is widespread and multifaceted.<ref name=":5">{{cite journal |vauthors=Gao X, Outley J, Botteman M, Spalding J, Simon JA, Pashos CL |title=Economic burden of endometriosis |journal=Fertility and Sterility |volume=86 |issue=6 |pages=1561–72 |date=December 2006 |pmid=17056043 |doi=10.1016/j.fertnstert.2006.06.015 |s2cid=20623034 |doi-access=free |title-link=doi}}</ref> Endometriosis is a chronic disease that has direct and indirect costs, which include loss of work days, direct costs of treatment, symptom management, and treatment of other associated conditions such as depression or chronic pain.<ref name=":5" /> One factor that seems to be associated with especially high costs is the delay between the onset of symptoms and diagnosis.

Costs vary greatly between countries.<ref>{{cite journal | vauthors = Koltermann KC, Dornquast C, Ebert AD, Reinhold T | s2cid = 32839234 | title = Economic Burden of Endometriosis: A Systematic Review | journal = Ann Reprod Med Treat | date = 2017 | volume = 2 | issue = 2m | page = 1015 }}</ref> Two factors that contribute to the economic burden include healthcare costs and losses in productivity. A Swedish study of 400 endometriosis patients found "Absence from work was reported by 32% of the women, while 36% reported reduced time at work because of endometriosis".<ref>{{cite journal | vauthors = Grundström H, Hammar Spagnoli G, Lövqvist L, Olovsson M | title = Healthcare Consumption and Cost Estimates Concerning Swedish Women with Endometriosis | journal = Gynecologic and Obstetric Investigation | volume = 85 | issue = 3 | pages = 237–244 | date = 2020 | pmid = 32248191 | doi = 10.1159/000507326 | s2cid = 214811610 | doi-access = free | title-link = doi }}</ref> An additional cross sectional study with Puerto Rican women, "found that endometriosis-related and coexisting symptoms disrupted all aspects of women's daily lives, including physical limitations that affected doing household chores and paid employment. The majority of women (85%) experienced a decrease in the quality of their work; 20% reported being unable to work because of pain, and over two-thirds of the sample continued to work despite their pain."<ref>{{cite journal | vauthors = Soliman AM, Coyne KS, Gries KS, Castelli-Haley J, Snabes MC, Surrey ES | title = The Effect of Endometriosis Symptoms on Absenteeism and Presenteeism in the Workplace and at Home | journal = Journal of Managed Care & Specialty Pharmacy | volume = 23 | issue = 7 | pages = 745–754 | date = July 2017 | pmid = 28650252 | doi = 10.18553/jmcp.2017.23.7.745 | pmc = 10398072 | doi-access = free | title-link = doi }}</ref> A study published in the UK in 2025 found that after women received a diagnosis of endometriosis in an English NHS hospital their earnings were on average £56 per month less in the four to five years after diagnosis than they were in the two years before. There was also a reduction in the proportion of women in employment.<ref>{{cite news |last1=Snowdon |first1=Catherine |title=Women with endometriosis earn less, research shows |url=https://www.bbc.co.uk/news/articles/c0k5rp87nzlo |access-date=5 February 2025 |publisher=BBC |date=5 February 2025}}</ref>

