Severe period pain is often dismissed as something women simply have to endure. But menstrual pain that repeatedly stops you from working, attending school, sleeping, exercising or carrying out normal activities deserves medical attention.
One possible cause is endometriosis, a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. These growths can cause inflammation, scarring, pelvic pain and, for some women, difficulty becoming pregnant.
Endometriosis affects an estimated 10% of women of reproductive age worldwide, about 190 million people, according to the World Health Organization (WHO). Despite being common, diagnosis can take years because symptoms vary widely and are sometimes normalized or mistaken for other conditions. (World Health Organization)
This guide explains what endometriosis is, the symptoms to look out for, how it differs from ordinary menstrual cramps, how it is diagnosed and treated, and what it can mean for fertility.
What Is Endometriosis?
Endometriosis is a chronic inflammatory disease in which endometrium-like tissue develops outside the uterus.
The endometrium is the tissue lining the inside of the uterus. Endometriosis involves tissue that resembles this lining but grows in places where it normally should not be.
Endometriosis most commonly affects structures within the pelvis, including the ovaries, fallopian tubes and tissues surrounding the uterus. It can also involve the bowel or bladder. Less commonly, endometriosis can occur outside the pelvis, including in the abdomen or chest. (World Health Organization)
The abnormal tissue and associated inflammation can contribute to irritation, scar tissue called adhesions and ovarian cysts known as endometriomas.
Endometriosis is not an infection, is not a sexually transmitted infection, and is not caused by poor hygiene.
It is also different from endometrial cancer.
How Common Is Endometriosis?
WHO estimates that approximately 190 million women of reproductive age worldwide have endometriosis. (World Health Organization)
The exact prevalence in Nigeria is difficult to determine because population-level data are limited and many women may remain undiagnosed.
One Nigerian study conducted among 239 women undergoing their first diagnostic laparoscopy for gynaecological indications at a centre in Ibadan found endometriotic lesions in 48.1% of participants. This does not mean that almost half of Nigerian women have endometriosis because the study involved a selected group already undergoing laparoscopy rather than the general population. However, it demonstrates that endometriosis is an important condition among Nigerian women presenting for gynaecological care. (PubMed)
What Causes Endometriosis?
The exact cause of endometriosis remains unknown.
Several biological mechanisms have been proposed, but no single explanation accounts for every case.
Research has explored possible roles for menstrual tissue moving backwards through the fallopian tubes, immune-system differences, genetic susceptibility, hormonal influences and transformation of certain cells into endometrium-like tissue.
WHO notes that emerging evidence also suggests an association between endometriosis and immune-system dysregulation. (World Health Organization)
Having a family history of endometriosis may increase the likelihood of developing the condition.
Importantly, endometriosis is not caused by sexual activity, contraception, abortion, personal hygiene or something a woman did wrong.
What Are the Symptoms of Endometriosis?
Endometriosis does not affect everyone in the same way.
Some women experience severe symptoms, while others have mild symptoms or none at all.
Common symptoms include:
severe menstrual cramps or painful periods
chronic pelvic pain
lower abdominal or back pain
pain during or after sex
pain during bowel movements, particularly around menstruation
pain when urinating, particularly during menstruation
heavy menstrual bleeding
abdominal bloating
nausea
fatigue
difficulty becoming pregnant
WHO also recognizes the substantial effect endometriosis can have on mental health, relationships, sexual health, education, employment and overall quality of life. (World Health Organization)
When Is Period Pain Not Normal?
Having some discomfort during menstruation does not automatically mean you have endometriosis.
What matters is the severity, persistence and impact of the pain.
Period pain deserves medical assessment when it regularly:
prevents you from going to work or school
makes normal daily activities difficult
causes vomiting, fainting or severe weakness
does not improve adequately with ordinary pain relief
becomes progressively worse
occurs during sex
occurs during bowel movements or urination
continues outside your menstrual period
occurs alongside difficulty becoming pregnant
A useful rule is simple:
Pain that repeatedly disrupts your life should not automatically be dismissed as a normal period.
Can Teenagers Have Endometriosis?
Yes.
Endometriosis can begin during adolescence.
Teenagers with severe menstrual pain are sometimes told that painful periods are simply part of growing up. This can contribute to delayed diagnosis.
Persistent menstrual pain that interferes with school, sleep, sport or daily activities deserves assessment, particularly when symptoms do not respond adequately to initial treatment.
Current endometriosis guidelines specifically recognize the importance of evaluating adolescents with symptoms suggestive of the condition. (ACOG)
Endometriosis and Heavy Periods
Some women with endometriosis experience heavy menstrual bleeding.
Repeated heavy bleeding may contribute to iron deficiency and anaemia, which can cause tiredness, weakness, dizziness, headaches or shortness of breath.
