Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Endometriosis

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In one line

·Tissue that looks and acts like the lining of the uterus grows outside the uterus, bleeds every month with your period, and causes pain, scarring, and trouble getting pregnant.

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Normal physiology

·The endometrium (the lining of the uterus) grows on the inside wall of the uterus, thickens during the first half of the menstrual cycle under estrogen, and sheds through the cervix and vagina during your period if no pregnancy occurs. This cycle repeats every month, and the tissue stays inside the uterus and leaves the body when it bleeds.

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What goes wrong

·Tissue that looks and acts like the endometrium grows outside the uterus—on the ovaries, fallopian tubes, the outer uterus wall, the lining of the pelvis, the bowel, or the bladder—where it does not belong.

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Hallmark signs

·Pelvic pain that gets worse during your period
·Pain during or after sex (deep pain with sex (dyspareunia))
·Heavy or irregular menstrual bleeding
·Trouble getting pregnant (infertility)
·Painful bowel movements or blood in the stool during your period
·Painful urination or blood in the urine during your period
·Tender nodules or lumps felt behind the uterus on pelvic exam
·Uterus is tilted backward and does not move freely (fixed retroverted uterus)

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Red flags · escalate now

·Severe, sudden pelvic pain that does not go away — may mean an endometriosis cyst on the ovary has ruptured or twisted (ovarian torsion), cutting off blood supply and causing tissue to die
·Blood in the stool or urine during your period, or painful bowel movements that make you unable to pass stool — may mean endometriosis has grown deep into the bowel or bladder wall and needs urgent evaluation
·Trouble getting pregnant after one year of trying (or six months if you are over 35) — endometriosis is a common hidden cause of infertility and needs specialist evaluation and treatment

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Workup

·Pelvic ultrasound (transvaginal is best)
·CA-125 blood test
·MRI of the pelvis (if ultrasound is not clear or surgery is being planned)
·Laparoscopy with biopsy (camera surgery through a small cut in the belly)
·Assessment of pain with a validated pain scale (numeric rating scale or visual analog scale)

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Treatment

·Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400–800 mg or naproxen 220–500 mg during the period
·Combined oral contraceptive pills (estrogen plus progestin) or progestin-only pill, patch, or IUD (like levonorgestrel IUD)
·GnRH agonist (like leuprolide) or GnRH antagonist (like elagolix)
·Laparoscopic excision or ablation surgery (cutting out or burning the tissue spots)
·Fertility treatments like in vitro fertilization (IVF) or intrauterine insemination (IUI)

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NCLEX trap

·Endometriosis spots are often too small or scattered to show on imaging. Normal imaging does NOT rule it out. Diagnosis is made by the story (pain pattern, exam findings) and confirmed by laparoscopy (camera surgery that lets the surgeon see and biopsy the tissue). Many women with proven endometriosis have completely normal scans.
·Start with medicine first: NSAIDs (like ibuprofen) for pain and hormonal birth control (pills, patch, or IUD) to stop the monthly cycle that feeds the disease. Reserve surgery for patients who don't get better on medicine or who need fertility treatment and want the tissue removed to improve their chances of pregnancy.
·Endometriosis causes pain DURING the period AND chronic pelvic pain all month long. The misplaced tissue bleeds and scars, and those scars pull on nerves and organs even when the period is over. Pain with sex, pain with bowel movements, and constant aching between periods are all part of endometriosis.
·Endometriosis can happen even with perfectly regular periods. The disease is about where the uterus lining tissue grows (outside the uterus instead of inside), not whether the cycle is regular. Regular bleeding does not protect against or rule out endometriosis.
·Pregnancy may pause endometriosis symptoms temporarily (because ovulation and periods stop), but it does NOT cure the disease. The tissue and scars remain. Infertile patients with endometriosis need real help — surgery to remove tissue blocking the tubes or IVF — not false hope that pregnancy will fix it.
·Endometriosis causes debilitating chronic pain, deep pain during sex, and pain with bowel movements or urination. These symptoms ruin quality of life, limit work, and strain relationships whether or not the patient wants children. Pain is a valid, urgent reason to treat.

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