Endometriosis diagnosis and treatment (Diagnosis and management of endometriosis)

What is endometriosis, and how is it diagnosed and treated?

Endometriosis is a common long-term condition where tissue similar to the lining of the womb grows in other places, most often around the pelvis, on the ovaries, the bowel or the bladder. Each month this tissue responds to hormones and bleeds, causing inflammation, pain and sometimes scar tissue. It affects roughly 1 in 10 women and people assigned female at birth of reproductive age.

It can cause painful, heavy periods, ongoing pelvic pain, pain during or after sex, painful bowel movements or urination, tiredness, and difficulty getting pregnant. Importantly, the amount of endometriosis seen does not always match how bad the symptoms are — some people with a lot of disease have few symptoms, and some with little have severe pain. This, and the fact that symptoms overlap with other conditions, is part of why diagnosis is so often delayed.

Many people wait years for a diagnosis — studies suggest an average delay of around 4 to 10 years from first symptoms. If you feel you have not been listened to, or have been told period pain is 'just normal' when it stops you living your life, that experience is real and common, and it is reasonable to ask for further assessment.

Diagnosis uses your history, an examination, and a transvaginal ultrasound (and sometimes an MRI), which can show ovarian cysts (endometriomas) and deeper disease. However, a normal scan does not rule endometriosis out. A laparoscopy (keyhole look inside the tummy under general anaesthetic) remains the most definitive way to confirm it, and treatment can often be done at the same time. There is currently no cure, but the condition can usually be managed well, and treatment is tailored to whether your main concern is pain, fertility, or both.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your treatment

• Keep a symptom and period diary (pain, timing, effect on daily life, sex, bowels and bladder) to take to your appointment.
• Note any family history of endometriosis, as it raises the likelihood.
• Write down what you have already tried (painkillers, contraceptives) and how well it worked.
• Be clear about your priorities — pain relief, fertility, or both — as treatment is chosen around these.
• Bring a list of your medicines and any previous scan or surgery details.
• If a laparoscopy is planned, follow fasting instructions and arrange a lift home and about 1 to 2 weeks off.
• Consider bringing someone with you, and do not be afraid to ask for a referral to a specialist if symptoms are severe or complex.

What happens

Assessment usually starts in clinic with your symptom history and an examination. A transvaginal ultrasound is arranged, and sometimes an MRI, to look for ovarian cysts and deeper disease and to help plan any surgery. Because scans can be normal even when endometriosis is present, your clinician weighs the whole picture rather than relying on one test.

If the diagnosis is unclear, or if treatment is needed, a laparoscopy may be offered. Under general anaesthetic, the surgeon makes small cuts in the tummy, fills it with gas, and uses a camera to look directly at the pelvic organs. Endometriosis can usually be confirmed and, where appropriate, treated at the same time by removing or destroying the deposits and freeing any scar tissue.

For many people, treatment is medical rather than surgical: simple painkillers and anti-inflammatories first, then hormone treatments to reduce pain. The plan is shared with you and shaped around whether pain, fertility or both matter most, and it is often adjusted over time as symptoms change.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The biggest issue many people face is delay and not being believed — if period pain stops you living normally, that is a reason to push for assessment. With treatment, the main uncertainties are that pain may not fully resolve and can return, and that surgery for ovarian endometriomas can reduce egg reserve. If fertility matters, raise it early so treatment protects your options. Complex disease (bowel, bladder, ureter) is best managed in a specialist endometriosis centre.

Published figures to discuss

Endometriosis is variable, and so are outcomes. The figures worth understanding are the long diagnostic delay, the chance that pain returns or surgery needs repeating, and the effect of surgery on fertility. Because the disease and treatments differ so much between people, these are best discussed individually rather than quoted as precise odds, and reliable exact percentages for many outcomes do not exist.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from clinic assessment or scans. After a laparoscopy, most people recover within about 1 to 2 weeks. Managing endometriosis is usually an ongoing process rather than a one-off treatment, with the plan reviewed and adjusted over time.

• After laparoscopy: tummy and shoulder-tip pain, bloating and tiredness for several days
• Light vaginal bleeding or spotting after surgery
• A settling-in period of a few months when starting a new hormone treatment
• Pain that improves but may not disappear completely
• Needing to try more than one treatment to find what works for you

Aftercare

• After laparoscopy, take painkillers as advised, move gently, and keep wounds clean and dry.
• Build activity up gradually and avoid heavy lifting until cleared.
• Take hormone treatments as prescribed and give them time to work before judging them.
• Use a symptom diary to track whether treatment is helping.
• Use heat, gentle exercise, stretching, pelvic physiotherapy and relaxation techniques alongside medical treatment, as many find these help.
• Seek support — endometriosis can affect mood, relationships and work, and support groups and counselling can help.
• Report side effects or returning pain so the plan can be adjusted.
• If fertility is a goal, ask about timing and whether referral to a fertility service is appropriate.

