Endometriosis is a disease in which tissue similar to the lining of the uterus grows in other places in the body. It is one of the most common gynecological diseases, and its primary symptoms include pain and infertility.

NICHD conducts and supports research to improve understanding of the mechanisms, diagnosis, and treatments of endometriosis.

About Endometriosis

Endometriosis is a disease in which tissue similar to the lining of the uterus grows in other places in the body.

The word endometriosis comes from the word “endometrium”—endo means “inside,” and metrium means “uterus,” where a mother carries her baby. Healthcare providers call the tissue that lines the inside of the uterus the endometrium.

Researchers aren’t exactly sure what causes endometriosis, but some theories include the following:

  • Retrograde menstruation. This theory proposes that endometriosis cells flow backward through the fallopian tubes and into the pelvis during menstruation.
  • Coelomic metaplasia. This theory refers to a change in the characteristics of the cells that line the organs in the pelvis.

These theories don’t explain every instance of endometriosis, like endometriosis that occurs in organs such as the lungs (possibly due to spreading through the blood system or lymphatics) or the rare cases of endometriosis in men.

Healthcare providers may use the terms “implants,” “nodules,” or “lesions” to describe areas or patches of endometriosis. Most endometriosis patches are found in the pelvic cavity:

  • On the ovaries
  • On the fallopian tubes, which carry egg cells from the ovaries to the uterus
  • Behind the uterus
  • On the tissues that hold the uterus in place
  • On the bowels or bladder

In rare cases, endometriosis may grow outside the pelvic cavity, such as on the lungs or in other parts of the body.1

The female reproductive organs are shown with red patches of endometriosis located on the ovaries and on the outside of the uterus. The uterus, fallopian tubes, ovaries, vagina, and areas of endometriosis are labeled.

Researchers’ understanding of endometriosis is changing with new scientific evidence. For example, researchers used to think that pain from endometriosis was related to the size of the patches growing outside the uterus. But evidence shows this is not the case. In fact, the size and location of the lesions are not related to the severity or to the location of the pain.2,3 Studies also indicate that pain is not associated with a woman’s ability to get pregnant.4,5


  1. Office on Women’s Health, U.S. Department of Health and Human Services. (2019). Endometriosis. Retrieved October 10, 2019, from https://www.womenshealth.gov/a-z-topics/endometriosis
  2. Stratton, P., & Berkley, K. J. (2011). Chronic pelvic pain and endometriosis: Translational evidence of the relationship and implications. Human Reproduction Update, 17(3), 327–346. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072022/
  3. American College of Obstetricians and Gynecologists. (2010, reaffirmed 2018). Practice Bulletin No. 114: Management of endometriosis. Obstetrics & Gynecology, 116(1), 223–236. Retrieved February 11, 2020, from https://journals.lww.com/greenjournal/Citation/2010/07000/Practice_Bulletin_No__114__Management_of.41.aspx external link
  4. Santulli, P., Bourdon, M., Presse, M., Gayet, V., Marcellin, L., Prunet, C., et al. (2016). Endometriosis-related infertility: Assisted reproductive technology has no adverse impact on pain or quality-of-life scores. Fertility and Sterility, 105(4), 978–987. Retrieved February 11, 2020, from https://www.sciencedirect.com/science/article/pii/S0015028215021755?via%3Dihub external link
  5. Wilson-Harris, B. M., Nutter, B., & Falcone, T. (2014). Long-term fertility after laparoscopy for endometriosis-associated pelvic pain in young adult women. Journal of Minimally Invasive Gynecology, 21(6), 1061–1066. Retrieved February 11, 2020, from https://www.sciencedirect.com/science/article/pii/S155346501400288X?via%3Dihub external link

What are the risk factors for endometriosis?

Research shows that certain factors may increase or decrease a woman’s risk for endometriosis.