===Medical culture===
There are many barriers that those affected face in receiving a diagnosis and treatment for endometriosis. Some of these include outdated standards for laparoscopic evaluation, stigma about discussing menstruation and sex, lack of understanding of the disease, primary-care physicians' lack of knowledge, and assumptions about typical menstrual pain.<ref>{{cite journal | vauthors = As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, Laufer MR, Milspaw AT, Missmer SA, Norman A, Taylor RN, Wallace K, Williams Z, Yong PJ, Nebel RA | title = Assessing research gaps and unmet needs in endometriosis | journal = American Journal of Obstetrics and Gynecology | volume = 221 | issue = 2 | pages = 86–94 | date = August 2019 | pmid = 30790565 | doi = 10.1016/j.ajog.2019.02.033 | s2cid = 73480251 }}</ref> On average, those later diagnosed with endometriosis waited 2.3 years after the onset of symptoms before seeking treatment, and nearly three-quarters of women receive a misdiagnosis before endometriosis.<ref>{{cite journal |vauthors=Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, Tammaa A, Salzer H |title=Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences |journal=Human Reproduction |volume=27 |issue=12 |pages=3412–6 |date=December 2012 |pmid=22990516 |doi=10.1093/humrep/des316 |doi-access=free |title-link=doi}}</ref> Self-help groups say practitioners delay making the diagnosis, often because they do not consider it a possibility. There is a typical delay of 7–12 years from symptom onset in affected individuals to professional diagnosis.<ref>{{cite journal |date=December 2003 |title=Test d'auto-évaluation du JOGC |journal=Journal of Obstetrics and Gynaecology Canada |volume=25 |issue=12 |pages=1046–1051 |doi=10.1016/s1701-2163(16)30350-4 |issn=1701-2163}}</ref> There is a general lack of knowledge about endometriosis among primary care physicians. Half of the general health care providers surveyed in a 2013 study could not name three symptoms of endometriosis.<ref>{{cite journal | vauthors = Quibel A, Puscasiu L, Marpeau L, Roman H | title = [General practitioners and the challenge of endometriosis screening and care: results of a survey] | journal = Gynécologie, Obstétrique & Fertilité | volume = 41 | issue = 6 | pages = 372–80 | date = June 2013 | pmid = 22521982 | doi = 10.1016/j.gyobfe.2012.02.024 }}</ref> Healthcare providers are also likely to dismiss described symptoms as normal menstruation.<ref name="Time elapsed from onset of symptoms">{{cite journal | vauthors = Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL | title = Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women | journal = Human Reproduction | volume = 18 | issue = 4 | pages = 756–9 | date = April 2003 | pmid = 12660267 | doi = 10.1093/humrep/deg136 | doi-access = free | title-link = doi }}</ref> Younger patients may also feel uncomfortable discussing symptoms with a physician.<ref name="Time elapsed from onset of symptoms"/>

===Race and ethnicity===
Race and ethnicity may impact how endometriosis affects one's life. Endometriosis is less thoroughly studied among Black people, and the research that has been done is outdated.<ref>{{cite journal| vauthors = Shade GH, Lane M, Diamond MP |date=24 June 2011 |title=Endometriosis in the African American woman—racially, a different entity? |journal=Gynecological Surgery |volume=9 |pages=59–62 |doi=10.1007/s10397-011-0685-5 |s2cid=6288739 |doi-access=free |title-link=doi}}</ref><ref name=":6">{{cite journal | vauthors = Hoffman KM, Trawalter S, Axt JR, Oliver MN | title = Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites| journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 113 | issue = 16 | pages = 4296–301 | date = April 2016 | pmid = 27044069 | pmc = 4843483 | doi = 10.1073/pnas.1516047113 | doi-access = free | title-link = doi | bibcode = 2016PNAS..113.4296H }}</ref>
Cultural differences among ethnic groups also contribute to attitudes toward and treatment of endometriosis, especially in Hispanic or Latino communities. A study done in Puerto Rico in 2020 found that health care and interactions with friends and family related to discussing endometriosis were affected by stigma.<ref name=":8">{{cite journal | vauthors = Matías-González Y, Sánchez-Galarza AN, Flores-Caldera I, Rivera-Segarra E | title = "Es que tú eres una changa": stigma experiences among Latina women living with endometriosis | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 42 | issue = 1 | pages = 67–74 | date = March 2021 | pmid = 32964770 | doi = 10.1080/0167482X.2020.1822807 | pmc = 8893272 | s2cid = 221862356 }}</ref> The most common finding was a referral to those expressing pain related to endometriosis as "changuería" or "changas", terms used in Puerto Rico to describe pointless whining and complaining, often directed at children.<ref name=":8" />

