Endometriosis occurs when tissue similar to the lining of the womb grows elsewhere in the body, most often in the pelvis. It can affect daily life in different ways. A clinician uses your symptom pattern, examination and appropriate tests to decide whether endometriosis, another condition, or more than one cause may explain what you are experiencing.[1]
This guide explains the usual assessment pathway and the questions worth taking to an appointment. It does not diagnose a condition or replace urgent medical care.
When to seek medical advice
Make an appointment if period pain affects normal activities, you have ongoing pelvic pain, pain during or after sex, cyclical bowel or urinary symptoms, or difficulty conceiving. These symptoms can have several causes, so a clear description of when they occur and how they affect you helps guide assessment.[2]
When to seek urgent help
Call 999 or go to A&E if you have sudden or severe pelvic or abdominal pain and feel very unwell, faint or collapse, have heavy bleeding with dizziness or fainting, or have pain or bleeding in a possible pregnancy. These symptoms need urgent assessment and are not specific to endometriosis.
How endometriosis is assessed
Assessment starts with the story of your symptoms. A clinician may ask about your periods, pain, bowel and bladder symptoms, sex, fertility priorities, medicines and family history. You may be offered an abdominal or internal pelvic examination with your consent. You can ask questions, request a chaperone and discuss alternatives if an examination feels unsuitable.[2] [4]
NICE recommends transvaginal ultrasound for suspected endometriosis, including where examination findings are normal. The scan can help identify ovarian endometriomas, deep endometriosis and other possible causes of symptoms. It cannot exclude endometriosis when normal, so the result must stay alongside the clinical assessment.[2]
| Part of the pathway | What it can contribute | Important limit |
|---|---|---|
| History and examination | Builds a picture of symptoms, impact and possible alternative explanations. | Symptoms and examination findings alone do not describe every person's condition. |
| Pelvic ultrasound | May identify endometriomas, some deep disease or another cause of symptoms. | A normal scan does not rule out endometriosis. |
| Specialist ultrasound or MRI | May help assess suspected deep disease and its extent. | A specialist decides whether this would add useful information. |
| Laparoscopy | May be considered where it could clarify the diagnosis or contribute to an agreed management plan. | It is surgery, so benefits, risks and alternatives require individual discussion. |
| Blood tests | May answer a different clinical question, such as checking for anaemia with heavy bleeding. | CA125 should not be used to diagnose endometriosis. |
Where laparoscopy fits
Laparoscopy is keyhole surgery performed under general anaesthetic. It may be considered when symptoms, previous assessment and your priorities indicate that it could help clarify the diagnosis or form part of a treatment plan. NICE says it can still be considered after a normal ultrasound or MRI.[2]
A specialist should discuss what the procedure involves, what it may and may not show, the possible benefits and risks, alternatives, and the possibility of further treatment or follow-up. A clinic providing consultation or imaging should not imply that it can promise a surgical outcome or replace specialist surgical care.[2] [4]
Treatment options are individual
There is currently no cure for endometriosis. Treatment can help manage symptoms, but the right plan depends on the symptoms that matter most to you, the findings of your assessment, whether pregnancy is a priority, your medical history and your preferences.[3] [4]
Pain management
A clinician may discuss pain-relieving options and review whether they are helping. The choice should take account of your symptoms, other health conditions and preferences.[2]
Hormonal treatment
Hormonal treatment can reduce pain for some people. It is not used to improve spontaneous pregnancy rates when someone is trying to conceive, so fertility plans need to be part of the conversation.[2]
Surgery
Surgery may be considered in selected situations. A specialist should discuss potential benefits, risks, recurrence and the impact of different approaches before a decision is made.[2]
Support beyond treatment
Long-term pelvic pain can affect work, relationships and mental wellbeing. A care plan may include support for those effects as well as treatment directed at symptoms.[2]
Fertility priorities deserve early discussion. If you are trying to conceive, or want to understand how a proposed treatment may affect future plans, ask for gynaecology or fertility-specialist advice. Decisions about surgery, hormone treatment and assisted reproduction are not interchangeable and need individual assessment.[2]
Questions to take to an appointment
Bringing a short symptom diary, a list of medicines and copies of previous results can make a consultation more useful. You may also want to ask:
- What conditions are being considered alongside endometriosis?
- Would an examination or pelvic ultrasound answer a clear question in my situation?
- What would a normal or abnormal result change in the next step?
- How do my pain, bleeding, fertility priorities and wider health affect the options?
- Which symptoms mean I should seek urgent care rather than wait for a routine appointment?
Frequently asked questions
Can a normal ultrasound rule out endometriosis?
No. A normal pelvic examination or ultrasound does not exclude endometriosis. Imaging can still help identify some findings and guide the next clinical step, but a clinician considers the result alongside your symptoms and examination.
Is a blood test used to diagnose endometriosis?
No blood test confirms endometriosis. NICE specifically advises against using CA125 to diagnose it. A clinician may request blood tests for another clinical question, such as checking for anaemia when bleeding is heavy.
Will I need a laparoscopy?
Not everyone needs a laparoscopy. A gynaecology team may consider it when it could add useful information or form part of an agreed management plan, including after normal imaging. The benefits, risks and alternatives need individual discussion.
Can endometriosis affect fertility?
Endometriosis can make it harder for some people to conceive, but experiences vary. If pregnancy is a priority, discuss this early with a gynaecology or fertility specialist so that investigation and treatment options can be considered in context.
Is hormone treatment right if I am trying to conceive?
This needs individual advice. NICE does not recommend hormonal treatment alone or with surgery to improve spontaneous pregnancy rates in people trying to conceive. A specialist can discuss the options that fit your symptoms and fertility priorities.
Do I need a GP referral for a gynaecology appointment?
The clinic confirms the appropriate appointment route and any referral requirements at booking. Bring any previous scan reports, test results or referral information so the clinician can consider them in context.
Related assessment and support
References
- [1]NICE guideline NG73: Endometriosis: diagnosis and management, updated 11 November 2024
- [2]NICE NG73 recommendations: symptoms, ultrasound, referral, laparoscopy and management
- [3]NHS: Endometriosis, reviewed 27 August 2024
- [4]Royal College of Obstetricians and Gynaecologists: Endometriosis patient information, published December 2023
- [5]ESHRE Guideline: Endometriosis, issued 2 February 2022
Sources checked 30 August 2026. This evidence-only educational page does not replace individual assessment, diagnosis or urgent medical care.