Pelvic Pain – Endometriosis

What is endometriosis?

Endometriosis is a common gynecological disorder, affecting up to 10 percent of women of reproductive age. You’re not alone if you have endometriosis.

Usually, the tissue that lines the uterus (endometrium) is found only in the uterus. But in endometriosis, microscopic bits of the endometrium grows outside the uterus. It may develop on the ovaries, the outer wall of the uterus, the fallopian tubes, the ligaments that support the uterus, and the tissue lining your pelvis. Rarely, the endometrium may spread beyond the pelvis. Endometrial tissue growing outside of your uterus is known as an endometrial implant.

With endometriosis, the escaped tissue acts as endometrial tissue would – it thickens, sheds, and bleeds with each menstrual cycle. But because the tissue is growing outside the uterus, it doesn’t have anywhere to leave the body and becomes trapped in your pelvis. As a result, it can cause painful symptoms and irritate the surrounding tissue and may cause the formation of scars, cysts, and adhesions. This scar tissue may eventually cause the reproductive organs to fuse.

If left untreated, severe endometriosis can result in infertility and may also increase your risk of certain cancers.

What causes endometriosis?

The precise cause of endometriosis is not fully understood. There are several theories regarding the cause, although no one theory has been scientifically proven.

Retrograde menstruation

Endometriosis may occur due to a process called retrograde menstruation. This happens when menstrual blood containing endometrial cells flows back through your fallopian tubes into your pelvic cavity, instead of leaving the body. These endometrial cells adhere to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed throughout each cycle.

Underlying factors that can result in retrograde menstrual flow include:

  • Increased estrogen production
  • Uterine growths, like fibroids or polyps
  • Structural abnormality of your uterus, cervix, or vagina
  • Obstruction in your cervix or vagina
  • Asynchronous uterine contractions

Embryonic cell transformation

Another theory is that hormones (e.g., estrogen) transform the cells outside the uterus into endometrial cells. Small areas of your abdomen and pelvis may also transform into endometrial tissue within those cavities.

Fetal development

Endometrial tissue may be implanted during fetal development with misplaced tissue that begins to respond to pubertal hormones (e.g., estrogen).

Surgical scar implantation

It’s also possible for the menstrual blood to leak into the pelvic cavity through a surgical scar, such as after hysterectomy or cesarean delivery (C-section). If your immune system doesn’t destroy this misplaced tissue, it may attach to the surgical incision, culminating in endometriosis.

Endometrial cell transport

Endometrial cells may be transported away from the uterus via the lymphatic system to other parts of the body.


Endometriosis may run in families. If an immediate family member has endometriosis, you are at a higher risk of developing the condition yourself.

Immune system disorder

A weak immune system may be unable to recognize and destroy the misplaced endometrial tissue.

Transformation of peritoneal cells

In the induction theory, it is proposed that hormones or immune factors facilitate the transformation of peritoneal cells into endometrial-like cells.

Menstrual cycle characteristics

Irregular periods can include shorter cycles, heavier and longer periods, or menstruation that starts at a young age. These factors may place you at a higher risk.

More specifically, menstrual factors that increase your risk of endometriosis include:

  • Having 27 days or fewer between each period
  • Starting your first period before the age of 12 years
  • Experiencing periods that last seven days or longer each month


Symptoms are usually present during the reproductive years. Sometimes, endometriosis does not cause any symptoms at all, but other times, it can cause significant pain and discomfort during monthly menstruation. Pregnancy may provide temporary relief from symptoms.

Pelvic pain

The primary symptom of endometriosis is pelvic pain during menstrual periods. Severe cramping may accompany pelvic pain before the menstrual period and may persist for several days.

The severity of your pain does not always correlate with the extent or stage of the condition. You may have a mild form of endometriosis yet experience agonizing pain, or you could also have a severe form and have minimal discomfort.

Pain often resolves after menopause, when the body stops producing estrogen. However, if hormonal therapy is used during menopause, the symptoms may persist.

Endometriosis pain vs. menstrual pain

Several factors distinguish endometrial pain from menstrual pain.

