Over time, endometriosis can cause a wide range of complications that affect not only reproductive health, but also bowel, bladder, and emotional wellbeing. Understanding what endometriosis can cause is essential for recognising symptoms early and managing the condition effectively.
Endometriosis is a long-term, inflammatory condition where tissue similar to the lining of the womb (endometrial stroma and glands) grows outside the uterus. This misplaced tissue responds to monthly hormonal changes, leading to internal bleeding, inflammation, and scarring.
How Common Is Endometriosis?
Endometriosis affects an estimated 10% of women and people assigned female at birth (AFAB) during their reproductive years. This equates to roughly 190 million individuals worldwide [1].
Despite its prevalence, many people are undiagnosed or misdiagnosed for years. Symptoms can vary in intensity and are not always linked directly to disease severity.
Where Does Endometriosis Occur?
Endometrial-like tissue can implant and grow on a number of structures in the body, including:
- Ovaries, forming cysts called endometriomas
- Fallopian tubes
- Pelvic peritoneum (the lining of the abdominal cavity)
- Uterine ligaments, such as the uterosacral ligaments
- Bowel and rectum
- Bladder and ureters
- Diaphragm, lungs, and rarely, the brain
Lesions in these locations react to hormonal signals during the menstrual cycle, causing a repeated cycle of bleeding, inflammation, and scar formation.
Common Symptoms of Endometriosis
Typical symptoms associated with endometriosis include:
- Pelvic pain, especially before or during menstruation
- Heavy or irregular periods
- Painful intercourse (dyspareunia)
- Painful urination or bowel movements, particularly during periods
- Chronic fatigue
- Infertility or difficulty becoming pregnant
Some individuals experience no symptoms, making detection more difficult.
What Can Endometriosis Cause?
Endometriosis is a progressive condition. If untreated or inadequately managed, it can lead to several complications:
1. Chronic Pelvic Pain
Persistent or cyclical pelvic pain is the most common result of untreated endometriosis. This pain may:
- Become constant over time
- Interfere with sleep, work, and relationships
- Be worsened by adhesions (bands of scar tissue) between organs
Pain may also radiate to the lower back or thighs.
2. Ovarian Cysts (Endometriomas)
Endometriosis can cause cysts on the ovaries filled with old blood, known as “chocolate cysts.” These:
- Can rupture or cause ovarian torsion (twisting)
- May lead to chronic inflammation
- Reduce ovarian reserve (the number of viable eggs available for fertility)
Large endometriomas often require surgical removal.
3. Infertility
Up to 30–50% of people with endometriosis experience difficulty conceiving [2].
This may result from:
- Blocked fallopian tubes
- Damaged ovaries
- Pelvic adhesions
- Inflammatory changes affecting egg quality or implantation
Treatment may involve surgery or assisted reproductive technologies such as IVF (in vitro fertilisation).
4. Bowel and Bladder Dysfunction
When endometriosis affects the bowel or bladder, it can cause:
- Pain during bowel movements or urination
- Constipation, diarrhoea, or bloating
- Blood in the stool or urine during menstruation
- Urinary urgency or retention
In severe cases, surgical intervention may be required to remove deep infiltrating lesions.
5. Adhesions and Organ Displacement
Inflammation leads to the formation of adhesions—bands of fibrous tissue that stick organs together. These can:
- Pull the uterus, ovaries, and other organs out of position
- Restrict movement and cause ongoing pain
- Complicate surgical procedures
Severe cases may result in a “frozen pelvis,” where organs are fused by scar tissue.
6. Bowel Obstruction or Ureteral Blockage
Rare but serious complications include:
- Intestinal obstruction from large bowel lesions or adhesions
- Hydronephrosis (swelling of the kidney due to blocked urine flow), if the ureters are compressed
Both require urgent medical or surgical attention.
7. Mental Health Challenges
Chronic pain, infertility, and social disruption can lead to:
- Anxiety and depression
- Low self-esteem
- Social withdrawal
- Sexual dysfunction
Emotional support and psychological care are essential parts of holistic management.
8. Rare Malignant Changes
Although uncommon, there is a slightly increased risk of certain types of ovarian cancer in individuals with endometriosis, particularly in those with long-standing or untreated disease [3].
Regular monitoring is advised for those with complex or recurrent ovarian cysts.
Common Misconceptions
Myth: Endometriosis only affects the reproductive organs
Fact: It can involve the bladder, bowel, diaphragm, and even the lungs.
Myth: It always causes infertility
Fact: Many people with endometriosis conceive naturally.
Myth: Symptoms stop after menopause
Fact: Some individuals continue to experience pain due to residual tissue or hormone therapy.
When to Seek Medical Advice
Speak to a GP or gynaecologist if you experience:
- Severe or persistent pelvic pain
- Pain during sex, urination, or bowel movements
- Difficulty becoming pregnant
- Worsening fatigue or mood disturbances
Early diagnosis can prevent complications and improve quality of life.
Conclusion
Endometriosis can cause a wide range of health problems beyond period pain. From ovarian cysts to infertility, bowel issues to chronic fatigue, its impact can be extensive and deeply personal.
Understanding the complications it may cause enables better symptom tracking, earlier diagnosis, and more effective management. Seek professional advice if you suspect endometriosis, and advocate for your health.
References
[1] Giudice, L.C. Endometriosis: Science and Practice
[2] Vercellini, P., et al. Clinical Management of Endometriosis
[3] Rizk, B., et al. Endometriosis and Infertility: A Comprehensive Guide