=== Stigma ===
The existing stigma surrounding women's health, specifically endometriosis, can lead to patients not seeking diagnoses, lower quality of healthcare, increased barriers to care and treatment, and negative reception from members of society.<ref name="Stigma and Endometriosis: A Brief O">{{cite journal | vauthors = Sims OT, Gupta J, Missmer SA, Aninye IO | title = Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay | journal = International Journal of Environmental Research and Public Health | volume = 18 | issue = 15 | page = 8210 | date = August 2021 | pmid = 34360501 | pmc = 8346066 | doi = 10.3390/ijerph18158210 | doi-access = free }}</ref> Additionally, [[menstrual stigma]] significantly contributes to the broader issue of endometriosis stigma, creating an interconnected challenge that extends beyond reproductive health.<ref>{{cite journal | vauthors = Kocas HD, Rubin LR, Lobel M | title = Stigma and mental health in endometriosis | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | volume = 19 | article-number = 100228 | date = September 2023 | pmid = 37654520 | pmc = 10465859 | doi = 10.1016/j.eurox.2023.100228 | publisher = Elsevier BV | doi-access = free }}</ref><ref>{{cite web |vauthors=Henry JE |date=27 May 2022 |title=Period Stigma and the Unacknowledged System of Oppression |url=https://digitaleducation.stanford.edu/period-stigma-and-unacknowledged-system-oppression |access-date=24 November 2023 |website=Stanford {{!}} Digital Education |archive-date=24 November 2023 |archive-url=https://web.archive.org/web/20231124232217/https://digitaleducation.stanford.edu/period-stigma-and-unacknowledged-system-oppression |url-status=live }}</ref>
Widespread [[awareness campaign]]s, developments, and implementations aimed at multilevel anti-stigma organizational and structural changes, as well as more qualitative studies of the endometriosis stigma, help to overcome the harm of the phenomenon.<ref name="Stigma and Endometriosis: A Brief O"/>

== Research ==
A priority area of research is the search for endometriosis [[biomarker]]s, which can help with earlier diagnoses.<ref>{{cite journal |last=Pant |first=Anuja |last2=Moar |first2=Kareena |last3=K. Arora |first3=Taruna |last4=Maurya |first4=Pawan Kumar |date=2023 |title=Biomarkers of endometriosis |url=https://www.sciencedirect.com/science/article/pii/S0009898123003650 |journal=Clinica Chimica Acta |volume=549 |article-number=117563 |doi=10.1016/j.cca.2023.117563 |issn=0009-8981|url-access=subscription }}</ref> Studies have examined potential biomarkers such as [[microRNA]]s, [[glycoprotein]]s, and immune markers in blood, menstrual and urine samples, but none have shown the high accurarcy needed for clinical use yet. [[CA-125]], a tumor marker, has been studied extensively. It is elevated in endometriosis, but also in many other conditions, and cannot be used on its own. MicroRNAs might be most promosing, but the high diversity in expression makes them a challenging target.<ref>{{cite journal |last1=Agostinis |first1=C. |last2=Battista |first2=N. |last3=Costanzo |first3=M. |year=2021 |title=The Search for Biomarkers in Endometriosis: a Long and Windy Road |journal=Reproductive Sciences |volume=28 |issue=10 |pages=2751–2766 |doi=10.1007/s43032-021-00668-2}}</ref>

Preliminary research on mouse models showed that monoclonal antibodies, as well as inhibitors of [[MYD88|MyD88]] downstream signaling pathway, can reduce lesion volume. Thanks to that, clinical trials are being done on using a monoclonal antibody directed against IL-33 and using [[anakinra]], an IL-1 receptor antagonist.<ref name="Saunders Horne 2021 pp. 2807–2824">{{cite journal | vauthors = Saunders PT, Horne AW | title = Endometriosis: Etiology, pathobiology, and therapeutic prospects | journal = Cell | volume = 184 | issue = 11 | pages = 2807–2824 | date = May 2021 | pmid = 34048704 | doi = 10.1016/j.cell.2021.04.041 | publisher = Elsevier BV | hdl = 20.500.11820/bb7ded31-cc3d-449e-a0dc-ce4b1a0531d2 | s2cid = 235226513 | doi-access = free | title-link = doi | hdl-access = free }}</ref>