With endometriosis:

  • The pain is chronic. It repeatedly happens before and during your menstrual period – sometimes during other times of the month – for more than six months.
  • The pain is severe. Sometimes OTC pain relievers such as ibuprofen (Advil) or aspirin (Ecotrin) will not provide pain relief.
  • The pain is persistent. It happens often enough that you can anticipate it, and you recognize what it feels like.

Back pain

Endometrial cells may fuse to your lower back, as well as the front of your pelvic cavities. This could explain why some endometriosis patients also experience sciatica. Back pain related to endometriosis may be felt deep within your body.

Leg pain

If endometrial lesions grow on or around your sciatic nerve, the pain can radiate to your leg.

The leg pain may feel like:

  • A sudden twinge, similar to a leg cramp
  • A sharp stabbing
  • A dull throb

In some cases, the pain may interfere with your ability to walk comfortably or stand up quickly.

Pain during intercourse

Sometimes endometrial tissue could form nodular scar tissue that is painful to the touch. These nodules can appear in your uterus, cervix, or pelvic cavities. You may feel sharp vaginal and abdominal pains during sexual activity, particularly sexual intercourse.

Painful bowel movements

Endometrial cells can grow in the region between your vagina and abdomen. This is called rectovaginal endometriosis. This condition has its own set of symptoms, including:

  • Irritable bowels
  • Difficulty passing urine
  • Diarrhea
  • Painful bowel movements

This kind of endometriosis pain can feel sharp and persistent and may mimic that of irritable bowel syndrome (IBS).


Infertility may occur if the endometrial tissue blocks the ovaries or fallopian tubes, preventing the egg from traveling to the uterus. It’s also possible that endometriosis could damage a woman’s egg or a man’s sperm, and therefore, you may be unable to get pregnant.

Weight gain

Weight gain may not be a direct consequence of endometriosis, but certain aspects of the disorder and its treatments may cause you to put on weight. This includes:

  • Hormonal imbalances
  • Certain medications
  • A hysterectomy
  • Bloating
  • Pain

Excessive bleeding

You may occasionally experience heavy menstrual periods or bleeding between periods (intermenstrual bleeding).

Other symptoms

Endometriosis can also cause other symptoms, including:

  • Excessive bloating
  • Cramping
  • Diarrhea
  • Constipation
  • Nausea
  • Difficulty focusing
  • Food intolerances
  • Ovarian cysts

Endometriosis can sometimes mimic other conditions, such as pelvic inflammatory disease (PID), ovarian cysts, and irritable bowel syndrome (IBS).


Women with endometriosis can sometimes experience complications.

Fertility problems

Endometriosis can cause infertility in some women. It may be due to damage to the fallopian tubes or ovaries. But not all women with endometriosis have fertility problems.

Adhesions and ovarian cysts

Some women will develop:

  • Adhesions – “sticky” areas of endometriosis tissue that can fuse organs
  • Ovarian cysts – fluid-filled cysts in the ovaries that can sometimes be large and painful

These can both occur if the endometriosis tissue is in or near the ovaries.

Ovarian cancer

Ovarian cancer may occur at a higher rate in those with endometriosis, but the risk is still relatively low. Although rare, another type of cancer – endometriosis-related adenocarcinoma – can develop later in life in those who have had endometriosis.

Surgery complications

Like all types of surgery, surgery for endometriosis carries a risk of complications. Common complications include minor bleeding and bruising around the wound.

Bladder and bowel problems

Endometriosis affecting the bowel or bladder can be challenging to treat and may require major surgery. Surgery for endometriosis in the bowel or bladder may involve cutting away part of the affected organ.

When to see your doctor

If you feel like your periods are more painful than usual or if you experience pain in many parts of your body during your period, see your doctor.

If you intend to become pregnant, you may want to see your fertility specialist. In some cases, they may recommend surgery to remove growths that are keeping you from getting pregnant.


Early diagnosis and understanding of the diagnosis may facilitate better management of endometriosis. It takes, on average, seven to ten years from the onset of symptoms to get a proper diagnosis.

Detailed history

To diagnosis endometriosis, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Your doctor will also note your personal and family history of endometriosis.