However, heavy periods have many possible causes. Fibroids, adenomyosis, hormonal disorders and other gynaecological conditions can produce similar symptoms.
Heavy bleeding therefore should not automatically be attributed to endometriosis.
Endometriosis and Pain During Sex
Deep pelvic pain during or after sexual intercourse can occur with endometriosis.
This can affect sexual wellbeing, relationships and emotional health. Some women begin avoiding intercourse because they expect it to hurt.
Pain during sex has many possible causes, so persistent or recurrent pain should be discussed with a healthcare professional rather than self-diagnosed.
Endometriosis and Bowel or Bladder Symptoms
Endometriosis can sometimes affect areas around the bowel or bladder.
Possible symptoms include pain when passing stool, painful urination, constipation, diarrhoea, abdominal bloating or other bowel symptoms that become noticeably worse around menstruation.
These symptoms can resemble gastrointestinal or urinary conditions.
A useful clue for clinicians is whether symptoms repeatedly worsen in relation to the menstrual cycle.
Endometriosis and Fertility
One of the biggest concerns after an endometriosis diagnosis is:
Will I still be able to have a baby?
For many women, the answer is yes.
Having endometriosis does not automatically mean infertility.
However, endometriosis is associated with fertility problems in some women. WHO reports that among women experiencing infertility, an estimated 25% to 50% may have endometriosis. (World Health Organization)
Endometriosis may affect fertility through inflammation, adhesions, changes involving the ovaries or fallopian tubes and other mechanisms.
The effect varies considerably from person to person.
Some women with endometriosis become pregnant naturally. Others may require treatment.
Depending on age, disease severity, ovarian reserve, how long pregnancy has been attempted and other fertility factors, options may include surgery or assisted reproductive treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). (World Health Organization)
Women with endometriosis who hope to become pregnant should discuss their fertility goals early with their gynaecologist because treatment choices can differ depending on whether pregnancy is currently desired.
How Is Endometriosis Diagnosed?
One of the most important changes in modern endometriosis care is that women do not always have to undergo surgery before treatment can begin.
A clinician may start by taking a detailed history covering menstrual pain, pelvic pain, bleeding, pain during sex, bowel and urinary symptoms, previous pregnancies, fertility history and family history.
A physical or pelvic examination may also be performed where appropriate.
Imaging can then contribute to diagnosis.
Ultrasound
Ultrasound is commonly used when investigating suspected endometriosis.
A transvaginal ultrasound may help identify ovarian endometriomas and some forms of deeper endometriosis.
But an important point is:
A normal ultrasound does not necessarily rule out endometriosis.
Some endometriotic lesions are too small or located in places that routine ultrasound cannot easily identify.
MRI
Magnetic resonance imaging may be useful in selected cases, particularly when deeper disease is suspected or more detailed anatomical information is needed before treatment.
Laparoscopy
Laparoscopy is keyhole surgery in which a small camera is inserted into the abdomen to examine the pelvic organs. Suspicious tissue may also be removed for examination.
Historically, laparoscopy was considered central to establishing an endometriosis diagnosis.
Current practice has changed.
WHO states that a clinical diagnosis may be made using symptoms and imaging and that surgery is not necessarily required before treatment begins. (World Health Organization)
The American College of Obstetricians and Gynecologists' new 2026 endometriosis diagnostic guideline similarly supports clinical evaluation and imaging as part of establishing a presumptive diagnosis, helping patients begin appropriate management without automatically waiting for surgery. (ACOG)
This is particularly important in settings where specialist surgery is expensive or difficult to access.
Why Can Endometriosis Take So Long to Diagnose?
Endometriosis has historically been associated with substantial diagnostic delays.
WHO reports that the average time to diagnosis can range from approximately 4 to 12 years. (World Health Organization)
Several factors contribute:
Severe menstrual pain may be normalized.
Symptoms can resemble fibroids, irritable bowel syndrome, pelvic inflammatory disease, ovarian cysts, urinary problems or other conditions.
Routine scans may sometimes appear normal.
Symptoms vary widely between women.
Some patients also move between different healthcare providers before endometriosis is considered.
Greater awareness among women and healthcare professionals can help shorten this delay.
Is There a Blood Test for Endometriosis?
There is currently no routine blood test that can reliably diagnose or rule out endometriosis on its own.
Researchers continue to investigate blood, menstrual-fluid and other biomarkers, but these have not replaced clinical evaluation and appropriate imaging.
A commercial test should therefore not be assumed to provide a definitive diagnosis simply because it is marketed as an endometriosis test.
How Is Endometriosis Treated?
There is currently no treatment guaranteed to permanently cure endometriosis.