Studies show that women are at higher risk for endometriosis if they:

  • Have a mother, sister, or daughter with endometriosis1
  • Started their periods at an early age (before age 11)2
  • Have short monthly cycles (less than 27 days)2
  • Have heavy menstrual periods that last more than 7 days2
  • Are infertile3

Some studies suggest that having a lean body mass or low body fat may increase a woman’s risk for endometriosis.4

Studies also show that some factors may lower the risk for endometriosis, including:

  • Pregnancy3
  • Periods that started late in adolescence5
  • Breastfeeding6
  • Eating more fruit, especially citrus fruits7


  1. American College of Obstetricians and Gynecologists (ACOG). (2019). Endometriosis. Retrieved October 10, 2019, from https://www.acog.org/Patients/FAQs/Endometriosis external link
  2. ACOG. (2010, reaffirmed 2018). Practice Bulletin No. 114: Management of endometriosis. Obstetrics & Gynecology, 116(1), 223–236. Retrieved February 11, 2020, from https://journals.lww.com/greenjournal/Citation/2010/07000/Practice_Bulletin_No__114__Management_of.41.aspx external link
  3. Peterson, C. M., Johnstone, E. B., Hammoud, A. O., Stanford, J. B., Varner, M. W., Kennedy, A., et al. (2013). Risk factors associated with endometriosis: Importance of study population for characterizing disease in the ENDO Study. American Journal of Obstetrics and Gynecology208(6), 451.e1–451.11. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114145/
  4. Farland, L. V., Missmer, S. A., Bijon, A., Gusto, G., Gelot, A., Clavel-Chapelon, F., et al. (2017). Associations among body size across the life course, adult height, and endometriosis. Human reproduction (Oxford, England), 32(8), 1732–1742. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850750/
  5. Treloar, S. A., Bell, T. A., Nagle, C. M., Purdie, D. M., & Green, A. C. (2010). Early menstrual characteristics associated with subsequent diagnosis of endometriosis. American Journal of Obstetrics and Gynecology, 202(6), 534.e1–534.e6. Retrieved February 11, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0002937809019802?via%3Dihub external link
  6. Farland, L. V., Eliassen, A. H., Tamimi, R. M., Spiegelman, D., Michels, K. B., & Missmer, S. A. (2017). History of breast feeding and risk of incident endometriosis: Prospective cohort study. BMJ (Clinical research ed.)358, j3778. Retrieved February 11, 2020, from https://www.bmj.com/content/358/bmj.j3778 external link
  7. Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. (2018). Fruit and vegetable consumption and risk of endometriosis. Human reproduction (Oxford, England)33(4), 715–727. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018917/

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are pain and infertility.1

Other common symptoms of endometriosis include:1

  • Painful or even debilitating menstrual cramps, which may get worse over time
  • Pain during or after sex
  • Pain in the intestine or lower abdomen
  • Painful bowel movements or painful urination during menstrual periods
  • Heavy menstrual periods
  • Premenstrual spotting or bleeding between periods2
  • Problems getting pregnant3

In addition, women with endometriosis may have painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue or lack of energy.4, 5

For some women, the pain associated with endometriosis gets milder after menopause. However, hormone therapy, such as estrogen or birth control pills given to reduce menopausal symptoms, may cause the pain and other symptoms to continue.

Endometriosis-Related Pain

Researchers know that pain is a primary symptom of endometriosis, but they do not know exactly what causes the pain.