Pelvic exam

Your doctor may conduct a pelvic exam to feel for areas of scarring. During the pelvic exam, your doctor will manually feel your abdomen or pelvis for scars or cysts.


Your doctor may use an abdominal ultrasound or a transvaginal ultrasound to obtain images of your reproductive organs. They won’t show whether you have endometriosis or otherwise, but can help your doctor identify cysts associated with endometriosis.

Magnetic resonance imaging (MRI)

An MRI is a diagnostic tool that uses a magnetic field and radio waves to create detailed images of the internal organs and tissues. For some, an MRI may help with surgical planning, giving your surgeon detailed information about the size and location of endometrial implants.


The only way to confirm endometriosis is by undergoing a surgical laparoscopy. Laparoscopy is a minor surgical procedure that allows definitive visual identification of the condition. If the doctor notices signs of endometriosis, the aberrant tissue can be removed in the same procedure. But these surgeries can result in scarring that impedes fertility.

Endometriosis stages

To determine the endometriosis stages, doctors assign points to what they see as they perform surgical laparoscopy. A score of 15 or less indicates that the disease visually is either stage 1 (minimal) or stage 2 (mild). A score of 16 to 40 indicates the disease is stage 3 (moderate), and 40 or more puts the disease at stage 4 (severe).

The four stages of endometriosis:

Stage 1: Minimal

In minimal endometriosis, there are superficial lesions and shallow endometrial implants on your ovary or pelvic cavity. There’s little to no scar tissue.

Stage 2: Mild

Mild endometriosis is characterized by light lesions and shallow implants on the ovary or pelvic lining. The lesions may be deeper and in greater quantity compared to that in stage 1.

Stage 3: Moderate

Moderate endometriosis is characterized by deep implants on your ovary and pelvic lining. There can also be more lesions than in the earlier stages. You may also have filmy adhesions and cysts in the ovaries, which can cause organs to fuse abnormally and cause bouts of sharp, stabbing pains. Stage 4: Severe

The most severe stage of endometriosis involves deep implants and lesions on your ovaries and pelvic lining. There may also be lesions on your bowels and fallopian tubes. Lesions are multiple and severe, with deep and prominent adhesions. There may also be large cysts on one or both ovaries.

What does it affect?

Endometriosis is also grouped based on the affected areas.

Superficial peritoneal endometriosis

Superficial peritoneal endometriosis is the most common type of endometriosis. The lesions attach to the peritoneum, which is a thin membrane that lines the pelvic cavity. The lesions are shallow and flat and do not invade into the peritoneal cavity. It is the least severe form of endometriosis.

Ovarian endometriomas (cystic ovarian endometriosis)

Less commonly, women may develop endometrioma in their ovaries. An endometrioma refers to a cyst in which the surface of the cyst contains areas of endometriosis. The cyst is filled with old blood, giving it a dark color, and is therefore referred to as “chocolate cysts.” Most women with ovarian endometriomas will also have superficial or deep lesions present elsewhere in the pelvis.

Deep infiltrating endometriosis (DIE)

Deep endometriosis is characterized by endometrial lesions that penetrate at least 5 mm beyond the peritoneum surface. Given that the peritoneum is thin, the deep lesions would invade the tissue underlying the peritoneum (the retroperitoneal space) and affect organs outside the pelvic cavity. Sometimes, the scar tissue can fuse organs, so they become stuck in place.

Abdominal wall endometriosis

Endometrial tissue may grow on the abdominal wall. The cells may attach to a surgical incision, such as those from a C-section.

Endometriosis treatments

Understandably, you want prompt relief from endometriosis. While there is no cure for endometriosis, its symptoms are manageable. The treatment approach depends on how severe your symptoms are and whether you hope to become pregnant.

Pain relief medications

Both prescription and over-the-counter (OTC) pain relief medications can be a good starting point for mild endometriosis. They relieve pain and inflammation by blocking the release of prostaglandins in the body.

The catch? For NSAIDs to be effective, they should be taken before the body starts producing prostaglandins. You need to take them at least 24 to 48 hours before ovulation and before the onset of your period. This will give the medication adequate time to block the production of prostaglandins in your body.

