Endometriosis is a chronic pelvic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe period pain, chronic pelvic pain, pain during intercourse, pain with bowel movements or urination, and fertility problems. According to the World Health Organization, endometriosis affects an estimated 10% of reproductive-age worldwide.
In Singapore, treatment of endometriosis is typically tailored to the patient’s symptoms, disease extent and fertility goals, and may include pain relief medication, hormone therapy, hormonal birth control, laparoscopic surgery, and fertility-focused treatment where appropriate. For more severe or complex cases, care may also involve multidisciplinary support to manage pain, protect fertility and improve quality of life.
What Is Endometriosis?
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, most commonly within the pelvis. It may affect the ovaries, fallopian tubes, bowel, bladder and the lining of the pelvis. Less commonly, it can also be found outside the pelvic region.
Like the tissue inside the uterus, these endometriosis deposits respond to hormonal changes during the menstrual cycle. As a result, they may thicken, break down and bleed, which can trigger inflammation, irritation and damage to surrounding tissues. Over time, this may lead to scar tissue, adhesions, ovarian cysts, pelvic pain and fertility problems.
Who Is at Higher Risk of Developing Endometriosis?
Women who have a history of endometriosis in their family or have a medical condition which prevents them from having normal menstrual flow are at a higher risk of developing endometriosis. Other possible risk factors for endometriosis include the following:
- Never go through childbirth before
- Starting menstruation at a younger age
- Having shorter menstrual cycles
- Experiencing heavier menstrual bleeding
What Causes Endometriosis?
The exact cause of endometriosis is not fully understood. However, several theories may explain how it develops. One widely accepted theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. This blood may carry endometrial-like cells that attach to pelvic tissues and continue to grow.
Other possible explanations include immune system dysfunction, which may reduce the body’s ability to clear tissue growing outside the uterus, as well as changes in cells within the pelvic cavity that allow them to behave like endometrial tissue. Although no single theory explains every case, these mechanisms are commonly used to understand endometriosis causes.
Symptoms of Endometriosis
The symptoms of endometriosis vary from person to person. The main symptom is usually pelvic pain, especially during menstrual periods, and this pain may be much worse than ordinary period pain or painful menstrual cramps. Some women also experience chronic pain beyond their menstrual cycle, while others may have little or no pain despite having endometriosis.
Common endometriosis symptoms include:
- Pelvic pain, especially during menstrual periods
- Painful menstrual cramps that feel worse than normal period pain
- Pain during sexual intercourse
- Pain during bowel movements
- Pain during urination during menstruation
- Excessive bleeding or heavy menstrual periods
- Abdominal bloating
- Fatigue
- Lower back pain
- Nausea, constipation or diarrhoea
- Fertility problems or difficulty conceiving
Because some of these symptoms overlap with other conditions such as irritable bowel syndrome or pelvic inflammatory disease, endometriosis diagnosis can be delayed if symptoms are dismissed as “normal” period pain.
How Is Endometriosis Diagnosed?
Endometriosis is usually diagnosed through a combination of symptom review, medical history, pelvic examination and imaging. A doctor may suspect the condition based on severe pain, painful periods, chronic pelvic pain, infertility, ovarian cysts, or pain associated with bowel movements and urination during menstruation.
Diagnostic assessment may include:
- Review of menstrual symptoms and medical history
- Pelvic examination or physical examination
- Ultrasound to look for ovarian cysts or other pelvic abnormalities
- MRI in selected cases, especially when deep infiltrating endometriosis is suspected
- Laparoscopy when confirmation or treatment is needed
Ultrasound is useful, but mild endometriosis may not always be visible on scans. SingHealth notes that minimal to mild disease cannot always be detected by tests or scans, and laparoscopy may sometimes be needed to definitively diagnose endometriosis and assess the extent of disease. WHO also notes that a clinical diagnosis may be made based on symptoms and imaging, and surgery is not always required before treatment begins.
What Are the Potential Complications of Endometriosis?