The severity of the pain does not correspond with the number, location, or extent of endometriosis lesions. Some women with only a few small lesions experience severe pain; other women may have very large patches of endometriosis but experience little pain.1,6

Current evidence suggests several possible explanations for pain associated with endometriosis, including the following:1,6

  • Patches of endometriosis respond to hormones in a similar way as the lining of the uterus. These tissues may bleed or have inflammation every month, like a regular menstrual period. However, the blood and tissue shed from endometriosis patches stay in the body and are irritants, which can cause pain.
  • In some cases, inflammation and chemicals produced by the endometriosis areas can cause the pelvic organs to stick together, causing scar tissue. This makes the uterus, ovaries, fallopian tubes, bladder, and rectum appear as one large organ.
  • Hormones and chemicals released by endometriosis tissue may irritate nearby tissue and cause it to release other chemicals that cause pain.
  • Over time, some endometriosis areas may form nodules or bumps on the surface of pelvic organs or become cysts (fluid-filled sacs) on the ovaries.
  • Some endometriosis lesions have nerves in them, tying the patches directly into the central nervous system. These nerves may be more sensitive to pain-causing chemicals released in the lesions and surrounding areas. Over time, they may be more easily activated by the chemicals than normal nerve cells are.
  • Patches of endometriosis might also press against nearby nerve cells to cause pain.
  • Some women report less endometriosis pain after pregnancy, but the reason for this is unclear. Researchers are trying to determine whether the pain reduction results from the hormones the body releases during pregnancy or from changes in the cervix, uterus, or endometrium that occur during pregnancy and delivery.

Endometriosis pain can be severe, interfering with day-to-day activities. Understanding how endometriosis is related to pain is a very active area of research because it could allow for more effective treatments for this type of pain.


  1. American College of Obstetricians and Gynecologists. (2019). Endometriosis. Retrieved October 11, 2019, from https://www.acog.org/Patients/FAQs/Endometriosis external link
  2. Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American Journal of Obstetrics and Gynecology, 211(4), 358.e1–358.e3586. Retrieved January 23, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/?term=24799313
  3. NICHD. (2018). Spotlight: What to know about endometriosis. Retrieved January 23, 2020, from https://www.nichd.nih.gov/newsroom/resources/spotlight/031218-spotlight-endometriosis
  4. Surrey, E. S., Soliman, A. M., Johnson, S. J., Davis, M., Castelli-Haley, J., & Snabes, M. C. (2018). Risk of developing comorbidities among women with endometriosis: A retrospective matched cohort study. Journal of Women’s Health, 27(9), 1114–1123. Retrieved November 1, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30070938
  5. Ramin-Wright, A., Kohl Schwartz, A. S., Geraedts, K., Rauchfuss, M., Wölfler, M. M., Haeberlin, F., et al. (2018). Fatigue - a symptom in endometriosis. Human Reproduction, 33(8), 1459–1465. Retrieved November 1, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/29947766
  6. Stratton, P., & Berkley, K. J. (2011). Chronic pelvic pain and endometriosis: Translational evidence of the relationship and implications. Human Reproduction Update, 17(3), 327–346. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072022/

How do healthcare providers diagnose endometriosis?

Surgery is currently the only way to confirm a diagnosis of endometriosis.

The most common surgery is called laparoscopy.

In this procedure:

  • The surgeon uses an instrument to inflate the abdomen slightly with a harmless gas.
  • After making a small cut in the abdomen, the surgeon uses a small viewing instrument with a light, called a laparoscope, to look at the reproductive organs, intestines, and other surfaces to see if there is any endometriosis.
  • If patches of tissue are present, the surgeon examines them to determine whether they are endometriosis and, if so, at what stage they might be.
  • In some cases, the surgeon will also do a biopsy, which involves taking a small tissue sample and studying it under a microscope, to confirm the diagnosis.1
  • The most common surgery is a laparoscopy, but sometimes a laparotomy—a surgical procedure involving a larger incision—is used to make a diagnosis.

Healthcare providers may also use imaging methods to produce a “picture” of the inside of the body. Imaging allows them to locate larger endometriosis areas, such as nodules or cysts. The two most common imaging tests are ultrasound, which uses sound waves to make the picture, and magnetic resonance imaging (MRI), which uses magnets and radio waves to make the picture. These types of imaging do not help diagnose small lesions or adhesions.1

Your healthcare provider will perform a laparoscopy only after learning your full medical history and giving you a complete physical and pelvic exam. This information and exam, in addition to the results of an ultrasound or MRI, will help you and your healthcare provider make more informed decisions about treatment.

