Sudden severe pelvic pain with faintness needs emergency care immediately. A ruptured endometrioma or ovarian torsion can present this way. Also seek urgent care for severe pain with a positive pregnancy test.
Tissue resembling the lining of the womb grows outside it, on the ovaries, pelvic lining and elsewhere. It causes severe period pain, and it reduces fertility through several different mechanisms.
Two warnings matter here. Diagnosis is typically delayed by years because severe period pain is normalised. And repeated surgery on the ovaries, intended to help, can permanently reduce the eggs available for treatment.
Tissue similar to the endometrium implants outside the uterus — most often on the ovaries, the pelvic peritoneum, the ligaments behind the uterus, and sometimes the bowel or bladder. It responds to the hormonal cycle, bleeding each month into tissues that cannot clear it, which causes inflammation, scarring and adhesions.
The pain is characteristic: severe period pain that worsens over years, pain during or after intercourse, and in advanced disease pain with bowel movements or urination during periods. It is frequently dismissed as normal, and the delay between first symptoms and diagnosis is measured in years in every health system studied.
Fertility is reduced through several mechanisms — distorted pelvic anatomy from adhesions, damage to the ovary from endometriomas, an inflammatory environment hostile to eggs and embryos, and in some women reduced ovarian reserve. Yet many women with endometriosis do conceive, and the relationship between disease severity and fertility is not straightforward.
Adenomyosis, where the same tissue grows within the muscle of the uterus itself, frequently coexists. It causes heavy painful periods and an enlarged tender uterus, and it appears to reduce implantation success independently.
Removing an endometrioma takes normal ovarian tissue with it, and each operation reduces ovarian reserve further. A woman who has had two or three ovarian cystectomies may have substantially fewer eggs available for IVF than her age would suggest, and that loss is permanent. Where an endometrioma is small, not causing severe pain and not obstructing egg collection, leaving it alone is frequently the better choice — particularly in a woman whose AMH is already falling. If further ovarian surgery has been proposed and you are hoping to conceive, ask specifically what it will do to your ovarian reserve and whether IVF first would be the wiser sequence.
Imaging finds the larger disease; laparoscopy remains the definitive test.
Ovarian reserve is the number that should inform every decision about operating on an endometrioma, and it is frequently not measured beforehand. Send your AMH and antral follicle count, your pelvic ultrasound or MRI report, details of every previous operation with dates and what was removed, and a description of your pain and cycle. If you have had ovarian surgery before, that history is particularly important.
Treatment for pain and treatment for fertility pull in opposite directions, which has to be navigated deliberately.
The combined pill, progestogens, hormonal coils and GnRH analogues all suppress the disease and control pain effectively. They are the mainstay of pain management — but every one of them prevents conception while being taken, so they are paused when actively trying. This conflict needs planning rather than discovering.
Laparoscopic excision or ablation of endometriotic deposits and division of adhesions improves pain and modestly improves natural conception rates in early-stage disease. Removing endometriomas relieves pain but costs ovarian tissue, which is the trade-off that must be weighed against ovarian reserve.
Bypasses distorted anatomy and the hostile pelvic environment, and is effective in endometriosis-associated infertility. In women with reduced ovarian reserve or advanced disease, going to IVF earlier rather than after repeated surgery is frequently the better sequence. A period of hormonal suppression before the cycle improves outcomes in some women.
Where ovarian reserve is already falling in a young woman with endometriomas, freezing eggs or embryos before further surgery preserves options that repeated operations would otherwise remove. This is rarely offered and worth raising yourself.
AMH and antral follicle count before any decision about ovarian surgery. This number should drive the sequence.
Effective pain treatment prevents pregnancy. The sequence needs planning around what matters most to you now.
Endometriosis progresses and reserve declines. Repeated cycles of surgery and waiting cost time that cannot be recovered.
If you have had ovarian surgery before and your AMH is low, we will suggest IVF before any further operation. Each cystectomy takes eggs you may need.
A ruptured endometrioma or ovarian torsion causes sudden severe pain and needs immediate local assessment. Do not wait to arrange travel.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
It depends heavily on your ovarian reserve and what has been done before. Surgery for early-stage disease modestly improves natural conception. But removing endometriomas takes normal ovarian tissue with them, and repeated operations reduce reserve permanently. If your AMH is already low or you have had previous ovarian surgery, IVF first is frequently the wiser sequence.
Because severe period pain is widely normalised, by patients, families and doctors. The delay between first symptoms and diagnosis is measured in years in every health system studied. Pain that stops you working or studying is not normal, and the pattern of symptoms alone is highly suggestive even before any scan.
This is the central difficulty. The hormonal treatments that control endometriosis pain effectively all prevent conception while being taken. Simple painkillers and anti-inflammatories can be used but are less effective. Many women alternate — controlling pain during periods when not actively trying, and pausing treatment during attempts. It needs planning rather than improvising.
Endometriosis reduces IVF success somewhat compared with other causes, but IVF remains effective and is frequently the best option, particularly in advanced disease. Ovarian reserve is the strongest predictor, which is why preserving it matters so much and why repeated ovarian surgery before IVF can be counterproductive.
Endometrial-type tissue growing within the muscle of the uterus itself, causing heavy painful periods and an enlarged tender uterus. It frequently coexists with endometriosis and appears to reduce implantation independently. It is diagnosed on ultrasound or MRI, and a period of hormonal suppression before embryo transfer helps some women.
No, though symptoms often improve during pregnancy and breastfeeding because ovulation and periods stop. They usually return afterwards. Pregnancy is not a treatment and should not be presented as one, but the temporary relief is real and some women plan around it.
Send your AMH and antral follicle count with details of any previous ovarian surgery. Those together determine whether more surgery or IVF is the right next step.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.