If left unmanaged, endometriosis may lead to complications that affect both physical health and quality of life.
- Chronic pelvic pain
- Scar tissue and adhesions
- Ovarian cysts
- Fertility problems
- Reduced quality of life
- Emotional stress linked to long-term symptoms
What Are the Treatments Available for Endometriosis?
Endometriosis treatment in Singapore is usually tailored to the patient’s symptoms, the extent of disease, response to previous treatment, and whether fertility is a priority. There is currently no treatment that definitively cures endometriosis, so the main goals are to relieve symptoms, slow or suppress disease activity, protect quality of life, and support fertility where possible.
Treatment for endometriosis is not one-size-fits-all. In practice, doctors usually consider how severe the pelvic pain is, whether ovarian cysts, adhesions or deep infiltrating endometriosis are present, whether the bowel or bladder may be involved, and whether the patient is trying to conceive now or in the near future. These factors help determine whether medical treatment, surgical treatment, fertility treatment, or a combination of approaches is most appropriate.
Medical treatment for endometriosis
For many women, medical treatment is used to manage endometriosis pain and reduce the hormonal stimulation of endometriosis tissue. Common options include:
- Pain relief medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help relieve painful periods and pelvic pain. These medicines do not remove endometriosis tissue, but they can reduce pain and inflammation.
- Hormonal birth control: Combined hormonal contraceptives such as the pill, patch or ring may help regulate or suppress menstrual periods, reduce menstrual flow and relieve symptoms. Some patients use them continuously to reduce monthly bleeding.
- Progestin-based treatment: Oral progestins such as dienogest, as well as progestin-containing devices such as Mirena or Implanon, may reduce pain and slow the growth or progression of endometriotic deposits. These options are commonly included in Singapore treatment pathways.
- GnRH medicines: Injection-based or other GnRH medicines may be used to block the menstrual cycle and lower oestrogen levels, creating a temporary menopause-like state that helps shrink endometriotic tissue and relieve symptoms. In some cases, add-back hormone therapy may be used to reduce menopausal side effects.
These medicines often need to be taken long term, because symptoms can recur after treatment stops. Medical therapy can be effective for pain control, but it may not be suitable for women who are actively trying to get pregnant, since some hormonal treatments work by suppressing ovulation or menstruation.
Surgical treatment for endometriosis
Surgery may be recommended if symptoms remain severe despite medication, if imaging suggests significant disease such as ovarian cysts or deep infiltrating endometriosis, or if fertility is a major concern. In Singapore, surgery is usually performed through laparoscopy, which is a minimally invasive or keyhole approach.
Laparoscopic surgery can serve both diagnostic and therapeutic purposes. It may be used to confirm the presence of endometriosis, remove endometriosis lesions, excise endometriotic cysts, release adhesions and restore normal pelvic anatomy. In selected patients, this can reduce severe pain and may improve fertility outcomes. In some SingHealth hospitals, robot-assisted laparoscopic surgery is also available for selected severe cases.
For women who have completed their family or are close to menopause, hysterectomy with or without removal of the ovaries may sometimes be considered when other treatments have not provided adequate relief. However, hysterectomy is not a guaranteed cure, and some patients may continue to have symptoms even after surgery.
If fertility is a priority
When pregnancy is a priority, treatment planning becomes more individualised. Medical therapy may help control symptoms, but some hormonal treatments are not suitable while trying to conceive. Depending on the severity and location of disease, surgery may sometimes improve the chance of pregnancy by removing lesions, cysts or adhesions and restoring pelvic anatomy. Fertility treatments such as ovulation induction, intrauterine insemination (IUI) or in vitro fertilisation (IVF) may also be recommended for women who are struggling to conceive because of endometriosis.
However, fertility-preserving decisions should be made carefully, especially when ovarian endometriotic cysts are present. KKH notes that surgery for ovarian endometriotic cysts can reduce ovarian reserve in some patients, so treatment has to balance symptom relief, disease control and future reproductive plans.