Researchers are also seeking less invasive ways to diagnose endometriosis and determine how severe it is. NICHD-funded researchers in the National Centers for Translational Research in Reproduction and Infertility created a “diagnostic classifier” for endometriosis based on the presence of particular genes. The classifier was 90% to 100% accurate. Once the classifier is validated, a simple biopsy in the doctor’s office may be a nonsurgical way to diagnose endometriosis in most women.2


  1. American College of Obstetricians and Gynecologists. (2010, reaffirmed 2018). Management of endometriosis. Practice Bulletin No. 114. Washington, DC. Retrieved February 11, 2020, from https://insights.ovid.com/article/00006250-201007000-00041 external link
  2. Tamaresis, J. S., Irwin, J. C., Goldfien, G. A., Rabban, J. T., Burney, R. O., Nezhat, C., et al. (2014). Molecular classification of endometriosis and disease stage using high-dimensional genomic data. Endocrinology, 155(12), 4986–4999. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239429/

What are the treatments for endometriosis?

There is currently no cure for endometriosis, but there are treatment options for related pain and infertility.

Healthcare providers consider several factors when determining the best treatment for endometriosis symptoms, including:

  • Your age
  • How severe your symptoms are
  • How severe the disease is
  • Whether you want children

Not all treatments work well for all women with endometriosis. Also, endometriosis symptoms may return after the treatment is stopped or, in the case of surgery, as more time passes after the procedure.

Hormone Therapy

Because hormones cause endometriosis patches to go through a cycle similar to the menstrual cycle, hormones also can be effective in treating endometriosis symptoms. Additionally, different hormones may alter our perception of pain.

Hormone therapy is used to treat endometriosis-associated pain. Hormones come in the form of a pill, a shot or injection, or a nasal spray.

Hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation. This may help slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment also prevents new areas and scars (adhesions) from growing, but it will not make existing adhesions go away.

Healthcare providers may suggest one of the following hormone treatments to treat pain from endometriosis:1,2,3

