Written by Carolina Machado
Medically reviewed by Maria Emilia Garralda (Gynecologist and Obstetrician, Expert in Sexual and Reproductive Health)
Art by Jouli Di Marco

Endometriosis is a chronic disease that affects nearly 10% of people with a uterus—including cisgender women and transgender men. It causes life-impacting symptoms such as severe menstrual pain; pain during sex, bowel movements, or urination; chronic pelvic pain; bloating; nausea; fatigue; and, in some cases, depression, anxiety, or infertility. Symptoms can begin at the first period and last until menopause.

While there’s no known cure yet, many treatments can manage symptoms and help people live better lives. As this disease has historically been one of the most widely misdiagnosed—and nowadays many people may take up to seven years or more to be diagnosed—early diagnosis and improved physician training are critical for effective treatment.

Endometriosis Symptoms: More Than Just a Menstruation Problem

Endometriosis symptoms vary widely and often overlap with other conditions. According to the ESHRE Guideline, symptoms may develop a few days before menstruation and disappear a few days after it ends—or they may occur only during menstruation. Symptoms can include: 

• Painful menstrual periods (dysmenorrhea)
• Chronic pelvic pain
• Pain during/after sex (dyspareunia)
• Pain during urination (dysuria) or bowel movements (dyschezia)
• Fatigue
• Infertility
• Cyclical symptoms like chest pain, coughing blood, rectal bleeding, or shoulder pain

Diagnosis can’t rely on symptoms alone because they’re not specific. That’s why early and accurate detection is so important.

Endometriosis and Adenomyosis: Key Differences and Overlap

Both involve endometrial-like tissue, but differ in location:

• Endometriosis: Tissue grows outside the uterus, often on the ovaries, fallopian tubes, or other pelvic organs.
• Adenomyosis: Tissue grows into the myometrium, the muscular wall of the uterus. It may cause heavy bleeding, intense cramps and pelvic pain. Diagnosis often requires imaging, such as ultrasound or MRI. If imaging is inconclusive and symptoms persist, a definitive diagnosis may only be confirmed after hysterectomy.

How Endometriosis is Diagnosed

• A careful history of menstrual disorder symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. This should guide doctors in beginning the diagnostic process.
• Transvaginal ultrasound or MRI can be performed to support the diagnosis: they help detect ovarian endometrioma or adhesions and deep nodular forms of disease. However, these techniques cannot always detect the endometriosis lesions. It is important to know that you may still have peritoneal endometriosis, even if imaging tests come back negative.
• Laparoscopy is usually considered if symptoms persist and imaging shows nothing.

Endometriosis Treatment Options 

Managing endometriosis requires an individualized, multimodal, and interdisciplinary approach, tailored to each person’s symptoms and fertility goals. While there is currently no cure, treatment options focus on reducing pain and improving quality of life.

Conventional treatments include pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics, and hormonal treatments like birth control pills, hormonal IUDs or vaginal rings (these aren’t suitable for those trying to get pregnant).

Surgical excision remains an important option for treating advanced endometriosis, especially when deep lesions cause severe symptoms. Minimally invasive techniques—such as laparoscopic or robotic-assisted surgery—can improve precision, outcomes, and recovery times. While surgery doesn’t cure endometriosis, it’s often necessary to remove deep lesions and relieve pain.

Complementary and Alternative Therapies for Endometriosis

Herbal Therapy

Phytomedicine has been used around the world since ancient times to treat or ease a wide range of human diseases. When it comes to endometriosis, many herbal remedies show potential in helping manage the condition by reducing inflammation, oxidative stress, and abnormal tissue growth, as well as by balancing hormone activity. Herbs such as turmeric, ginger, green tea, açaí extract, and ginseng—among many others—are being studied for their anti-inflammatory, antioxidant, and hormone-regulating properties. These natural treatments may offer symptom relief and improve quality of life for those living with endometriosis.

Physical Activity

Regular exercise may help reduce inflammation and support mental well-being. Suggested options include pelvic floor therapy, yoga, strength training, cardio, and swimming. There are many options—what matters most is listening to your body and choosing what works for you. Start slow and be patient with yourself.

FODMAP Diet

This diet manages digestive symptoms. FODMAPs are a group of fermentable short-chain carbohydrates found in a wide range of foods and food additives that can be hard for some people to digest, leading to bloating, gas, or stomach discomfort. It involves eliminating certain fermentable carbs, then reintroducing them to identify triggers, ending on a personalized diet.

Homeopathy

A natural therapy that uses highly diluted substances to stimulate the body’s healing response. While some people with endometriosis report relief, scientific evidence remains limited.

Acupuncture

Evidence from several studies suggests that acupuncture may activate the brain’s analgesic mechanisms, inhibit ectopic endometrial growth, alleviate pain, and potentially enhance immune function. Nonetheless, more rigorous studies are needed to validate these findings.

Rethinking Your Diet

Following an anti-inflammatory diet that includes magnesium-rich foods, along with a high intake of fruits and vegetables, may help reduce bloating and, in some cases, even prevent the need for surgery in individuals with endometriosis. However, dietary responses vary from person to person. As seen with the low FODMAP diet, identifying which foods make you feel better—or worse—can be a helpful approach. According to the Endometriosis Foundation of America, it’s generally recommended that people with endometriosis avoid heavily processed foods, alcohol, caffeine, dairy products, red meat, soy products, grains and gluten, high-fat foods, sweets, and non-organic foods. Ultimately, it’s important to listen to your body and determine what works best for you.

New and Emerging Treatments for Endometriosis

• Cannabis (CBD): Compounds like CBD and THC may have analgesic, anti-inflammatory, immune-modulating, anti-angiogenic, antiproliferative, and neuroprotective effects. But more clinical trials are needed. 
• Dichloroacetate (DCA): A non-hormonal therapy currently in clinical trials in the UK. Preclinical studies suggest that endometriosis cells produce excess lactate, which promotes lesion growth. DCA reduces this lactate production, potentially shrinking lesions.
• Linzagolix: A daily pill that blocks hormones causing symptoms. It’s approved in Europe for fibroids and is being tested for endometriosis. Taken with low-dose hormonal “add-back” therapy to reduce side effects. 

Endometriosis Resources and Support Networks

• The Endometriosis Foundation (UK): A UK based organization offering emotional support groups and opportunities for community connection. It does not provide medical advice or treatment services.
• Endometriosis Association: An international organization headquartered in Milwaukee, Wisconsin (USA), with members and activities in numerous countries. It offers support, education, resources, and private support groups, and also extends assistance to families and close friends of those affected.
• Endometriosis Foundation of America (EndoFound): Focus on increasing awareness of the disease, promoting public education, funding research, and  facilitating expert surgical training.
• My Endometriosis Team: An independent social network based in San Francisco for people living with endometriosis. It provides a judgment free space for sharing personal experiences, practical tips, emotional support, and community-recommended referrals to healthcare providers. 
• Endo Army: A patient-led initiative dedicated to accessible, patient-centered education and community groups. Through a multimedia platform, EndoArmy  shares the latest findings in endometriosis research in an accessible format.

Living With Endometriosis

Listening to your body is key. If you suspect you have endometriosis, don’t ignore it. Seek medical advice, research options, and share your experience—it helps build awareness and support. Tracking your symptoms with a journal or app can also help you notice patterns—what makes you feel better or worse, whether it’s certain foods, activities, or treatments. All of this can guide you toward a better, more manageable way of living. 

The more openly we speak about endometriosis, the sooner we can improve diagnosis, care, and quality of life for everyone affected.