Make sure you take NSAIDs with food to prevent side effects like stomach upset and ulcers. You should also avoid taking them for more than one week.

Hormone therapy

Supplemental hormones may relieve pain and halt the progression of endometriosis. They help your body regulate the monthly hormonal spikes responsible for endometrial tissue growth during the menstrual cycle. Hormone therapy can help to slow endometrial tissue growth, prevent new implants of endometrial tissue, and reduce endometriosis-related pain. It may reduce or stop menstruation altogether. It’s generally not an ideal option if you’re trying to become pregnant.

Hormone therapy is not a permanent fix for endometriosis. You could experience a recurrence of your symptoms after stopping treatment.

Hormonal contraceptives

Hormonal contraceptives can control the hormones responsible for the monthly buildup of endometrial tissue. Using hormonal contraceptives – especially continuous-cycle regimens – may reduce or eliminate pain in mild cases of endometriosis. Birth control pills, patches, hormonal IUD, and vaginal rings are examples of hormonal contraceptives.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists

Gonadotropin-releasing hormone agonists and antagonists can be used to block ovarian-stimulating hormone production, reduce estrogen levels, and halt menstruation. It puts the body into artificial menopause, which, in turn, can help shrink the endometrial tissue. These medications are available by injection, nasal spray, and a daily pill.

To mitigate the menopausal side effects (e.g., vaginal dryness and hot flashes), your doctor may prescribe a concurrent low dose of estrogen or progestin.

Progestin therapy

Progestins may mitigate the symptoms of endometriosis by slowing the growth of endometrial implants and by preventing menstrual periods. Options include IUD, implant, injection, or pill forms of progestin.

Fertility treatments

If you’ve had difficulty getting pregnant due to endometriosis, you may wish to undergo fertility treatment. The fertility specialist can work with your doctor to determine the severity of your endometriosis and what could be contributing to your infertility.

Conventional fertility treatments include:

Freezing your eggs

Endometriosis can affect your ovarian reserve, so some doctors may recommend preserving your eggs in case you intend to become pregnant later.

Superovulation and intrauterine insemination (SO-IUI)

SO-IUI is an option for women with healthy fallopian tubes, mild endometriosis, and whose partner has good quality sperm.

Fertility medications

Your doctor may prescribe fertility medications such as Clomiphene. These medications help to produce two to three mature eggs. You may also be given progestin injections.

In vitro fertilization (IVF)

IVF treatments can be carried out, whereby you undergo an ultrasound to ensure the eggs are ready before they are fertilized with the partner’s sperm outside the body before being re-implanted into the uterus. Many women with moderate-to-severe endometriosis have successfully become pregnant, thanks to IVF treatments.


Laparoscopic excision surgery is a minimally-invasive surgery that is considered a gold-standard for endometriosis surgical treatment. The goal is to remove endometrial implants without damaging the healthy reproductive organs.

Last-resort surgery (hysterectomy)

Total hysterectomy may be recommended as a last resort if your condition doesn’t improve with other treatments. It involves the removal of the uterus and possibly the ovaries, cervix, and fallopian tubes. The goal is to prevent any more endometrial tissue from depositing. After this surgery, you won’t be able to get pregnant. Before you agree to the procedure, make sure you fully understand the benefits and risks.

Alternative and complementary therapies

You may also try alternative and homeopathic remedies in combination with your conventional medical treatment. At present, there is insufficient research to support alternative endometriosis therapies. That being said, some women find symptom relief from combining a range of different complementary and alternative medicines.


Acupuncture is a natural, non-invasive treatment for endometriosis. It is less risky, less costly, and also has fewer side effects than conventional medicine. It minimizes endometriosis pain by inducing the release of pain-relieving chemicals and promote anti-inflammatory effects.

The most common acupuncture treatment for endometriosis target imbalances in the body, including:

  • Blood stasis
  • Qi stagnation
  • Kidney yang deficiency
  • Spleen qi deficiency
  • Damp heat stagnation and stasis

Transcutaneous electrical nerve stimulation (TENS)

TENS machines have been safely used for decades to relieve pain. The devices usually comprise a battery-operated stimulator that emits low-level electrical impulses to the site of the pain, via electrode pads that are applied to the skin.

