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Endometriosis

Endometriosis is a common, long-lasting condition in which tissue similar to the lining of the uterus grows outside it. It can cause painful periods, pelvic pain and trouble getting pregnant. There is no cure yet, but many treatments can ease the pain and help with fertility — and severe period pain is never something you just have to put up with.

Call 911 or go to the emergency room if you have:

Get care the same day (your clinician, urgent care or the ER) for:

Don’t assume sudden, severe new pain is “just my endometriosis,” and don’t wait for a complementary-care appointment for any of these signs.

What is endometriosis?

Endometriosis (“endo”) is a disease in which tissue similar to the lining of the uterus (the endometrium) grows in other places in the body (NICHD, Office on Women’s Health). It is most often found on the ovaries, fallopian tubes, the tissues that hold the uterus in place and the outside of the uterus, and can also grow on the bowel, bladder or rectum (Office on Women’s Health). It is a chronic (long-lasting) condition (WHO).

The growths respond to hormones and can bleed around each period, irritating nearby tissue and causing inflammation and scar tissue (adhesions) that can make organs stick together (NICHD, Office on Women’s Health). On the ovaries they can form cysts called endometriomas, which can be painful during sex and during your period (Office on Women’s Health); see our Cysts guide.

How common? About 1 in 10 women of reproductive age have it — an estimated 190 million worldwide (WHO). It can also affect transgender men and non-binary people who menstruate (WHO).

Symptoms

The amount of pain doesn’t always match the amount of disease: a few small patches can hurt badly, while large areas may cause little pain, and some people have no symptoms (NICHD, WHO).

Causes, and what it is not

No one knows exactly what causes endometriosis. Menstrual tissue flowing backward into the pelvis is one theory, but it doesn’t explain every case (NICHD); genes, the immune system and hormones are also being studied (Office on Women’s Health). It is more likely if your mother, sister or daughter has it, or if your periods started early, your cycles are short, or your periods are heavy and last more than 7 days (NICHD). There is no known way to prevent it (WHO) — it is not something you caused.

It is not cancer. The growths are benign (Office on Women’s Health). Endometriosis is not linked with a significantly higher risk of cancer overall; it is linked with a higher risk of ovarian, breast and thyroid cancer, but the increase in absolute risk is low (ESHRE guideline, 2022).

Why diagnosis can take years

Symptoms vary and are often dismissed as “normal” period pain. The World Health Organization reports that the average time to diagnosis is between 4 and 12 years (WHO). Period pain that keeps you from normal activities is worth raising — and raising again if it isn’t taken seriously.

How is it diagnosed?

Adenomyosis, a related condition

In adenomyosis, uterine-lining tissue grows into the muscle wall of the uterus. It can also cause painful, heavy periods, usually affects women over 35, and is more likely if you have given birth or have endometriosis. Treatment may include a hormonal IUD or other hormonal birth control, NSAIDs or medicine to reduce heavy bleeding, and, if these don’t work, uterine artery embolization or hysterectomy (NHS). Our Female Problems guide, coming soon, will say more.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Pain relievers (NSAIDs); hormonal treatment — combined birth control, progestins including the hormonal IUD, GnRH agonists or GnRH antagonists; laparoscopic surgery to remove (excise) or destroy (ablate) lesions; hysterectomy as a last resort; fertility treatment such as IVF; and pelvic floor physical therapy as part of pain care. Cost estimate being researched (medicine, imaging, surgery and physical therapy). There is no cure, but treatments can help manage symptoms. Hormones work only while you take them, pain often returns after surgery, and hysterectomy doesn’t always end the pain.
Chiropractic No role in treating endometriosis. Chiropractic care cannot remove or shrink endometriosis lesions. Not a treatment for endometriosis, so no cost is listed. We found no studies of chiropractic care for endometriosis, and reviews found no clear benefit from spinal manipulation for period pain. Don’t let it delay a gynecology visit.
Acupuncture A course of needle sessions for pain, used alongside — not instead of — medical care. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Small trials suggest it may ease period pain during treatment, but in the largest trial the benefit faded after treatment stopped. Evidence is limited, and it doesn’t treat the lesions.
Herbal medicine Chinese herbal medicine and supplements such as turmeric are sometimes tried. None is proven to treat endometriosis. Cost estimate being researched. Evidence is limited; a 2025 review found supplements no better than placebo for pain. Some herbs have hormone-like effects or weaken birth control pills. Avoid them while trying to conceive unless your provider agrees.
Massage therapy Relaxing massage, including gentle belly and lower-back massage, as a comfort measure alongside medical care. At one national chain, memberships run about $70–$90 a month for one 60-minute session. A few small studies reported less period pain, but the evidence is limited. A pleasant, low-risk extra, not a treatment for the disease.
MBHA Wellness Coach A pain and symptom diary, heat, regular exercise, sleep, realistic eating changes, preparing for appointments, mental health support and connecting with support groups. Cost estimate being researched. Supports — never replaces — medical care. Self-care can make pain easier to manage and visits more useful; diet evidence is still limited.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on your symptoms, how severe the disease is, your age and whether you want to get pregnant (NICHD, WHO), and some treatments can be used together (Office on Women’s Health). Europe’s specialist guideline asks clinicians to decide with you, weighing side effects, cost and your preferences (ESHRE guideline, 2022).

