How Often Should I see a Doctor for Endometriosis?
Dr. Kate Dudek • November 27, 2022 • 5 min read
There is no definitive rule with regards to how often you should see a doctor if you have endometriosis. The main thing is to find a sympathetic doctor who will take the time to listen to any concerns you might have.
Endometriosis can be difficult to diagnose and often the symptoms will closely resemble those of other conditions, such as irritable bowel syndrome (IBS). For this reason you may initially be referred to a gastroenterologist rather than a gynaecologist. In fact, even once diagnosed, the best approach may well be to consult a multidisciplinary team of experts, depending on the specific symptoms you are experiencing.
Looking after your emotional health
It is also important to consider that endometriosis can have a large impact on your emotional wellbeing, and thus you need to manage more than just the physical symptoms of the condition. Chronic pain can be psychologically draining, as can putting on a ‘brave face’ in front of friends and family.
It is not unusual for endometriosis patients to report feeling isolated and alone and the condition has a strong association with depression. It is important to consult your doctor before these feelings start to overwhelm you. Your doctor should also be able to put you in contact with local support groups, where you will have the opportunity to talk to other women who are in the same position.
Personalised treatment approach
The wide ranging clinical presentation of endometriosis means that every patient ideally needs to have a personalised treatment plan, tailored to their own requirements. This can take time to optimise, so in the early days after diagnosis, it might be necessary to see the doctor on a regular basis. As symptoms improve, the frequency of visits should subside.
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Sources:
- Endometriosis FAQs. Endometriosis UK, https://www.endometriosis-uk.org/endometriosis-faqs.
- Overview: Endometriosis. NHS, www.nhs.uk/conditions/endometriosis/. Page last reviewed: 18/01/2019.
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What Medications are Recommended for Endometriosis?
Medication for [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the most common [symptom](https://nabtahealth.com/the-symptoms-of-endometriosis/) of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is pain, with up to 80% of patients complaining of period pain and up to 50% experiencing chronic pelvic pain. Aside from the physical discomfort and day-to-day limitations that long-term, chronic pain causes, it can also massively impact a patient’s quality of life, potentially leading to psychological conditions including anxiety and depression. The anxiety can be exacerbated in those patients who experience heavy periods every month, which causes additional discomfort and worry. #### Painkillers The first line approach for managing the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are over-the-counter painkillers. Non-steroidal anti-inflammatories ([NSAIDs](https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids)), such as ibuprofen, partly function by inhibiting the production of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/). [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) cause the [uterus](https://nabtahealth.com/glossary/uterus/) to contract during [menstruation](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) and this contributes to the [period pain](https://nabtahealth.com/articles/what-is-period-pain/) experienced by patients with _[endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Reducing the levels of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) will reduce the painful [contractions](https://nabtahealth.com/glossary/contraction/). Codeine-based medications and paracetamol-containing products are other options for pain relief. #### Hormone treatment If painkillers do not provide sufficient relief from the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) there is the option of hormonal treatment. This is not a suitable option for those who are seeking help for [infertility](https://nabtahealth.com/glossary/infertility/). The endometrial deposits that develop outside the [uterus](https://nabtahealth.com/glossary/uterus/), and are characteristic of the condition, form in response to the hormone [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Hormonal therapy aims to block or reduce the production of [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Frequently prescribed hormonal therapies include the [combined contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/), [progesterone](https://nabtahealth.com/glossary/progesterone/) pills and gonadotrophin releasing hormone (GnRH) analogues: * The combined pill contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/); it prevents [](https://nabtahealth.com/articles/is-oligo-ovulation-anovulation-a-symptom-of-pcos/)[ovulation](https://nabtahealth.com/glossary/ovulation/) and makes periods lighter and less painful. * [Progesterone](https://nabtahealth.com/glossary/progesterone/) suppresses the growth of endometrial tissue, reducing [inflammation](https://nabtahealth.com/glossary/inflammation/) and pain. * GnRH analogues block [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, causing the endometrial tissue to shrink and become inactive. These drugs place the body into a temporary [menopausal](https://nabtahealth.com/i-am-post-menopause/) state, and long term use may require further medication to combat [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/)\-associated symptoms, such as [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and bone density loss. #### Alternative options Medication is just one option for the treatment of [endometriosis](https://nabtahealth.com/glossary/endometriosis/). If symptoms persist, another option to consider is [surgery](https://nabtahealth.com/should-i-have-surgery-for-endometriosis/). A fully personalised treatment approach is recommended for each patient, taking into account their age, symptoms, [fertility](https://nabtahealth.com/product/fertility-selfcare/) status and family situation. Nabta is reshaping [women’s healthcare](https://nabtahealth.com/). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, [pregnancy](https://nabtahealth.com/articles/pregnancy-symptoms/), and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#225b434e4e43624c434056434a47434e564a0c414d4f) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Treatment. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/endometriosis-treatment)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-treatment. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). Mayo Clinic, 24 July 2018, [https://www.mayoclinic.org/diseases-conditions/](https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/diagnosis-treatment/drc-20354661. * Treatment: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/treatment/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/treatment/. Page last reviewed: 18/01/2019.