Treatment instead aims to control pain and other symptoms, improve quality of life, address fertility concerns where necessary and reduce the effects of the disease.
Management should be individualized according to:
symptoms
age
severity and location of disease
treatment preferences
previous treatments
possible side effects
fertility plans
cost and availability of care
Treatment may involve medication, hormonal therapy, surgery or a combination of approaches. (World Health Organization)
1. Pain Relief
Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen may be used to help control endometriosis-related pain in appropriate patients.
These medicines are not suitable for everyone. People with certain kidney problems, stomach ulcers, bleeding risks or other medical conditions may need alternatives.
Pain medicines can reduce symptoms but do not remove endometriosis lesions.
2. Hormonal Treatment
Hormonal treatment can reduce endometriosis-related pain for many women.
Options may include:
combined hormonal contraceptives
progestin-containing medicines
hormonal intrauterine devices
injectable hormonal contraception
gonadotropin-releasing hormone, or GnRH, medicines
other specialist hormonal treatments
The appropriate choice depends on the individual.
Hormonal treatment generally suppresses disease activity and symptoms rather than permanently eliminating endometriosis.
Some hormonal treatments also prevent pregnancy while being used, making fertility plans an important part of treatment decisions. (World Health Organization)
3. Surgery
Surgery may be considered when symptoms are severe, medical treatment has not worked adequately, particular forms of endometriosis need treatment or fertility circumstances make surgery appropriate.
Laparoscopic surgery can be used to remove endometriosis lesions, adhesions and endometriomas.
Surgery can substantially improve symptoms for some women.
However:
Endometriosis can recur after surgery.
Surgery should therefore not be presented as a guaranteed permanent cure.
Complex endometriosis, particularly disease affecting the bowel, bladder or other organs, may require care from an experienced multidisciplinary surgical team.
Does Removing the Uterus Cure Endometriosis?
Not necessarily.
A hysterectomy removes the uterus, but endometriosis is defined by tissue growing outside the uterus.
WHO notes that hysterectomy may be considered for selected patients who have not responded to other treatments and who do not plan future pregnancy, but it is not guaranteed to cure endometriosis, and symptoms can persist. (World Health Organization)
A decision about hysterectomy should therefore involve careful specialist counselling rather than being presented as a simple cure.
Can Endometriosis Come Back After Treatment?
Yes.
Symptoms may recur after medication is stopped, and endometriotic lesions or symptoms can recur after surgery.
Recurrence does not necessarily mean that treatment failed. Endometriosis is a chronic condition, and some women require long-term management.
Follow-up should therefore focus not only on eliminating visible lesions but also on pain control, fertility goals, daily functioning and quality of life.
Endometriosis vs Fibroids
Endometriosis and uterine fibroids are different conditions, although both can cause painful or heavy periods.
Endometriosis involves endometrium-like tissue outside the uterus.
Fibroids are non-cancerous growths made from muscle and fibrous tissue that develop in or around the uterus.
A woman can also have both conditions at the same time.
Ultrasound and clinical evaluation can help distinguish between them.
Endometriosis vs Adenomyosis
These conditions are also frequently confused.
In endometriosis, endometrium-like tissue occurs outside the uterus.
In adenomyosis, endometrial-type tissue is located within the muscular wall of the uterus.
They are separate conditions, although they can coexist. The European Society of Human Reproduction and Embryology specifically distinguishes adenomyosis from endometriosis rather than treating it as a subtype. (ESHRE)
Is Endometriosis Cancer?
No.
Endometriosis is not cancer.
It is a benign chronic inflammatory disease.
Research has identified associations between endometriosis and a small increase in the risk of certain ovarian cancers, but the absolute risk for an individual woman remains low. Having endometriosis does not mean that a woman has cancer or will develop cancer.
New or changing symptoms still deserve medical assessment rather than being automatically attributed to previously diagnosed endometriosis.
Can Endometriosis Be Prevented?
There is currently no proven method that prevents endometriosis.
WHO states that there is no known way to prevent the disease at present. (World Health Organization)
This makes early recognition and appropriate treatment particularly important.
Living With Endometriosis
Endometriosis is more than a painful-period condition.
Chronic pain can affect sleep, work, school, relationships, sexual health, fertility and mental wellbeing.
Some people benefit from multidisciplinary care involving gynaecologists, fertility specialists, pain specialists, physiotherapists and mental-health professionals.
Pelvic-floor physiotherapy and psychological approaches such as cognitive behavioural therapy may form part of chronic-pain management for selected patients. (World Health Organization)
Lifestyle measures such as regular physical activity, adequate sleep and balanced nutrition may support general wellbeing, but they should not be promoted as cures for endometriosis.
