Endometriosis: Symptoms, Diagnosis and Integrative Treatment

Clinical content by Trevor Wing MBRCP FRCHM MBAcC BSc (Hons) MSc (Dist) DMed (Img). Last reviewed October 2026.

Key facts

  • Endometriosis affects about 1 in 10 women of reproductive age.
  • In the UK it takes on average 8 to 10 years from first symptoms to diagnosis.
  • NICE recommends a transvaginal ultrasound for anyone with suspected endometriosis, even if an examination is normal.
  • Treatment aims to control pain, protect fertility and improve quality of life; it does not have to be surgery.
  • We offer specialist women’s health ultrasound and integrative care at our clinic in St Margaret’s, Twickenham.

What is endometriosis?

Endometriosis is a long-term inflammatory condition in which tissue similar to the lining of the womb (the endometrium) grows outside the womb. It is most often found on the ovaries, the ligaments behind the womb and the lining of the pelvis and can also affect the bowel and bladder. This tissue responds to the monthly cycle, causing inflammation, pain and, over time, scarring (adhesions) that can bind organs together.

What are the symptoms of endometriosis?

  • Period pain that stops you doing normal activities
  • Pelvic pain between periods
  • Pain during or after sex
  • Pain when opening your bowels or passing urine, especially during a period
  • Bloating, fatigue and low mood
  • Difficulty getting pregnant

The severity of symptoms does not always match the amount of endometriosis present. Some women with extensive disease have few symptoms, while others with small deposits have severe pain.

What causes endometriosis?

The cause is still not fully understood. Theories include retrograde menstruation (some menstrual blood flowing backwards through the fallopian tubes into the pelvis), changes in the cells lining the pelvis, spread through blood or lymph vessels, genetic factors and differences in how the immune system clears misplaced cells. It is likely that several of these work together. Endometriosis depends on oestrogen to grow, which is why many treatments aim to reduce oestrogen activity.

How is endometriosis diagnosed?

The NICE guideline, updated in 2024, recommends a transvaginal ultrasound for everyone with suspected endometriosis, even if an abdominal or pelvic examination is normal. Ultrasound can identify ovarian endometriomas (“chocolate cysts”) and deep endometriosis affecting the bowel or bladder and helps decide whether specialist referral is needed. A normal scan does not rule endometriosis out, and laparoscopy (keyhole surgery) remains the only way to confirm some forms of the condition.

Our clinic offers specialist gynaecological ultrasound on our GE Voluson S10, which can help guide your care and any referral.

We also offer the Ziwig Endotest, a saliva microRNA test that is 95 to 97% accurate in diagnosing endometriosis.

What are the conventional treatment options?

  • Pain relief: anti-inflammatory painkillers (NSAIDs) such as ibuprofen or naproxen, and paracetamol.
  • Hormonal treatment: the combined contraceptive pill (often taken back-to-back), progestogens or a hormonal coil, which suppress endometriosis and reduce pain while you use them.
  • GnRH analogues: create a temporary menopause-like state and are usually given with add-back HRT to protect bone density.
  • Surgery: laparoscopic removal or destruction of endometriosis and endometriomas. Deep endometriosis should be treated at a BSGE-accredited specialist endometriosis centre. Hysterectomy is reserved for severe cases where other treatment has not helped.

Hormonal treatments control symptoms but do not remove endometriosis, and symptoms often return when they are stopped. They also prevent pregnancy while in use, so fertility plans shape the choice of treatment.

How do we treat endometriosis at the Women’s Natural Health Clinic?

We combine specialist diagnosis with natural medicine and work alongside your GP or gynaecologist. Your plan may include:

  • Chinese herbal medicine, chosen according to your pattern. In Traditional Chinese Medicine, endometriosis is usually understood as Liver qi stagnation and blood stasis, and treatment aims to move qi and blood and ease pain.
  • Anti-inflammatory nutrition and practical guidance on diet, exercise and sleep.
  • Ultrasound monitoring of endometriomas and response to treatment.
  • Fertility support for women trying to conceive, including cycle tracking and timing.

Research into herbal medicine for endometriosis pain is growing but still limited in quality, so we will discuss the evidence and set clear goals with you.

Frequently asked questions

Can endometriosis be seen on an ultrasound scan?

Ovarian endometriomas, deep endometriosis and scar tissue adhesions can often be seen on a specialist transvaginal scan. Small surface deposits usually cannot, so a normal scan does not rule endometriosis out.

Can I get pregnant with endometriosis?

Yes, many women with endometriosis conceive naturally. Endometriosis can reduce fertility, so if you have been trying for a while, early assessment of both partners is worthwhile.

Is endometriosis the same as adenomyosis?

No. Adenomyosis is when womb-lining tissue grows into the muscle wall of the womb. The two often occur together and adenomyosis can also be assessed on ultrasound.

Does endometriosis go away after the menopause?

Symptoms usually improve after the menopause as oestrogen levels fall, although some women continue to have pain, particularly if they take HRT.

Book a consultation

To book, book an appointment online or call 020 3811 8778. Initial consultations last up to one hour at our clinic at 16 Bridle Lane, St Margaret’s, Twickenham TW1 3EE.

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