How is Endometriosis Diagnosed?
[](https://nabtahealth.com/what-is-endometriosis/)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Diagnosis can be challenging because the [symptoms](../the-symptoms-of-endometriosis) are often difficult to distinguish from [irritable bowel syndrome](https://nabtahealth.com/glossary/irritable-bowel-syndrome/); symptoms such as diarrhea, [constipation](https://nabtahealth.com/glossary/constipation/) and abdominal cramping are frequently seen with either or both conditions. Other symptoms, such as heavy and painful periods, and migraines, may be dismissed as normal ‘[monthly women problems](https://nabtahealth.com/articles/how-can-i-regulate-my-periods/)’. As well as regularly presenting with symptoms that are indistinguishable from other conditions, there is also a great deal of variability from patient to patient, further complicating diagnosis. 20-25% of _women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/)_ are [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/), suggesting that the cited incidence rate of 6-10% of the female population having [endometriosis](https://nabtahealth.com/glossary/endometriosis/), is probably an under-estimation. Due to the inefficiency of the diagnostic tools currently in place, it very often takes years to diagnose a woman with [endometriosis](https://nabtahealth.com/glossary/endometriosis/). Diagnostic techniques --------------------- If you suspect you have [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the first thing your doctor will do is examine your tummy and pelvis. They will feel for any abnormalities, such as cysts around your [](https://nabtahealth.com/articles/do-polycystic-ovaries-equal-pcos/)[ovaries](https://nabtahealth.com/glossary/ovaries/). Of course there are other conditions that cause [cysts](../are-ovarian-cysts-the-same-thing-as-pcos) to form on the [ovaries](https://nabtahealth.com/glossary/ovaries/), so this alone is not sufficient to diagnose [endometriosis](https://nabtahealth.com/glossary/endometriosis/). The current ‘[gold](https://nabtahealth.com/glossary/gold/) standard’ test for [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is to perform a [](../what-is-a-laparoscopy)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/). This is a procedure performed under general anaesthetic, where a small tube is passed through a cut in your abdomen. The surgeon will use a camera to view any abnormal tissue. Ideally, at least a single [biopsy](https://nabtahealth.com/glossary/biopsy/) will be taken at the same time, for further histological analysis. Histological diagnosis is usually accurate and, if this supports a positive diagnosis, an appropriate treatment plan can be implemented. Alternative, non-invasive tests, such as [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) and MRI scans have been shown to have very good accuracy at diagnosing deep [endometriosis](https://nabtahealth.com/glossary/endometriosis/), particularly when used in combination. Accuracy of diagnosis can be as high as 95%, which matches the level seen with [](https://nabtahealth.com/articles/what-is-a-laparoscopy/)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/). Deep [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is thought to affect up to 20% of patients. The main advantage to these imaging techniques is that they are less invasive than the current tests of choice and their popularity in the clinical setting is likely to continue to grow. The future for [endometriosis](https://nabtahealth.com/glossary/endometriosis/) diagnosis ----------------------------------------------------------------------------------------- An understudied area of research for the diagnosis of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is the identification of serum biomarkers of the condition. Levels of a protein, CA-125, are often raised in patients with [endometriosis](https://nabtahealth.com/glossary/endometriosis/). However, as a general marker of [](https://nabtahealth.com/product/vitamin-d-and-inflammation-test/)[inflammation](https://nabtahealth.com/glossary/inflammation/), it is not specific to [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and can be indicative of an alternative inflammatory condition such as appendicitis, [pelvic infection](https://nabtahealth.com/articles/pelvic-inflammatory-disease-a-simple-guide/) or ovarian cysts. Ideally an [endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-specific marker, or panel of markers, will be found, enabling accurate diagnosis using a simple blood test, negating the need for more invasive treatment. Nabta is reshaping [women’s healthcare.](https://nabtahealth.com) We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a1d8c0cdcdc0e1cfc0c3d5c0c9c4c0cdd5c98fc2cecc) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bazot, M, and E Daraï. “Diagnosis of Deep [Endometriosis](https://nabtahealth.com/glossary/endometriosis/): Clinical Examination, Ultrasonography, Magnetic Resonance Imaging, and Other Techniques.” _Fertility and Sterility_, vol. 108, no. 6, Dec. 2017, pp. 886–894., doi:10.1016/j.fertnstert.2017.10.026. * Hickey, M, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _BMJ_, vol. 348, 19 Mar. 2014, p. g1752., doi:10.1136/bmj.g1752. * Kennedy, S, et al. “ESHRE Guideline for the Diagnosis and Treatment of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _Human Reproduction_, vol. 20, no. 10, Oct. 2005, pp. 2698–2704., doi:10.1093/humrep/dei135. * May, K E, et al. “Peripheral Biomarkers of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/): a Systematic Review .” _Human Reproduction Update_, vol. 16, no. 6, 2010, pp. 651–674., doi:10.1093/humupd/dmq009. * _Overview: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/. Page last reviewed: 18/01/2019. * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Mayo Clinic, 24 July 2018, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/symptoms-causes/syc-20354656.