  • Gonadotropin-releasing hormone (GnRH) medicines stop the production of certain hormones to prevent ovulation, menstruation, and the growth of endometriosis. This treatment sends the body into a “menopausal” state.
    • A GnRH medicine called elagolix (also called Orilissa®) also stops the release of hormones to prevent the growth of endometriosis. It is the first pill approved by the U.S. Food and Drug Administration (FDA) to treat pain associated with endometriosis. Foundational research that led to the new drug was supported by NICHD through its Small Business Innovation Research program.4
      • The low-dose pill should not be taken for more than 24 months and the high‑dose pill should not be taken for more than 6 months because it may cause bone loss.5
      • The drug’s most common side effects include headache, nausea, difficulty sleeping, absence of periods, anxiety, depression, and joint pain.5
    • Some GnRH medicines come in a nasal spray taken daily, as an injection given once a month, or as an injection given every 3 months.
    • Most healthcare providers recommend staying on GnRH medicine for only about 6 months at a time, with several months between treatments if they are repeated. The risk for heart complications and bone loss can rise when taking them longer.1 After stopping the GnRH medicine, the body comes out of the menopausal state, menstruation begins, and pregnancy is possible.6
    • As with all hormonal treatments, endometriosis symptoms return after women stop taking GnRH medicine.
    • These medications also have side effects, including hot flashes, tiredness, problems sleeping, headache, depression, joint and muscle stiffness, bone loss, and vaginal dryness.
  • Oral contraceptives, or birth control pills. These help make a woman’s period lighter, shorter, and more regular. Women prescribed contraceptives also report relief from pain.7
    • In general, the therapy contains two hormones: estrogen and progestin, a progesterone-like hormone. Women who can’t take estrogen because of cardiovascular disease or a high risk of blood clots can use progestin-only pills to reduce menstrual flow.
    • Typically, a woman takes the pill for 21 days and then takes sugar pills for 7 days to mimic the natural menstrual cycle. Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. Taken without the sugar pills, birth control pills may stop the menstrual period altogether, which can reduce or eliminate the pain. There are also birth control pills available that provide only a couple days of sugar pills every 3 months; these also help reduce or eliminate pain.
    • Pain relief usually lasts only while taking the pills, while the endometriosis is suppressed. When treatment stops, the symptoms of endometriosis may return (along with the ability to get pregnant). Many women continue treatment indefinitely. Occasionally, some women have no pain for several years after stopping treatment.
    • These hormones can have some mild side effects, such as weight gain, bloating, and bleeding between periods, especially when women first start to take the pills continuously.
  • Progesterone and progestin, taken as a pill, by injection, or through an intrauterine device (IUD), improve symptoms by reducing a woman’s period or stopping it completely. This also prevents pregnancy.
    • As a pill taken daily, these hormones reduce menstrual flow without causing the uterine lining to grow. As soon as a woman stops taking the progestin pill, symptoms may return, and pregnancy is possible.
    • An IUD containing progestin, such as Mirena®, may be effective in reducing endometriosis-associated pain. It reduces the size of lesions and reduces menstrual flow (one-third of women no longer get their period after a year of use).8
    • As an injection taken every 3 months, these hormones usually stop menstrual flow. However, some women may experience irregular menstrual bleeding in the first year of injection use. During these times of bleeding, pain may occur.9 After a year of using the injection, about half of women report having no period. Additionally, it may take a few months for a period to return after stopping the injections. Even if a woman does not have a period, she may still be able to get pregnant; if pregnancy is not desired, a woman should take steps to prevent pregnancy.
    • Women taking these hormones may gain weight, feel depressed, or have irregular vaginal bleeding.
  • Danazol (also called Danocrine®) treatment stops the release of hormones that are involved in the menstrual cycle. While taking this drug, women will have a period only occasionally or not at all.
    • Common side effects include oily skin, pimples or acne, weight gain, muscle cramps, tiredness, smaller breasts, and sore breasts. Headaches, dizziness, weakness, hot flashes, or a deepening of the voice may also occur while on this treatment. Danazol’s side effects are more severe than those from other hormone treatment options.1
    • Danazol can harm a developing fetus. Therefore, it is important to prevent pregnancy while on this medication. Hormonal birth control methods are not recommended for women taking danazol. Instead, healthcare providers recommend using barrier methods of birth control, such as condoms or a diaphragm.

Researchers are exploring the use of other hormones for treating endometriosis and the pain related to it. One example is gestrinone, which has been used in Europe but is not available in the United States. Drugs that lower the amount of estrogen in the body, called aromatase inhibitors, are also being studied. Some research shows that they can be effective in reducing endometriosis pain, but they are still considered experimental in the United States. The FDA has not approved them for treatment of endometriosis.7

Pain Medications

Pain medications may work well if pain or other symptoms are mild. These medications range from over-the-counter pain relievers to strong prescription pain relievers.

The most common types of pain relievers are nonsteroidal anti-inflammatory drugs, also called NSAIDS.

Evidence on the effectiveness of these medications for relieving endometriosis-associated pain is limited. Understanding which drugs relieve pain associated with endometriosis could also shed light on how endometriosis causes pain.1,10

Surgical Treatments

Research shows that some surgical treatments can provide significant, although short-term, relief from endometriosis-related pain,1 so healthcare providers may recommend surgery to treat severe pain from endometriosis. During the operation, the surgeon can locate any areas of endometriosis and examine the size and degree of growth; he or she also may remove the endometriosis patches at that time.

It is important to understand what is planned during surgery because some procedures cannot be reversed, and others can affect a woman’s fertility. Therefore, women should discuss all available options with their healthcare providers before making final decisions about treatment.