Osteopathic manipulative treatment (OMT)

An osteopathic physical can use manipulation techniques, including stretching, gentle pressure, and resistance, to move your muscles and joints. Osteopathic manipulative treatment can erase menstrual pain, increase overall mobility, and promote healing.

Chinese herbal medicine

Chinese herbal medicine uses herbal ingredient preparation that is taken orally, through an enema, or injection. It is used to reduce pain, enhance fertility, and prevent the recurrence of endometriosis.

Home remedies

Some home remedies can help relieve pain and discomfort that endometriosis brings.

Cannabidiol oil

CBD oil can help relieve pain and inflammation. While there isn’t much research that links CBD explicitly to endometriosis, some women claim that taking CBD oil helps ease their pain. Until scientists find a definite link between CBD oil and endometriosis, you should consult a trusted medical professional before implementing it into your treatment regime.

The endocannabinoid system in the body is integral to the healthy functioning of the female reproductive tract. Imbalances in the endocannabinoid neurotransmitters may, therefore, trigger endometriosis.

There are numerous ways that CBD oil may influence the development of endometrium tissue:

CBD can stop cell multiplication

Impairment of the apoptotic cell death function allows the aberrant growth of endometrium tissue. A study showed that the endocannabinoid system could facilitate apoptotic cell death and also prevent faulty endometrial cells from spreading (1). It may thus be a potential remedy for endometriosis.

CBD can prevent cell migration

A frustrating problem for women who underwent surgical removal of endometriotic lesions is that it often recurs as the endometrial tissue re-migrate to the adjacent organs. Nevertheless, scientists discovered that endocannabinoids could regulate cell migration (2), and therefore CBD oil may be used to stop endometriotic cells from migrating.

CBD reduces nerve pain

Some women with endometriosis experience severe nerve pain because the lesions contain a high density of nerves. Endocannabinoids regulate nerve growth, and their receptors (CB1) are expressed on the nerves that innervate endometriotic lesions (3). Therefore, CBD oil can interfere with the innervation by preventing the activation of this receptor.

Vitamins and dietary supplements

Vitamins A, C, and E

Vitamin A, vitamin C, and vitamin E supplementation are shown to reduce chronic endometriosis-related pelvic pain and inflammation (4).

Vitamin D

A study found that women with a higher vitamin D level in their diet had a decreased rate of endometriosis (5). There are many vitamin D supplements that you may try.


Curcumin has anti-inflammatory properties that may help with endometriosis management. It may also reduce estradiol production and suppress the migration of endometrial tissue (6). It can also be used to manage endometriosis in the long term.

Chamomile tea

Drinking chamomile tea may help with endometriosis symptoms. A study showed that chrysin, a compound found in chamomile, may suppress the growth of endometrial cells (7).


When endometriosis pain becomes intense, you can put a heating pad around your belly or take a warm bath. The heat may help relax tight muscles in your pelvis, which can reduce cramping and pain.

Pelvic massage

Massaging the pelvic area can help relax the muscles and reduce endometriosis-related pain. Use a few drops of essential oil and gently massage the abdomen, sides, and back for 10 to 15 minutes at a time.

Pelvic massages should only be done shortly before the menstrual cycle. Do not massage during your period – it may aggravate symptoms.

Manage your stress levels

Endometriosis could exacerbate your stress levels due to the painful symptoms. Not only can stress be increased by endometriosis, but so can endometriosis symptoms be exacerbated by stress in a vicious never-ending cycle.

Stress management and relaxation techniques can keep your stress in check. They can also increase your body awareness, refocus on something calming, and reduce the activity of stress hormones. If you find that one relaxation technique does not work for you, try another. Finding the best method for you can take time and practice. Popular methods include autogenic training, progressive muscle relaxation, visualization, and deep breathing.


Getting adequate rest is essential, especially during menstruation. Lying on the side with the knees pulled into the chest can help to relieve pain or pressure in the back.

Watch your diet

While dietary changes will not cure endometriosis, eating the right foods may help improve its symptoms.