There is currently no specific diet proven to eliminate the disease.
Endometriosis in Nigeria: What Women Should Know
Endometriosis can be particularly challenging where access to specialist gynaecological care, advanced imaging, laparoscopy or fertility treatment is limited or expensive.
Women may also delay seeking care because painful periods are regarded as normal or because reproductive-health symptoms are difficult to discuss.
The Nigerian evidence that does exist shows why endometriosis should not be overlooked. In the Ibadan study of women undergoing diagnostic laparoscopy, painful menstruation was significantly associated with endometriosis. (PubMed)
If menstrual or pelvic pain is repeatedly disrupting your life, you do not need to wait until you are trying unsuccessfully to become pregnant before seeking medical care.
Start with a qualified healthcare provider and, where necessary, request referral to a gynaecologist.
Keeping a symptom diary for several menstrual cycles can also be useful. Record when pain occurs, its severity, bleeding, bowel or urinary symptoms, pain during sex, medicines taken and how symptoms affect work, school or normal activities.
That information can help your clinician see patterns that may otherwise be missed.
When Should You See a Doctor?
Arrange a medical assessment if you have severe or worsening menstrual pain, persistent pelvic pain, pain during sex, recurrent pain during bowel movements or urination around your period, unusually heavy periods or difficulty becoming pregnant.
Seek urgent medical care for sudden severe abdominal or pelvic pain, fainting, severe weakness, very heavy bleeding, persistent vomiting, fever with significant pelvic pain, or severe pain during pregnancy.
These symptoms are not specific to endometriosis and can sometimes indicate other conditions requiring urgent treatment.
Common Myths About Endometriosis
Myth: Severe period pain is normal.
Some menstrual discomfort is common, but pain that repeatedly prevents normal activities should be evaluated.
Myth: Endometriosis only affects older women.
Endometriosis can begin during adolescence.
Myth: Pregnancy cures endometriosis.
Pregnancy may temporarily change symptoms in some women, but it is not a treatment or cure.
Myth: Endometriosis always causes infertility.
No. Many women with endometriosis become pregnant naturally.
Myth: A normal ultrasound means you cannot have endometriosis.
No. Some forms of endometriosis may not be visible on routine ultrasound.
Myth: Surgery is always required before treatment can start.
No. Current guidance supports clinical assessment and imaging as part of diagnosis, and treatment may sometimes begin without surgical confirmation. (ACOG)
Myth: Hysterectomy permanently cures endometriosis.
Not necessarily. Endometriosis exists outside the uterus, and symptoms can persist after hysterectomy. (World Health Organization)
Frequently Asked Questions
Can endometriosis disappear on its own?
Symptoms may change over time, but endometriosis should not be assumed to have permanently disappeared simply because pain improves.
Can endometriosis cause back pain?
Yes. Some women experience lower back or pelvic pain associated with endometriosis.
Can you have endometriosis without painful periods?
Yes. Symptoms vary significantly, and some women have few or no obvious symptoms.
Can endometriosis make it difficult to get pregnant?
It can contribute to infertility in some women, but many women with endometriosis conceive naturally.
Can a scan detect endometriosis?
Ultrasound and MRI can detect some forms of endometriosis, but normal imaging does not necessarily exclude all disease.
Is there a permanent cure for endometriosis?
There is currently no guaranteed cure. Treatment focuses on controlling symptoms, improving quality of life and addressing fertility concerns when needed. (World Health Organization)
The Bottom Line
Endometriosis is a real chronic disease, not simply “bad period pain.”
Severe menstrual pain, chronic pelvic pain, painful sex, bowel or bladder symptoms that worsen around menstruation, heavy bleeding and difficulty becoming pregnant can all be reasons to investigate endometriosis.
Diagnosis also no longer automatically means waiting for surgery. Clinical history, examination and appropriate imaging can allow clinicians to identify suspected endometriosis and begin management in many patients. (ACOG)
Most importantly, women should not have to normalize pain that repeatedly disrupts their lives. Earlier recognition and appropriate care can make a substantial difference.
References
World Health Organization. Endometriosis. Updated October 15, 2025.
WHO Endometriosis Fact Sheet
American College of Obstetricians and Gynecologists. Diagnosis of Endometriosis. Clinical Practice Guideline No. 11. March 2026.
ACOG 2026 Diagnosis of Endometriosis Guideline
European Society of Human Reproduction and Embryology. ESHRE Guideline: Endometriosis.
ESHRE Endometriosis Guideline
Fawole AO, Bello FA, Ogunbode O, et al. Endometriosis and associated symptoms among Nigerian women. International Journal of Gynecology & Obstetrics. 2015;130(2):190-194.
PubMed record for the Nigerian endometriosis study
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