Endometriosis
Endometriosis is a chronic inflammatory condition affecting around 10% of women worldwide—approximately 190 million people. In Ireland, an estimated 155,000 women are affected.
It occurs when tissue similar to the lining of the uterus grows outside the womb, most commonly within the pelvis. This tissue responds to hormonal changes, leading to inflammation, pain, and sometimes scar tissue formation.
Endometriosis is a complex and highly individual condition. Symptoms can vary widely—or be absent altogether—often making diagnosis delayed and challenging.
For many patients, endometriosis is associated with:
Moderate to severe menstrual pain
Chronic pelvic pain
Subfertility or infertility
However, symptom severity does not always reflect disease extent. Some individuals experience significant symptoms, while others may have minimal or no signs, with diagnosis sometimes made incidentally.
Given its impact on quality of life and fertility, early recognition and a personalised, specialist-led approach to management are essential.
Symptoms of Endometriosis
Symptoms of endometriosis vary widely in type and severity, and some individuals may have no symptoms at all. However, severe period pain is not normal and should not be ignored.
Common symptoms:
Painful periods
Pelvic pain (may radiate to back or legs)
Pain during intercourse
Bowel symptoms (bloating, constipation, pain)
Fatigue
PMS
Heavy or irregular bleeding
Painful urination
Infertility
Important Considerations
Many symptoms of endometriosis can overlap with other conditions, making accurate diagnosis essential. It is important to consult your healthcare provider to determine the underlying cause of your symptoms and to review any changes over time.
Endometriosis can affect fertility; however, many individuals conceive naturally. It is estimated that 60–70% of those with endometriosis achieve spontaneous pregnancy. In some cases, surgical treatment or assisted reproductive options, such as IVF, may be recommended.
As a chronic condition, endometriosis can impact daily life, relationships, and overall wellbeing. Ongoing communication with your healthcare provider is key to effective, personalised management.
Diagnosis & Treatment
Diagnosis & Early Intervention
Endometriosis can develop from the time of the first menstrual period. Early recognition is key to improving quality of life, limiting disease progression, and protecting fertility. However, diagnosis is often delayed—globally by an average of over 8 years—due to symptom normalisation, access barriers, and clinical challenges.
Your doctor may suspect endometriosis based on symptoms and history. Initial assessment may include examination and imaging (such as ultrasound or MRI), although these cannot definitively confirm the condition.
A laparoscopy remains the gold standard for diagnosis. This minimally invasive procedure allows direct visualisation of the pelvis, with tissue sampling for histological confirmation. It is best performed by a specialist in endometriosis.
Early consultation and a specialist-led approach are essential for timely diagnosis and personalised management.
Treatment & Management
There is currently no permanent cure for endometriosis. Treatment focuses on reducing symptoms, improving quality of life, and supporting long-term wellbeing.
The most effective approach has to be tailored to individual needs, and may depend on age, symptom severity, disease extent, fertility plans, and personal preference.
Treatment options include:
Medical management
Surgical management
Complementary therapies
Early consultation and a specialist-led approach are essential for timely diagnosis and personalised management.
Medical & Surgical Management
Surgical Management
Surgery is an important treatment option for endometriosis, aimed at relieving pain and improving function by removing endometriosis, dividing adhesions, and treating cysts.
Laparoscopy (keyhole surgery) is the most commonly used approach. It is minimally invasive, associated with less pain and faster recovery, and allows excellent visualisation of the pelvis. The extent of disease is often documented during the procedure to guide further care.
In more advanced cases, a laparotomy (open surgery) may be required. Your surgeon will discuss this possibility with you in advance if relevant.
Medical Management
Medical treatments are often used as a first-line approach to manage symptoms and may help reduce disease activity and limit long-term complications such as scarring and adhesions. All medical treatments are temporary, with effects typically wearing off within months of stopping therapy.
Hormonal Treatments
These include the combined oral contraceptive pill, progestogens, the Mirena coil, Depo Provera, and GnRH analogues.
Non-Hormonal Treatments
Pain relief options include NSAIDs (e.g. ibuprofen), paracetamol, and codeine-based analgesics where appropriate. These are most effective when taken early and as directed. While they help manage symptoms, they do not treat the underlying condition and are often used alongside other therapies.
Surgical Techniques
Endometriosis is typically treated using one of two techniques:
Ablation: uses heat to destroy endometriosis tissue
Excision: involves surgically cutting out the affected tissue
The choice of technique depends on the surgeon’s expertise, training, and available resources. Outcomes are closely linked to surgical skill and the completeness of disease removal.
Prior to surgery, it is essential that you are fully informed about the planned procedure and other available treatment options.
Endometriosis & Fertility
At Vividah, our fertility specialists provide a comprehensive and personalised approach to your care. We take the time to listen carefully to your concerns, understand your medical history, and carry out a thorough assessment to identify the underlying cause of any fertility challenges. From there, we develop a tailored treatment plan aligned with your individual needs, goals, and reproductive plans.
Throughout your journey, we offer clear guidance, ongoing support, and evidence-based care—ensuring you feel informed, supported, and confident at every stage as we help you move forward on the right path.
Endometriosis & Fertility
Fertility may be a concern for some individuals with endometriosis, though it is important to note that many conceive naturally. While there is a recognised association between endometriosis and infertility, the exact mechanisms remain unclear. Approximately one-third of those with endometriosis may experience difficulties conceiving.
Age remains the most significant factor in fertility for all individuals, with a natural decline after 35. Delays in diagnosis of endometriosis can further impact reproductive planning, making early assessment and informed decision-making important.
Pregnancy does not cure endometriosis. While some may experience temporary symptom relief during pregnancy, symptoms often return once menstrual cycles resume.
Fertility support, including assisted reproductive treatments such as IVF, may be considered where needed.
How does Endometriosis impact Fertility
Endometriosis can impact fertility through several mechanisms:
It may cause dyspareunia (painful intercourse), which can reduce the frequency of sexual activity and, consequently, the chances of conception.
Involvement of the fallopian tubes may lead to partial or complete blockage. Complete occlusion prevents sperm from reaching the egg, while partial blockage may allow fertilisation but hinder the embryo’s passage back to the uterus, increasing the risk of ectopic pregnancy.
When the ovaries are affected, endometriosis can disrupt normal ovulation and menstrual regularity, potentially leading to anovulation.
The condition is associated with increased inflammatory activity (including macrophages), which can negatively affect sperm, egg quality, and embryo development.
It may also impair the endometrial lining, reducing its ability to support implantation.
Overall, these factors can contribute to reduced fertility in some individuals with endometriosis.