Reduce intake of foods that either causes inflammation or raise estrogen levels, both of which contribute to endometriosis. Instead, you may benefit from eating plenty of plant-based proteins.

Make sure to pay attention to how your body responds when you eat certain foods. Keep a food diary to check if the food is affecting your symptoms. Record everything you eat throughout the day, as well as any symptoms you experience.

Increase fiber intake

A diet rich in fiber may lower the risk of developing endometriosis. Fruits, vegetables, and whole grains are packed with dietary fiber, which may help decrease estrogen concentration in the body. They also contain vitamins, minerals, and antioxidants, which may help fight inflammation and oxidative stress. High fiber intake may also lower estrogen levels.

Boost intake of omega-3 fatty acids

Omega-3 fats are healthy, anti-inflammatory fats that can be found in fatty fish, such as salmon. Plant sources of omega-3 include avocado, olive oil, flaxseeds, and walnuts. Omega-3 is also available as a daily supplement.

Preliminary evidence suggests that omega-3 fats might help discourage the implantation of endometrial cells in the first place, thereby reducing your risk of endometriosis (8). Researchers have also found that having a high ratio of omega-3 to omega-6 fats may help reduce endometriosis-related pain and inflammation (9). What’s more, it’s shown to inhibit cell survival.

Reduce your intake of trans fats

Trans fats, which are found in some fried or processed foods, may increase the risk of endometriosis. Hence, you should avoid foods with ingredient labels that contain trans fats or hydrogenated fats.

Cut down on processed foods

Processed foods contain unhealthy fats and sugar, both of which induce pain and inflammation. Hence, minimizing your intake of processed foods may help with the management of endometriosis.

Types of processed foods you should avoid include pastries, chips, crackers, candy, and fried foods. Instead, replace it with fatty fish, whole grains, or fresh fruits and vegetables.

Cut down on red meat

High intake of red meat may increase endometriosis risk by increasing estrogen levels (10). Replacing red meat with a plant-based protein source may reduce inflammation.

Limit caffeine and alcohol intake

Caffeine and alcohol can increase estrogen levels and increase the risk of endometriosis. Hence, women with endometriosis should limit their intake of caffeine and alcohol.

Try a gluten-free diet

There is some evidence that a gluten-free diet may benefit people with endometriosis. Studies found that women with endometriosis pain experience significant improvement after 12 months on a gluten-free diet (11).

Low-FODMAP diet

The low-FODMAP diet may reduce gastrointestinal symptoms in women who have concurrent endometriosis and irritable bowel syndrome (IBS). FODMAP is a term that stands for fermentable oligo, di-, and monosaccharides and polyols. Gut bacteria ferment FODMAPs, resulting in the production of gas, which would worsen symptoms.

With a low-FODMAP diet, you eliminate certain carbohydrates from your diet to reduce your intake of potentially irritating foods to allow the gastrointestinal system to heal. You can gradually re-introduce some of these foods to see how the body tolerates them.

Exercise regularly

Exercise may support the management of endometriosis by reducing estrogen levels and also stimulating the release of a natural pain-relieving hormone called endorphins. Hence, regular exercise may decrease the pain and discomfort that you experience. It may also reduce stress and facilitate blood circulation.

Get 150 minutes of moderate-intensity cardio or 75 minutes of high-intensity cardio each week. You should also incorporate strength training on at least two days a week.

Prevent endometriosis pain during sex

For some women with endometriosis, sexual intercourse may amplify the pain. That’s because penetration can stretch and pull the endometrial tissue behind the vagina and uterus.

Although endometriosis can hurt your sex life, it doesn’t have to remain that way. There are things you can do to lessen your pain.

Track your cycle and try during times of the month

For most women, endometriosis discomfort is constant. But the pain becomes even more debilitating during your period and ovulation. This will help you understand what time of the month triggers severe pain, and when you’re likely to be pain-free. Rate the pain so you can identify the times of the month when the pain is worse.

Take a pain reliever one hour before

You may be able to mitigate the pain you feel during sex if you have an over-the-counter (OTC) pain reliever at least an hour before intercourse. You could also take a pain reliever after sex if your discomfort persists.