Severe or complex endometriosis
For severe endometriosis, especially when the bowel, bladder, ureters or other pelvic organs may be involved, a multidisciplinary approach may be needed. KKH’s endometriosis service includes gynaecologists, pain specialists, a colorectal surgeon, a mental wellness specialist, and nurse coordination, which reflects how complex endometriosis care may extend beyond medication or surgery alone.
Supportive care can also matter. WHO notes that multidisciplinary pain management, including physiotherapy and cognitive behavioural therapy, may help reduce endometriosis-related pain and improve quality of life, especially in women with chronic pain or persistent symptoms after treatment.
Long-term management and recurrence
Endometriosis should be approached as a chronic disease rather than a one-time event. Symptoms may recur after stopping medical treatment or even after surgery, so long-term follow-up is important. SingHealth states that for patients who retain their ovaries, medical treatment is often recommended after surgery to reduce the risk of regrowth. KKH also notes that recurrence is common over time, which is why long-term symptom control and ongoing review matter.
When Should You See a Doctor?
You should see a gynaecologist if you have painful menstrual periods that affect your work, relationships or quality of life, or if you have persistent pelvic pain, pain during sex, pain during bowel movements or urination during menstruation, heavy bleeding or difficulty conceiving. SingHealth specifically advises early review when painful periods affect quality of life.
Early assessment may help shorten the delay to diagnosis and identify suitable treatment options before symptoms become more disruptive. It may also help distinguish endometriosis from other causes of pelvic pain, such as pelvic inflammatory disease, ovarian cysts or bowel-related conditions.
Book a Consultation with Dr Law Wei Seng for Endometriosis Care
Endometriosis is a chronic disease that can affect the pelvic cavity, reproductive organs and overall well-being. Its symptoms may range from painful periods and chronic pelvic pain to bowel symptoms, ovarian cysts and fertility problems. Because these symptoms can overlap with other conditions, and because some women may have little or no pain, diagnosis may not always happen early.
While there is currently no cure, endometriosis can often be treated effectively with pain relief, hormone therapy, minimally invasive surgery and fertility-focused care where needed. Early medical review is important, especially when symptoms begin to affect your quality of life, work, relationships or ability to conceive. If you are looking for personalised evaluation and endometriosis treatment in Singapore, book a consultation with Dr Law Wei Seng to discuss your symptoms and the most suitable treatment options for your needs.
Frequently Asked Questions
What are the most common symptoms of endometriosis?
The most common symptoms of endometriosis include pelvic pain, painful periods, heavy bleeding, pain during sex, pain during bowel movements or urination, abdominal bloating and fertility problems. Some women may also have little or no pain.
How is endometriosis diagnosed?
Endometriosis is usually diagnosed through symptom review, menstrual history, pelvic examination and imaging such as ultrasound. In some cases, laparoscopy may be needed to confirm the diagnosis or treat the disease at the same time.
What treatment for endometriosis is usually tried first?
For many women, treatment starts with pain relief medication or hormone-based treatment to manage symptoms and suppress disease activity. Surgery is more often considered when symptoms are severe, persistent, linked to ovarian cysts or adhesions, or when fertility is a major concern.
Can laparoscopic surgery cure endometriosis?
Laparoscopic surgery can remove endometriosis lesions, ovarian cysts and adhesions and may provide meaningful pain relief. However, endometriosis can recur after surgery, so long-term follow-up may still be needed.
Can endometriosis affect fertility?
Yes. Endometriosis may affect fertility through inflammation, scar tissue, adhesions, damage involving the fallopian tubes or ovaries, and changes to pelvic anatomy. However, many women with endometriosis can still achieve pregnancy naturally or with fertility treatment when needed.
Will I need long-term treatment?
Possibly. Endometriosis is a chronic condition, and symptoms may return after medical treatment is stopped or even after surgery. Some patients therefore need ongoing review and longer-term management.