What is Abnormal Uterine Bleeding?
A normal menstrual cycle lasts between 21 and 35 days. Day one of the cycle is always the first day of menstrual bleeding (also known as having your period). Menstrual bleeding typically lasts for between 2 and 7 days and is often incorrectly used as a sign that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred. In fact, women can have apparently normal periods without ovulating, click [here](https://nabtahealth.com/i-have-regular-periods-could-i-still-have-pcos/) to find out more. Normal [ovulation](https://nabtahealth.com/glossary/ovulation/) is essential for maintaining healthy levels of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). Whilst these two hormones play a pivotal role during pregnancy, their beneficial effects are not limited to this; they are also vital for maintaining general health and help to protect against [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), breast cancer and heart disease. #### What defines abnormal uterine bleeding? Abnormal uterine bleeding affects 2-5% of women of reproductive age. It occurs when the cycle length and period duration differ from the normal values. It is a broad term that also encompasses bleeding or spotting between periods. Unfortunately this wide categorisation means that there are many potential causes of abnormal uterine bleeding and, often, diagnosis becomes a process of elimination. When abnormal uterine bleeding takes the form of prolonged, or heavy bleeding it is termed [menorrhagia](https://nabtahealth.com/glossary/menorrhagia/). Medically a ‘heavy’ period is defined as losing more than 80ml blood and/or it having a duration of over 7 days. Young teenagers and women experiencing the [perimenopause](https://nabtahealth.com/glossary/perimenopause/) are most at risk. For young teenagers it is usually just a case of their bodies settling into a regular cycle. Women who are perimenopausal are nearing the end of their reproductive years and will probably find the bleeding becomes more irregular and sporadic, before stopping altogether. Treatment options range from non-steroidal anti-inflammatory drugs, which block [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) (easing painful period cramps) and reduce menstrual flow; to hormonal treatment, such as the combined [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/%MCEPASTEBIN%), which stabilises the endometrial lining and ensures controlled monthly bleeds. In the most severe cases a female may need to undergo a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/). Broadly speaking, abnormal uterine bleeding occurs because of structural abnormalities, lifestyle disruptions or [ovulation](https://nabtahealth.com/glossary/ovulation/) disorders. #### Structural abnormalities These can include [benign](https://nabtahealth.com/glossary/benign/) lesions such as [](../a-simple-guide-to-fibroids)[fibroids](https://nabtahealth.com/glossary/fibroids/), [](../what-are-uterine-polyps)[polyps](https://nabtahealth.com/glossary/polyps/) and [](../what-is-adenomyosis)[adenomyosis](https://nabtahealth.com/glossary/adenomyosis/), as well as lesions of the [cervix](https://nabtahealth.com/glossary/cervix/) and the [vagina](https://nabtahealth.com/glossary/vagina/). [](../what-is-endometriosis)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) is a well characterised condition that results from a build-up of endometrial-like tissue elsewhere in the body; chronic period pain and heavy periods are two of the main symptoms. Complications during the early stages of pregnancy, such as [miscarriage](https://nabtahealth.com/glossary/miscarriage/) and [](../what-is-an-ectopic-pregnancy)[ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) can also result in abnormal bleeding. Sometimes women who have an intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) fitted for contraception will experience abnormal bleeding. Most structural abnormalities can be identified with ultrasound; for lesions deep within the pelvic region, a high resolution [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) is a very useful diagnostic aid. Occasionally surgery will be required; [hysteroscopies](../what-is-a-hysteroscopy) (within the uterine cavity) and [laparoscopies](../what-is-a-laparoscopy) (outside the [uterus](https://nabtahealth.com/glossary/uterus/)) can be used for both diagnosis and ablation of unwanted lesions. #### Lifestyle disruptions Certain medications and medical conditions can disrupt the menstrual cycle. Diabetes is one example. There appears to be some association between [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) and a thickening of the uterine lining, the latter of which results in heavy periods. Emotional and physical stress can cause the menstrual cycle to become irregular, as can [obesity](https://nabtahealth.com/what-is-body-mass-index-bmi/%MCEPASTEBIN%) ([BMI](https://nabtahealth.com/glossary/bmi/) >30) and smoking. These are known as modifiable risk factors because through making behavioural adjustments, the risk of experiencing menstrual irregularities is reduced. #### [Ovulation](https://nabtahealth.com/glossary/ovulation/) disorders If no other cause can be established for abnormal uterine bleeding then an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder will probably be considered. These are classed as dysfunctional uterine bleeding and the most common examples are [polycystic ovary syndrome](../treating-the-associated-symptoms-of-pcos) ([PCOS](https://nabtahealth.com/glossary/pcos/)), thyroid disease and premature ovarian insufficiency ([POI](https://nabtahealth.com/glossary/poi/)). Thyroid disease is frequently misdiagnosed as [PCOS](https://nabtahealth.com/glossary/pcos/) because it shares a number of common symptoms, including [anovulation](https://nabtahealth.com/glossary/anovulation/) and [hair loss](../coping-with-pcos-hair-loss). However, thyroid disease itself has a strong association with irregular menstrual cycles. One study found that 44% of people with menstrual disorders had an underlying thyroid issue. The predominant thyroid issue is [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/), which suppresses [ovulation](https://nabtahealth.com/glossary/ovulation/), impairs insulin sensitivity and reduces the availability of cellular energy (ATP). Normal ovarian function requires significant energy. The advantage to finding out you have an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder is that often it is [reversible](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) with changes to the diet and lifestyle. For example, losing weight can improve the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). [POI](https://nabtahealth.com/glossary/poi/) is one case where lifestyle modifications will unfortunately not help. It happens when the [ovaries](https://nabtahealth.com/glossary/ovaries/) stop producing eggs and can come on gradually or occur suddenly. The first sign of the condition will usually be irregular menstrual cycles. In 50% of cases the cause is unknown, although there is thought to be a familial component. This condition can also occur in women who have undergone [](https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/about)[radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) or [](https://nabtahealth.com/articles/skin-changes-after-chemotherapy/)[chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Symptoms can be alleviated with hormone replacement therapy, but to date there is no cure. Unfortunately doctors are often unsure how best to manage _abnormal uterine bleeding_ and treatment is, at best, random and speculative, and at worst, ineffective. It is of fundamental importance to identify the reasons for your [irregular cycles](https://nabtahealth.com/articles/why-are-my-periods-irregular/) and abnormal bleeding because only that way will you be able to find a solution that provides complete symptomatic relief. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0a736b66666b4a646b687e6b626f6b667e6224696567) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Abnormal Uterine Bleeding (Booklet).” ReproductiveFacts.org, The American Society for Reproductive Medicine, www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/. Revised 2012. * Ajmani, N S, et al. “Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi.” Journal of Obstetrics and Gynaecology of India , vol. 66, no. 2, Apr. 2016, pp. 115–119., doi:10.1007/s13224-014-0650-0. * Bae, J, et al. “Factors Associated with Menstrual Cycle Irregularity and [Menopause](https://nabtahealth.com/glossary/menopause/).” BMC Women’s Health, vol. 18, no. 1, 6 Feb. 2018, p. 36., doi:10.1186/s12905-018-0528-x. * Koutras, D A. “Disturbances of Menstruation in Thyroid Disease.” Annals of the New York Academy of Sciences, vol. 816, 17 June 1997, pp. 280–284. * “Overview: Heavy Periods.” NHS, [www.nhs.uk/conditions/heavy-periods/](http://www.nhs.uk/conditions/heavy-periods/). Page last reviewed: 07/06/2018. * “What Is Premature Ovarian Insufficiency (Also Called Premature Ovarian Failure)? .” ReproductiveFacts.org, The American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/). Revised 2015.