Pain relievers (NSAIDs)

NSAIDs such as ibuprofen and naproxen are often used for endometriosis pain (WHO), especially when symptoms are mild (Office on Women’s Health); if you are trying to get pregnant, you won’t be given hormones (NHS). Evidence for endometriosis pain specifically is limited (NICHD). Don’t take NSAIDs if you have ulcers or other stomach problems, bleeding problems or liver disease, or are allergic to aspirin (MedlinePlus).

Hormonal treatments

Hormones can slow lesion growth and ease pain, but they don’t make existing scar tissue go away, don’t work for everyone, and symptoms often return when they stop (NICHD). If you aren’t trying to get pregnant, hormonal birth control is generally the first step (Office on Women’s Health).

Surgery

Fertility treatment

Surgery and assisted reproduction such as IVF are covered in Endometriosis and fertility below.

Pelvic floor physical therapy

Pelvic floor muscle problems can add to chronic pelvic pain, and WHO says pain care that includes physiotherapy and cognitive behavioral therapy can reduce pain and improve quality of life (WHO). A 2026 review of 7 studies found physiotherapy reduced endometriosis pain (Can et al., 2026), though ESHRE judged the evidence too uncertain to recommend specific non-medical treatments (ESHRE guideline, 2022). Ask for a pelvic health physical therapist.

What it costs

Medicine, imaging, surgery, physical therapy and IVF costs: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating endometriosis. Spinal adjustments cannot remove, shrink or stop endometriosis lesions on the pelvic organs.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is among the most-studied complementary treatments for endometriosis pain. The results are encouraging but limited, and it does not remove lesions.

Safety and cost

Few complications have been reported, mostly from non-sterile needles or poor technique; most states license acupuncturists (NCCIH). Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer). Trials used many sessions, so check your coverage first.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to treat endometriosis, and ESHRE made no recommendation for Chinese medicine or nutrition-based treatments (ESHRE guideline, 2022).

  • Chinese herbal medicine: a Cochrane review found only two Chinese trials (158 women), neither against placebo. Herbs after surgery seemed about as helpful as a hormone drug, with fewer side effects, but more rigorous research is needed (Cochrane review, 2012).
  • Supplements: a 2025 analysis of 9 placebo-controlled trials found supplements no better than placebo for endometriosis pain (Salmeri et al., 2025). Some women report relief with cinnamon twig, licorice root, thiamine, magnesium or omega-3s (Office on Women’s Health), but reports are not the same as tested benefit.
  • Turmeric: not proven for any condition, and its NCCIH page doesn’t address endometriosis. “High-absorption” curcumin products have been linked to liver damage, and turmeric supplements may be unsafe in pregnancy (NCCIH).
  • Licorice root can cause serious heart problems, especially in large amounts or with high blood pressure or heart or kidney disease (NCCIH).

Hormonal effects and interactions

St. John’s wort can weaken birth control pills, a common endometriosis treatment (NCCIH). Chamomile might have estrogen-like effects and reduce the effect of birth control pills (NCCIH). Chasteberry may not be safe with hormone-sensitive conditions such as breast, uterine or ovarian cancer (NCCIH).

Trying to conceive?