Healthcare providers may suggest one of the following surgical treatments for pain from endometriosis.1,2,10

  • Laparoscopy. The surgeon uses an instrument to inflate the abdomen slightly with a harmless gas and then inserts a small viewing instrument with a light, called a laparoscope, into the abdomen through a small cut to see the growths.
    • To remove the endometriosis, the surgeon makes at least two more small cuts in the abdomen and inserts lasers or other surgical instruments to:
      • Remove the lesions, which is a process called excising.
      • Destroy the lesions with intense heat and seal the blood vessels without stitches, a process called cauterizing or vaporizing.
    • Some surgeons also will remove scar tissue at this time because it may contribute to endometriosis-associated pain.
    • The goal is to treat the endometriosis without harming the healthy tissue around it.
    • With surgery, most women have pain relief in the short term, but pain often returns. Surgery can provide long-term pain relief in women with deep lesions when those lesions are excised.1
    • Some evidence shows that surgical treatment for endometriosis-related pain is more effective in women who have moderate endometriosis rather than minimal endometriosis. Women with minimal endometriosis may have changes in their pain perception that persist after removing the lesions.8,10
  • Laparotomy. In this major abdominal surgery procedure, the surgeon may remove the endometriosis patches. Sometimes the endometriosis lesions are too small to see in a laparotomy.
    • During this procedure, the surgeon may also remove the uterus. Removing the uterus is called hysterectomy.
    • If the ovaries have endometriosis on them or if damage is severe, the surgeon may remove the ovaries and fallopian tubes along with the uterus. This process is called total hysterectomy and bilateral salpingo-oophorectomy.
    • When possible, healthcare providers will try to leave the ovaries in place because of the important role ovaries play in overall health.
    • Healthcare providers recommend major surgery as a last resort for endometriosis treatment.
    • Having a hysterectomy or salpingo-oophorectomy does not guarantee that the lesions will not return or that the pain will go away. There is still a slight chance that endometriosis symptoms and lesions may come back in some women even if they have a total hysterectomy with bilateral salpingo-oophorectomy.1
  • Surgery to sever pelvic nerves. If the pain is in the center of the abdomen, healthcare providers may recommend cutting nerves in the pelvis to lessen the pain. This can be done during either laparoscopy or laparotomy.1 The American College of Obstetricians and Gynecologists (ACOG) reports several clinical trials that showed these procedures to be ineffective at relieving pain from endometriosis. These procedures are not currently included in the ACOG recommendations for management of endometriosis.1,7,8
    • Two procedures are used to sever different nerves in the pelvis.
      • Presacral neurectomy severs the nerves connected to the uterus.
      • Laparoscopic uterine nerve ablation (LUNA) severs nerves in the ligaments that secure the uterus.

In some cases, hormone therapy is used before or after surgery to reduce pain and/or continue treatment. Current evidence supports the use of an IUD containing progestin after surgery to reduce pain.8 Currently, Mirena® is the only IUD approved by the FDA to treat pain after surgery.

In most cases, healthcare providers will recommend laparoscopy to remove or vaporize the growths to also improve fertility in women who have mild or minimal endometriosis.8 Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear.

If pregnancy does not occur after laparoscopic treatment, in vitro fertilization (IVF) may be the best option to improve fertility. Taking any other hormonal therapy usually used for endometriosis-associated pain will suppress ovulation and delay pregnancy. Performing another laparoscopy is not the preferred approach to improving fertility unless pain symptoms prevent undergoing IVF. Multiple surgeries, especially those that remove cysts from the ovaries, may reduce ovarian function and hamper the success of IVF.8

IVF makes it possible to combine sperm and eggs in a laboratory to make an embryo. The resulting embryos are placed into the woman’s uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.