Taking contraceptive pills or getting long-acting progestogen injections seems to be equally effective for preventing recurring pain after endometriosis surgery. Compared to taking the pill, progestogen might result in a reduced risk of needing further treatments or surgery.<ref name=":9" /><ref>{{cite journal |last1=Cooper |first1=Kevin G |last2=Bhattacharya |first2=Siladitya |last3=Daniels |first3=Jane P |last4=Cheed |first4=Versha |last5=Gennard |first5=Laura |last6=Leighton |first6=Lisa |last7=Pirie |first7=Danielle |last8=Melyda |first8=Melyda |last9=Monahan |first9=Mark |last10=Weckesser |first10=Annalise |last11=Roberts |first11=Tracy |last12=Denny |first12=Elaine |last13=Ocansey |first13=Laura |last14=Stubbs |first14=Clive |last15=Cox |first15=Emma |date=September 2024 |title=Preventing recurrence of endometriosis-related pain by means of long-acting progestogen therapy: the PRE-EMPT RCT |url=https://www.journalslibrary.nihr.ac.uk/hta/SQWY6998 |journal=Health Technology Assessment |volume=28 |issue=55 |pages=1–77 |doi=10.3310/SQWY6998 |issn=2046-4924 |pmc=11417646 |pmid=39259620 |archive-date=20 January 2025 |access-date=13 January 2025 |archive-url=https://web.archive.org/web/20250120151239/https://www.journalslibrary.nihr.ac.uk/hta/SQWY6998 }}</ref>

Clinical trials are exploring the potential benefits of cannabinoid extracts, [[dichloroacetic acid]], and [[curcuma]] capsules.<ref name="Saunders Horne 2021 pp. 2807–2824" />

== References ==
<references>

<ref name=zondervan32212520>{{cite journal |vauthors=Zondervan KT, Becker CM, Missmer SA |date=March 2020 |title=Endometriosis |journal=The New England Journal of Medicine |volume=382 |issue=13 |pages=1244–1256 |doi=10.1056/NEJMra1810764 |pmid=32212520 |s2cid=214644045}}</ref>

</references>

=== Cited sources ===
* {{cite book|url=https://bestpractice.bmj.com/topics/en-gb/355|vauthors=Solnik MJ, Sanders A|title=BMJ Best Practice: Endometriosis|year=2025|publisher=BMJ Publishing Group}}
* {{cite book |date=11 November 2024 |title=Recommendations {{!}} Endometriosis: diagnosis and management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293 |access-date=28 October 2025|publisher=[[National Institute for Health and Care Excellence]]|author=NICE}}
* {{cite book|url=https://www.eshre.eu/guideline/endometriosis|publisher=[[European Society of Human Reproduction and Embryology]]|title=Endometriosis: Guideline of European Society of Human Reproduction and Embryology|year=2022|author=ESHRE}}
{{SweGov}}

== External links ==
{{commons category|Endometriosis}}

{{Medical condition classification and resources
| DiseasesDB      = 4269
| ICD10           = {{ICD10|N|80||n|80}}
| ICD9            = {{ICD9|617.0}}
| ICDO            =
| OMIM            = 131200
| MedlinePlus     = 000915
| eMedicineSubj   = med
| eMedicineTopic  = 3419
| eMedicine_mult  = {{eMedicine2|ped|677}} {{eMedicine2|emerg|165}}
| MeshID          = D004715
| SNOMED CT       = 396224008
|ICD10CM={{ICD10CM|N80}}|ICD11={{ICD11|GA10}}
}}
{{Diseases of the pelvis, genitals and breasts}}
{{Portal bar | Medicine}}
{{Authority control}}

[[Category:Menstrual cycle]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Endometriosis| ]]
[[Category:Women's health]]