St. John’s wort, chasteberry and turmeric supplements may be unsafe in pregnancy (NCCIH, NCCIH, NCCIH), and no non-medical approach has been shown to improve fertility in endometriosis (ESHRE guideline, 2022). Don’t use herbs while trying to conceive or during fertility treatment without your care team’s advice, and tell every provider what you take — supplements aren’t FDA-approved before sale (NCCIH).

Approach 5 of 6

Massage therapy

Massage won’t remove endometriosis, but it may ease tension and help you relax. The NHS suggests massaging your tummy and back to help ease period pain (NHS). The research is small:

Rare serious problems such as blood clots or nerve injury have been reported, some with vigorous massage (NCCIH); tell your therapist about your endometriosis and any recent surgery. At one national chain, memberships run about $70–$90 a month for one 60-minute session (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that make endometriosis easier to live with, alongside — never instead of — your medical care.

Keep a pain diary

Track when and where pain happens, how bad it is, and how it relates to your period, bowel movements, urination and sex, plus how heavily you bleed. A diary hasn’t been proven to speed diagnosis, but it can help you describe and show your symptoms (ESHRE guideline, 2022).

Heat, exercise and sleep

Anti-inflammatory eating: what we know

Evidence is still weak. A 2024 review of 11 trials found most reported less pain, but the studies were small and at moderate or high risk of bias, and the best-designed ones showed no clear benefit (Meneghetti et al., 2024). Studies of omega-3-rich or gluten-free eating reported less pain, but most weren’t randomized (Sverrisdóttir et al., 2022), and evidence for a low-FODMAP diet comes from only three small studies (Rabelo et al., 2026). A balanced diet rich in fruits and vegetables, with little alcohol, is a sensible general goal (ESHRE guideline, 2022); a coach can help you test one change at a time.

Preparing for appointments

Bring your diary and your top questions. Before surgery, ask exactly what is planned — some procedures can’t be reversed and some affect fertility (NICHD) — and, if treatment isn’t working or symptoms are very severe, ask about a specialist endometriosis service (NHS).

Mental health and support

Endometriosis can affect mental health, including depression and anxiety (WHO), and ESHRE advises clinicians to consider psychological support (ESHRE guideline, 2022). GnRH antagonist labels advise seeking medical attention for new or worse depression or anxiety (Orilissa label, Myfembree label). See our Depression and Anxiety guides; in a crisis, call or text 988 (988 Lifeline). Support groups can help too (WHO), including the Endometriosis Foundation of America and the Endometriosis Association, which offers peer support for women and teens.

Another approach

Endometriosis and fertility

Many women with endometriosis get pregnant, but it can be harder (Office on Women’s Health); as many as 25–50% of women with infertility have endometriosis (WHO). Growths and scar tissue can block the fallopian tubes or change the shape of the pelvis and reproductive organs, making it harder for sperm to find the egg (Office on Women’s Health).

If you have endometriosis and are having trouble getting pregnant, talk to your doctor (Office on Women’s Health). Our Pregnancy guide, coming soon, will cover more.

Another approach

Teens and period pain

More than half of people who have periods get some pain around their period (Office on Women’s Health), but pain that is severe or worse than usual and not helped by painkillers, or that stops you doing your usual activities, needs a doctor’s attention (NHS). Period pain caused by a condition such as endometriosis often gets worse over time (MedlinePlus), and endometriosis can start from a girl’s first period (WHO, NHS).

Signs worth raising: missing school because of period pain or needing birth control to manage it; pelvic pain between periods; pain with bowel movements or urination; and a family history of endometriosis (ESHRE guideline, 2022). Heavy periods and blood clots larger than a quarter matter too (Office on Women’s Health).

What to expect: questions about symptoms and periods, and possibly a pelvic exam or an ultrasound or other imaging test (MedlinePlus). An internal exam should be discussed with the teen and caregiver first, and if a scan through the vagina isn’t appropriate, an MRI or a scan through the belly or perineum may be considered (ESHRE guideline, 2022). Treatment usually starts with pain relievers or hormones such as birth control pills or a hormonal IUD; if scans are normal and these don’t help, laparoscopy may be considered (ESHRE guideline, 2022).

Self-care: regular gentle exercise, a heating pad or warm bath, enough rest, and relaxation such as yoga (NHS, MedlinePlus). Parents: if your teen often misses school for period pain, take it seriously and bring a pain diary to the visit.

Member stories

Living with Endometriosis? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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