Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus. These growths — often found on the ovaries, fallopian tubes, bladder, bowel, and pelvic lining — behave like normal uterine lining: they thicken, break down, and bleed during menstrual cycles.
But because the tissue is outside the womb, it has nowhere to go. This trapped bleeding leads to:
- inflammation
- swelling
- scarring
- adhesions (organs sticking together)
- severe pelvic pain
Endometriosis is a chronic, progressive condition and is a leading cause of pelvic pain, menstrual pain, and infertility.
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Common Symptoms of Endometriosis
Symptoms vary widely. Some women have intense pain; others have minimal symptoms but struggle with fertility. Common signs include:
Painful periods (dysmenorrhoea)
Cramping that is far more severe than “normal period pain.” Pain often starts days before bleeding and lasts beyond the period.
Chronic pelvic pain
Daily, weekly, or cyclical pelvic pain lasting longer than 3 months.
(We will link to your Pelvic Pain article here.)
Pain during or after sex (dyspareunia)
Deep, sharp pain linked to penetration or certain positions.
Pain with bowel movements or urination
Especially during menstruation — often caused by endometriosis affecting the bowel or bladder.
Heavy bleeding
Including clots, prolonged periods, or bleeding between periods.
Fatigue, bloating, nausea
Hormonal and inflammatory responses contribute to these symptoms.
Infertility
Endometriosis is one of the most common causes of infertility in women.
Symptoms that get dismissed
Many South African women report being told their pain is:
- “normal period pain”
- “stress-related”
- “in their head”
This delay leads to years of untreated disease.
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What Causes Endometriosis?
Despite decades of research, the exact cause remains unclear. The leading theories include:
Retrograde menstruation
Menstrual blood flows backward into the pelvis instead of exiting the body.
Immune system dysfunction
A faulty immune response may allow endometrial-like tissue to grow outside the uterus.
Genetics
Endometriosis tends to run in families.
Cell transformation (metaplasia)
Cells in the pelvis may transform into endometrial-like cells.
Important: None of these theories fully explain the condition. Endometriosis is complex and likely caused by several interacting factors.
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How Is Endometriosis Diagnosed?
Diagnosis often takes 7–10 years worldwide — partly due to stigma, normalization of severe period pain, and limited access to specialists.
The diagnostic process usually includes:
1. Medical history
Your doctor will assess period patterns, pain characteristics, fertility concerns, and overall health.
2. Pelvic examination
3. Ultrasound
Useful for detecting ovarian cysts (endometriomas), but cannot confirm all types of endometriosis.
4. MRI
Helpful for deep infiltrating endometriosis.
5. Laparoscopy (gold standard)
A minimally invasive surgery where a camera is inserted into the abdomen to view and remove endometrial lesions.
Why diagnosis is often delayed:
- Symptoms mimic other conditions
- Period pain is downplayed culturally
- Limited gynaecology access in parts of South Africa
- Not all doctors are trained in endometriosis recognition
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Treatment Options in South Africa
Treatment depends on your symptoms, fertility goals, and disease severity. Most treatment plans combine medical management with supportive care.
1. Pain-relief medication
- NSAIDs (ibuprofen, naproxen)
- Chronic pain management for long-standing symptoms
2. Hormonal treatments
Aim to reduce or stop menstruation, slowing endometrial growth. Options include:
- Birth control pills
- Hormonal IUD (e.g., Mirena)
- Progesterone tablets
- GnRH analogues
3. Surgery
Laparoscopic excision surgery is the gold standard for removing endometriosis lesions.
It can improve pain, quality of life, and fertility.
4. Fertility support
Some patients may require fertility treatment, including IVF.
5. Lifestyle and supportive therapy
- Pelvic physiotherapy
- Anti-inflammatory diets
- Stress management
- Exercise and movement rehabilitation
- Pain education
6. What The Pain Collective Offers
For chronic pelvic pain associated with endometriosis, The Pain Collective provides:
- Pelvic nerve blocks
- Pulsed radiofrequency neuromodulation
- Pelvic floor rehabilitation
- Holistic chronic pain management
- Symptom mapping and personalised treatment plans
These treatments support women who experience ongoing pain even after surgery or medication.
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Living with Endometriosis
Endometriosis is more than a “bad period disease.” It can affect:
- relationships
- work or studies
- emotional wellbeing
- sexual health
- daily functioning
Many women experience anxiety, depression, or frustration when their symptoms are misunderstood or minimised.
Support matters.
South Africa has active communities, including Endo Warriors South Africa and local pelvic pain support groups, offering education and peer support.
A multidisciplinary approach — medical, physical, and psychological — offers the best outcomes.
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Why Awareness Matters
Endometriosis awareness is essential because:
- Severe period pain is often normalised
- Many women go undiagnosed for years
- Girls are taught to tolerate pain rather than question it
- Healthcare bias frequently minimises women’s symptoms
Earlier diagnosis leads to better quality of life, improved fertility outcomes, and reduced chronic pain.
Breaking the silence helps women feel validated and supported.
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When to See a Doctor
Seek medical help if you experience:
- Severe period pain that affects school, work, or daily life
- Pelvic pain lasting longer than 3 months
- Pain during intercourse
- Difficulty falling pregnant
- Heavy or irregular bleeding
- Pain with bowel movements or urination
What to expect at The Pain Collective:
- Comprehensive pelvic pain assessment
- Review of past medical history
- Imaging or nerve evaluation when indicated
- Clear explanation of treatment pathways
- A personalised plan focusing on restoring function and reducing pain
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Final Thoughts
Endometriosis is real, common, and treatable — but too often misunderstood or ignored.
If you suspect you may have endometriosis, trust your symptoms and seek help. Early diagnosis can change your long-term wellbeing and open the door to effective treatment.
You are not alone — and support is available.
FAQs
1. What are the signs that I might have endometriosis?
Severe period pain, chronic pelvic discomfort, pain during sex, heavy bleeding, bowel or bladder pain, fatigue, and infertility.
2. Can endometriosis be cured or only managed?
It cannot be cured, but symptoms can be managed effectively through medication, surgery, and supportive care.
3. Is surgery always required to treat endometriosis?
Not always. Many women respond to hormonal treatment, pain management, and lifestyle changes. Surgery is recommended for severe cases or infertility concerns.
4. How does endometriosis affect fertility in women?
It can cause inflammation, adhesions, and scarring that affects ovulation, egg quality, or tube function. Many women with endometriosis still conceive naturally.
5. What treatment options are available for endometriosis in South Africa?
Hormone therapy, laparoscopic surgery, pain management clinics, pelvic physiotherapy, neuromodulation, lifestyle changes, and fertility support.