Abi Saranya
· August 2025Had a very good experience with Dr. Vani sundarapandian mam at Jananam fertility centre. She explains everything clearly and provides treatment with great care and compassion.
Home › Conditions › Endometriosis
CONDITIONS · ENDOMETRIOSIS
Endometriosis: no, it isn't 'just a bad period'.
Tissue like the womb lining growing outside the womb. About 1 in 10 women have it. It often causes cycle-linked pain and can lower, but rarely ends, the chance of pregnancy.
- About 1 in 10 women of reproductive age
- Cycle-linked pain is the classic sign
- Lowers, not ends, the chance of pregnancy
- Scan first, surgery not always needed
- Ovary — A cyst of old blood (endometrioma, or chocolate cyst)
- Pelvic lining — Small surface deposits a scan cannot see
- Ligaments behind the womb — Deep disease, often the most painful
- Bowel or bladder — Deep disease that can flare with periods
Stages
Surgeons record endometriosis as stage I to IV. The stage describes what they saw, not how much pain you have or whether you will conceive.
Stage I: Minimal
A few small surface spots.
Stage II: Mild
More spots, some deeper, little or no scarring.
Stage III: Moderate
Deeper deposits, often a small ovarian cyst, some scarring.
Stage IV: Severe
Large ovarian cysts and dense scarring that can stick organs together.
Stage I can be very painful and stage IV can be silent. Treat the stage as a description of anatomy, not a prognosis.
01What is endometriosis?
Tissue similar to the lining of the uterus grows outside it, most often on the ovaries, the ligaments behind the uterus, the bowel and the pelvic lining.
It responds to your monthly hormones and bleeds, but that blood cannot drain. The result is inflammation, scarring and adhesions. It is not an infection, not sexually transmitted, and not caused by anything you did.
02What are the symptoms of endometriosis?
Pain that follows your cycle: period pain that starts before bleeding, pain during or after sex, and a deep ache in the pelvis, back or thighs.
Heavy or irregular bleeding, bowel symptoms that flare with periods, and tiredness are common too. Some women have no pain at all; it is found only when they are checked for not conceiving. Diagnosis is often late, because severe period pain gets treated as normal.
Honest note
20 symptoms of endometriosisIf pain stops you working, studying or sleeping, that is not normal. Ask for a review, not a stronger painkiller.
03Can you get pregnant with endometriosis?
Yes. Endometriosis lowers the monthly chance of pregnancy on average. It does not make pregnancy impossible.
Adhesions can stop a tube picking up the egg, ovarian cysts can reduce egg numbers, and inflammation can affect sperm and early embryos. Many women with endometriosis conceive with no help at all. Mild disease often needs no fertility treatment.
04How is endometriosis diagnosed?
A careful history, an examination and a transvaginal ultrasound come first, for you, and a semen analysis for your partner.
A scan shows ovarian cysts well but cannot see small surface deposits, so a normal scan does not rule it out. MRI helps when deep disease near the bowel or bladder is suspected. We also check egg reserve (AMH) and whether the tubes are open, because those decide the plan.
Honest note
Keyhole surgery is still the only way to see small surface deposits. But current ESHRE guidance no longer requires it before treating symptoms, which spares many women an operation.
05What treatment works for endometriosis?
It depends on what matters most right now: easing pain, or getting pregnant. Sometimes those pull in opposite directions.
Hormone treatment eases pain but stops ovulation, so it cannot be used while trying to conceive. Surgery helps pain but removing an ovarian cyst also removes healthy ovarian tissue, so we check egg reserve before any operation, and discuss freezing eggs first if reserve is already low. With open tubes and mild disease, IUI is a reasonable first step; IVF bypasses the pelvis altogether. Where the evidence is weak, we say so.
Honest note
We have used ERA in more than 750 patients in the past, but in our experience it did not improve live birth rates sufficiently for us to continue recommending it. (Dr Vani Sundarapandian, Medical Director)
Does this sound like you?
Do any of these sound like you?
- Period pain that needs medication or stops your day
- Pain during or after sex
- Trying for 12 months (6 if you are 35 or over)
- A cyst on the ovary seen on a scan
- Pain on the toilet around your period
- Told the scan is normal, but the pain goes on
The order we usually work in.
- 1
Check both of you
Pelvic scan, egg reserve (AMH), a tube check and a semen analysis. The answers decide everything after.
- 2
If pain comes first: medicine
Pain relief and hormone treatment. Good for pain, but not while you are trying to conceive.
- 3
Mild disease, open tubes: try, or IUI
Timed intercourse or IUI with mild stimulation, for a number of cycles agreed at the start, not indefinitely.
- 4
Surgery, if it will help
For pain, or a large cyst in the way of egg collection. Egg reserve is weighed first, and freezing eggs before surgery is discussed.
- 5
IVF
When tubes are damaged, disease is moderate or severe, sperm is also affected, or simpler treatment has had its fair chance.
Your first visit
1
Talk
Full history for both of you: where the pain is, when it comes, how long.
2
Test
Pelvic scan, ovarian reserve (AMH), tubes check, semen analysis.
3
Plan
Options explained with reasoning, alternatives, and the option of waiting.
4
Treat
Medicine, surgery, IUI or IVF, in the order that suits your goal.
Questions patients ask
Can I get pregnant naturally with endometriosis?
Yes, many women with endometriosis conceive with no help at all. It lowers the monthly chance on average, so if you have tried for 12 months (6 if you are 35 or over), get both of you checked.
Can endometriosis come back after surgery?
Yes. Symptoms returning over several years is well documented. Hormone treatment afterwards reduces this, but only while you are not trying to conceive.
Does pregnancy cure endometriosis?
No. Symptoms often settle during pregnancy and breastfeeding because ovulation stops, and usually return when periods do.
Is endometriosis hereditary?
It runs in families. A mother or sister with endometriosis raises your own likelihood, so mention family history early.
Can diet or exercise fix endometriosis?
No, neither removes the deposits. Regular activity, sleep, pelvic floor physiotherapy and proper pain management do improve daily life, and none of them do harm.
Should I freeze eggs before endometriosis surgery?
It is worth discussing if your egg reserve is already low or the surgery will be extensive. It is a decision to make before the operation, not after.
Is IVF better than surgery for endometriosis?
Neither is better for everyone: surgery mainly treats pain, while IVF is the shorter road to pregnancy when tubes are damaged, disease is severe or egg reserve is low. If you are over 35, have low reserve or have had one ovarian operation already, IVF is often wiser than operating again.
Off the Record
Not the question you had?
The questions people don't ask with their partner sitting beside them, answered by Dr Vani Sundarapandian.
Dr Vani on endometriosis.
Two short answers: whether to treat the pain or the fertility first, and whether a chocolate cyst needs an operation at all.
In their words, not ours.
Chitra Mani
· March 2025When i first started the journey I was very much worried, but Dr. Vani was so kind always soft, explained the procedure and prepared me well.
Pain is not something you have to put up with.
Tell us what the pain is like and how long you've been trying. Janvi, Jananam's companion for fertility treatment, replies straight away.
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