In general, the process of IVF involves the following steps. First, a woman takes hormones to cause “superovulation,” which triggers her body to produce many eggs at one time. Once the eggs are mature, a healthcare provider collects them using a probe inserted into the vagina and guided by ultrasound. The collected eggs are placed in a dish for fertilization with a man’s sperm. The fertilized cells are then placed in an incubator, a machine that keeps them warm and allows them to develop into embryos. After 3 to 5 days, the embryos are transferred to the woman’s uterus. It takes about 2 weeks to know whether the process is successful.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, ACOG does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. Using these hormonal agents prevents ovulation and delays pregnancy.1,11

In addition, the hormones used during IVF do not cure the endometriosis lesions, which means that pain may recur after pregnancy and that not all women with endometriosis are able to become pregnant with IVF. Researchers are still looking for hormone treatments for infertility due to endometriosis.


  1. American College of Obstetricians and Gynecologists. (2010, reaffirmed 2018). Practice Bulletin No. 114: Management of endometriosis. Obstetrics & Gynecology, 116(1), 223–236. Retrieved February 11, 2020, from https://journals.lww.com/greenjournal/Citation/2010/07000/Practice_Bulletin_No__114__Management_of.41.aspx external link
  2. American College of Obstetricians and Gynecologists. (2019). Endometriosis. Retrieved October 13, 2019, from https://www.acog.org/Patients/FAQs/Endometriosis external link
  3. Giudice, L. C. (2010). Endometriosis. New England Journal of Medicine, 362(25), 2389–2398. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108065/
  4. Struthers, R. S., Nicholls, A. J., Grundy, J., Chen, T., Jimenez, R., Yen, S. S., & Bozigian, H. P. (2009). Suppression of gonadotropins and estradiol in premenopausal women by oral administration of the nonpeptide gonadotropin-releasing hormone antagonist elagolix. Journal of Clinical Endocrinology and Metabolism, 94(2), 545–551. Retrieved October 28, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/19033369
  5. U.S. Food and Drug Administration. (2018). Drug Trials Snapshots: ORILISSA. Retrieved October 28, 2019, from https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-orilissa
  6. Limonta, P., Marelli, M. M., Moretti, R., Marzagalli, M., Fontana, F., & Maggi, R. (2018). Chapter two - GnRH in the human female reproductive axis. In G. Litwack (Ed.), Vitamins and hormones (Vol. 107, pp. 27–66). Cambridge, MA: Academic Press. Retrieved November 1, 2019, from https://www.sciencedirect.com/science/article/pii/S0083672918300037 external link
  7. Practice Committee of the American Society for Reproductive Medicine. (2014). Treatment of pelvic pain associated with endometriosis: A committee opinion. Fertility and Sterility, 101(4), 927–935. Retrieved February 11, 2020, from https://www.sciencedirect.com/science/article/pii/S0015028214001502?via%3Dihub external link
  8. Yeung, P. P., Jr., Shwayder, J., & Pasic, R. P. (2009). Laparoscopic management of endometriosis: Comprehensive review of best evidence. Journal of Minimally Invasive Gynecology, 16(3), 269–281. Retrieved February 11, 2020, from https://www.sciencedirect.com/science/article/pii/S1553465009001113?via%3Dihub external link
  9. U.S. Food and Drug Administration. (2002). Depo-Provera® Contraceptive Injection. Retrieved January 27, 2020, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/20246scs019_Depo-provera_lbl.pdf (PDF 152 KB)
  10. Stratton, P., & Berkley, K. J. (2011). Chronic pelvic pain and endometriosis: Translational evidence of the relationship and implications. Human Reproduction Update, 17(3), 327–346. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072022/
  11. Hughes, E., Brown, J., Collins, J. J., Farguhar, C., Fedorkow, D. M., & Vandekerckhove, P. (2007). Ovulation suppression for endometriosis. Cochrane Database of Systematic Reviews, (3), Art. No. CD000155. Retrieved February 11, 2020, from https://www.cochrane.org/CD000155/MENSTR_ovulation-suppression-for-endometriosis external link
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