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It can take time to get a diagnosis of endometriosis. The average time to get a diagnosis is seven years. This is because symptoms vary between women, and symptoms can change over time. Also, period pain is often accepted as normal.

Some women have asymptomatic endometriosis, which means they don’t experience infertility or common symptoms such as pelvic pain. In these cases, the condition may be found during an unrelated operation.

A thorough review of your symptoms, medical history and test results will improve your chances of an early diagnosis.

When endometriosis symptoms are acknowledged and treated, most women with the condition do well.

Learn more about how endometriosis is diagnosed and when to see your doctor.

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Laparoscopy is keyhole surgery (via the abdomen) performed under general anaesthetic. A laparoscopy is the only way to confirm that endometrial tissue is present. This operation is usually performed when other medical management has not worked, or when a woman has difficulty falling pregnant.


Ultrasound uses sound waves to produce images of your body. Doctors with expert training can use ultrasound to make a ‘working diagnosis’ of endometriosis. Depending on the findings, you may or may not require surgery.

Magnetic resonance imaging (MRI)

MRI is a technology used to take cross-sectional pictures of your body. In future, MRI might be used to help diagnose endometriosis. This may be a good option for people who can’t access specialist ultrasound scans or want to avoid surgery.

Stages of endometriosis

The American Society for Reproductive Medicine has created a staging system for endometriosis. Endometriosis may be classified as minimal, mild, moderate or severe (or stages one to four). The stages are based on the location, extent and depth of endometrial tissue seen during surgery.

Some research suggests that most women have superficial, or milder, forms of endometriosis, but more research is required in this area.

Stage I (minimal)

There are small endometrial patches or plaques, inflammation and mild adhesions.

Stage II (mild)

As above, but there are many patches and there may be some scarring. There may also be adhesions between the uterus and the rectum.

Stage III (moderate)

As above, but there are also adhesions on the ovaries.

Stage IV (severe)

As above, but there are also many implanted endometrial patches, patches that may form scarred nodules, adhesions to other organs such as the bladder and bowel, and changes to the shape of pelvic organs.

The above classifications are useful, but they don’t always reflect the severity of symptoms. For example, a woman with stage one endometriosis may have more pain than a woman with stage four endometriosis.

If there are fertility problems, a different system called the Endometriosis Fertility Index can be used to help predict pregnancy outcomes following surgery.

Endometriosis in teenage years

A diagnosis of endometriosis in teenagers is often delayed. This is because many young women with symptoms, such as pain before and during a period, do not have endometriosis. Other symptoms, such as pain between periods or pain related to the bowel or bladder, are also common in teenagers without endometriosis.

Doctors may explore different treatment options, such as medicines, before recommending surgery. Medicines commonly used to reduce pain include anti-inflammatory drugs such as aspirin, ibuprofen and naproxen.

Your doctor may also recommend hormonal treatments such as the combined oral contraceptive pill (COCP) and progestogens to reduce period pain.

Medical management of painful periods improves symptoms for many young women. But if pain persists and you’ve seen a doctor three or more times over a six-month period, your doctor is likely to recommend a laparoscopy. The surgery will remove the endometriosis and confirm the diagnosis.

Your doctor can refer you to a gynaecologist with specialist skills in treating endometriosis in teenage years.

When to see your doctor

It’s not OK or normal to have severe period pain. If you think you have endometriosis, see your doctor as soon as possible, as early diagnosis and treatment can reduce the severity of the condition.

It’s a good idea to keep a diary of your symptoms. This will help your doctor or gynaecologist find out what is wrong. Your doctor may ask questions about:

  • your periods: for example, if your periods are regular and if you have heavy bleeding
  • period pain: for example, where you have pain, how long the pain lasts, if the pain stops you from doing normal activities and what medicines help to reduce the pain
  • other pain: for example, if you have pain during or after sex, if you have pain when you go to the toilet and if you have pain at ovulation (around the middle of your cycle)
  • other symptoms: for example, if you have constipation, diarrhoea or bloating, if you have lower back or leg pain and if you feel very tired
  • family history: for example, if any family members have had endometriosis
  • pregnancy: for example, if you have ever tried to get pregnant.

Download our fact sheets or visit resources for more information.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at January 2023.

This con­tent has been reviewed by a group of med­ical sub­ject mat­ter experts, in accor­dance with Jean Hailes pol­i­cy.

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Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, Chen Z, Fujimoto VY, Varner MW, Trumble A, Giudice LC; ENDO Study Working Group. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril. 2011;96(2):360-5
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de Sanctis V, Matalliotakis M, Soliman AT, Elsefdy H, Di Maio S, Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018; 51:138-150. doi:10.1016/j.bpobgyn.2018.01.023
Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis.BMJ. 2022;379:e070750. doi:10.1136/bmj-2022-070750
Last updated: 
07 December 2023
Last reviewed: 
31 January 2023

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