What is the course and complications of endometriosis?

Adhesions and scar tissue

Endometriosis can be complicated by the formation of adhesions and scar tissue which distort pelvic anatomy and cause pain. Other rare complications from scar tissue can occur when extensive scarring causes obstruction (blockage) of the bowel or the ureter. Scar tissue and adhesions may contribute to reduced fertility. Less commonly adhesions can also result from the surgical treatment of endometriosis, although this is less likely if the surgery is performed through the laparoscope (keyhole surgery).


30-50% of women with endometriosis may have difficulty in conceiving. In moderate and severe endometriosis there may be scar tissue and adhesions around each tube and ovary which reduces fertility. Less severe endometriosis, even in the absence of any obvious damage to the tubes and ovaries is also associated with reduced fertility, although the reasons are less clear.

Impact on quality of life

Endometriosis can have physical, psychological and social consequences which can impair a woman’s quality of life. This can be due to chronic pain, fatigue, depression, problems with relationships and sex life, difficulty in fulfilling work, social and family commitments.

Acute complications

In rare cases, ovarian cysts (endometriomas) may bleed, rupture or twist causing sudden severe pain which may require urgent treatment.

Effects of treatment

Women receiving treatment for endometriosis can suffer from side effects or complications from both medical and surgical treatments.

How does endometriosis progress?

Endometriosis is a diverse condition with a highly variable course. Currently, there is no cure for endometriosis, although women who have completed their family or decided not to have children may benefit from removing all the endometriosis present and their pelvic organs (uterus and ovaries). The natural course of endometriosis, if untreated, is still uncertain. If endometriosis is left untreated, it may become worse in approximately 4 in 10 cases, or get better without treatment in about 3 in 10 cases. For the rest it stays the same.
The treatments currently used in endometriosis aim to reduce the severity of symptoms and improve the quality of life for a woman living with the condition.
Recurrence of symptoms is common once hormone treatment is discontinued, with 10-50% of women requiring further treatment. Recurrence of symptoms is also common after surgical treatment.