Use lube

Lube is your friend. Use water-based or silicone-based lube during sex can ease any discomfort. You should use as much lube as necessary so that you’re sufficiently lubricated, and remember to reapply when your vagina is drying out.

Try different positions

Some sex positions may cause intense pain if you have endometriosis. The missionary position is often the most painful for women with endometriosis because of how your uterus is tilted and the depth of penetration.

Experiment with different positions to understand which ones hurt and which ones to avoid forever so that you can have optimal pleasure during sex. Some positions exert less pressure on the pelvis. Shallow penetration works best for some women. Think modified doggy style, raised hips, spooning, face-to-face, or with you on top. Make a game of sex – it can be enjoyable.

Find the right rhythm

Deep penetration and quick thrusting can exacerbate endometriosis pain. Finding the right rhythm can minimize discomfort during sexual intercourse.

Discuss with your partner about thrusting not as quickly and deeply during intercourse. You may also switch positions so that you can control speed and limit penetration depth.

Explore alternatives to intercourse

Sex doesn’t have to mean intercourse. Foreplay, kissing, mutual masturbation, oral stimulation, erotic massage, and other arousing options to penetration can draw you and your partner more intimately together without triggering endometriosis symptoms. Talk to your partner about what turns you on, and experiment with all the sexually-arousing activities. Allow yourself to enjoy the different levels of intimacy.

Plan for potential bleeding

Postcoital bleeding, also known as bleeding after sex, is a common symptom of endometriosis. It can happen because penetration cause the endometrial tissue to become tender and irritated. It could be frustrating, but there are ways you can plan for potential bleeding.

You can:

  • Keep wipes nearby for easy cleanup
  • Lay a towel down before initiating sex
  • Focus on positions that cause less irritation

You should also prepare your partner ahead of time so that they’re not caught off guard.

Communicate with your partner

Communicate with your partner about the impact of endometriosis on your sexual desire and pleasure. It may feel embarrassing, intimidating, or otherwise uncomfortable to discuss sex with your partner, but communication is essential. Communication can increase intimacy and make sex more enjoyable. The goal is to foster open and genuine communication to ensure that sex is pain-free and pleasurable.

Endometriosis during pregnancy

Endometriosis can make it difficult to get pregnant.

Pregnancy complications

Women with endometriosis may be more likely to experience difficulties during pregnancy or when giving birth, although this is rare. Having endometriosis may increase the risk of the following complications:


A study found that pregnant women with endometriosis have a higher risk of pre-eclampsia (12).

Symptoms of pre-eclampsia include:

  • High blood pressure
  • A headache
  • Facial or non-gravity dependent swelling
  • Pain below the ribs
  • Vision changes

Placenta previa

Placenta previa occurs when the placenta lies very low in the womb, covering the cervix. It may endanger the baby and mother during childbirth. Having endometriosis during pregnancy may increase your risk of placenta previa. The first sign of placenta previa is bright red vaginal bleeding.

Preterm birth (premature birth)

Research suggests that having endometriosis may increase the risk of preterm birth (13). It occurs when the baby is born after less than 37 weeks of gestation.


Having endometriosis may increase the risk of miscarriage, which refers to a pregnancy loss that occurs before 20 weeks of gestation.

Symptoms of a miscarriage during early pregnancy include:

  • Vaginal bleeding
  • Pain and cramping in the lower abdomen
  • Fluid or tissue release from vagina
  • Cessation of pregnancy symptoms

Safe endometriosis treatments during pregnancy

You may manage your endometriosis symptoms with the following treatments if you are pregnant:

  • Over-the-counter (OTC) pain relievers with doctor’s approval
  • Gentle exercises or stretching to ease back pain
  • Eating fiber-rich foods to reduce bowel discomfort
  • Using heating pads to ease cramps (but do not place directly on the uterus)


Endometriosis is a painful chronic condition with no cure. But this doesn’t mean the condition has to interfere with your daily life. The outlook for women with endometriosis is positive, despite the discomfort it brings. Effective treatments are available to manage symptoms and fertility issues. Talk to your doctor about your options, as well as any alternative treatments they recommend.

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