• A symptom and period diary to track treatment
• Painkillers and any prescribed hormone treatment collected
• After surgery: a lift home, help at home and time off work
• Clarity on your priorities (pain, fertility or both) for the next review
• Contact details for your clinic or specialist centre
• Details of a support group or counselling if you want them
• A clear plan and date for your next review

⚠ Get urgent help if…

• After laparoscopy: a high temperature, severe or worsening tummy pain, or feeling very unwell (possible infection or internal bleeding)
• A red, hot, swollen calf, or breathlessness or chest pain (possible blood clot)
• Redness, swelling or discharge from a surgical wound
• Heavy vaginal bleeding or passing large clots
• Sudden, severe one-sided pelvic pain (which can have several causes and should be checked urgently)
• Low mood, hopelessness or thoughts of self-harm from living with chronic pain — seek help promptly
• New severe pain when passing urine or opening your bowels, or blood in either

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good result is a clearer diagnosis and a plan that reduces your pain and protects your fertility goals. Scans and laparoscopy together usually explain symptoms, and a thorough normal laparoscopy makes endometriosis unlikely. Surgery to remove endometriosis can ease pain and, when fertility is the aim, improve the chance of natural pregnancy.

It is honest to say there is no cure: treatment manages the condition, pain may not fully disappear, and symptoms or disease can return, sometimes needing further treatment. Hormone treatments control symptoms while you take them rather than removing the disease. Up to around 7 in 10 people with endometriosis are able to get pregnant naturally, but endometriosis can reduce fertility, so individual advice matters.

Endometriosis is a long-term condition, so management usually continues over years and the plan is adjusted as symptoms change. Hormone treatments work while you take them; surgery can give lasting relief for some but the condition can recur, and repeat surgery is sometimes needed. Symptoms often improve around the menopause as hormone levels fall. Ongoing review helps keep the plan matched to your needs and life stage.

Related tests, treatments or support

Endometriosis care is often combined: medical pain treatment alongside surgery, and surgery to remove endometriosis at the same time as treating an ovarian endometrioma or freeing adhesions. Pelvic physiotherapy, pain-management approaches and fertility care are commonly used together with medical and surgical treatment. If you are trying to conceive, hormone treatments are not used on their own to improve fertility, so the plan is coordinated with fertility care.

Follow-up & long-term care

Follow-up depends on your treatment: a review after starting hormone treatment to check it is helping, a post-operative review after laparoscopy, and ongoing reviews as a long-term condition. If pain returns, side effects are troublesome, or fertility plans change, that is a reason to be seen again and adjust the plan. Complex disease is followed up in a specialist endometriosis centre.

• Attend regular reviews to keep the plan matched to your symptoms and life plans.
• Continue hormone or pain treatment as agreed, and report if it stops working.
• Use self-management approaches (heat, exercise, stretching, pelvic physiotherapy, relaxation) alongside medical treatment.
• Raise fertility plans early, as timing can affect treatment choices.
• Seek emotional and peer support, as living with a chronic condition is demanding.
• Ask for referral to a specialist endometriosis centre if disease is complex or treatment is not helping.

Repeat, follow-on and what comes next

• Symptoms and disease can recur, so more than one treatment or operation may be needed over time.
• Hormone treatments work while taken; stopping them often allows symptoms to return.
• The diagnosis may be revisited if a laparoscopy is normal but symptoms persist, as other causes are considered.
• Complex or recurrent disease is best reviewed in a specialist endometriosis centre.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A named contact and clear plan for reviewing whether treatment is working.
• Coordination between gynaecology, pain management, physiotherapy and fertility care as needed.
• Honest information that the condition is managed rather than cured, with a plan that adapts over time.
• Access to emotional and peer support, and referral to a specialist centre for complex disease.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Consultation length and whether you see a general gynaecologist or a specialist endometriosis centre
• Imaging such as transvaginal ultrasound or MRI
• Whether a laparoscopy is done, and the surgeon, anaesthetist, theatre and facility fees
• The complexity of surgery (simple disease versus bowel, bladder or ureter involvement)
• Ongoing hormone or pain treatment and monitoring
• Follow-up appointments, pelvic physiotherapy and any fertility care

• What the consultation, scans and any laparoscopy each include
• The surgeon's, anaesthetist's and facility fees if surgery is planned
• What is included if surgery is more complex than expected
• Follow-up appointments and how results are given
• Whether ongoing treatment, physiotherapy or fertility care is included or separate
• What happens, and what it would cost, if symptoms persist or further surgery is needed

On the NHS? Endometriosis is diagnosed and treated on the NHS, including in specialist centres for complex disease; private care is also used, often to be seen sooner or for choice of specialist.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Based on my symptoms, do you think this could be endometriosis, and what assessment do you advise?
• Will a normal scan rule it out, or might I still need a laparoscopy?
• My main concern is pain / fertility / both — how does that change my treatment?
• What are the side effects of the hormone treatment you are suggesting?
• If I have surgery, could it affect my egg reserve, and how will you protect my fertility?
• Should I be referred to a specialist endometriosis centre, and what is the plan if treatment does not help?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for endometriosis diagnosis and treatment

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG73 — Endometriosis: diagnosis and management NHS — Endometriosis Endometriosis UK — What is endometriosis Endometriosis UK — Treatment and management Wellbeing of Women — What is endometriosis

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.