Good question: Could it be endometriosis? Signs, symptoms, and next steps

March  6, 2026 | 4 min read

If you have questions about endometriosis, you’re not alone. Studies have shown that more people are unfamiliar with the chronic inflammatory condition than understand it.¹  Even among women – who comprise nearly all endometriosis cases²– there are awareness gaps; some research shows that as many as 45 per cent are unable to list a single symptom.³

Yet endometriosis is far from rare. It currently affects approximately 10 per cent of women of reproductive age,⁴ and the rate of diagnoses is growing fast – up 32 per cent from 2017 to 2024, according to a 2025 review.⁵  In Canada, nearly two million people live with endometriosis.⁶

“Many people also don’t know how debilitating the condition can be,” explains Dr. Farzana Haq, physician lead of women’s health at Cleveland Clinic Canada, which serves as medical director for Group Benefits at Manulife Canada. “Or that different women experience it very differently.”  

We asked Dr. Haq to offer insights into preventing, treating, and supporting loved ones with this painful chronic condition.

Dr. Farzana Haq: Endometriosis is when endometrial⁷ tissue, which is tissue that lines the uterus, is found outside the uterine cavity.

Because this tissue remains active and responsive to hormones, it can cause pain, inflammation, and scarring on the areas where there are deposits. Most commonly, we see a deposit in the pelvic region: in and around the fallopian tubes, the ovaries, and the lower pelvic area. More rarely, we can find endometrial tissue on other organs throughout the body, such as the bladder or diaphragm.

Dr. Haq: There seems to be some genetic correlation: People who have a family history of endometriosis seem to have a higher risk.⁸ We also know that early menarche – which we define as having a first period before 11 years old – is associated with an increased risk.⁹ Shorter menstrual cycles of less than 28 days can be a bit of a risk factor.¹⁰ There is also some evidence that a history of uterine surgery, including Cesarean¹¹ sections, can cause seeding of endometrial tissue.¹²

Dr. Haq: There is no known way to completely prevent it. In part, that’s because some major risk factors are things we can’t change, such as genetics and family history, or when a first period starts. 

But it’s also important to note that we still don’t fully understand the exact pathophysiology of endometriosis. There are theories around retrograde menstruation, where there’s backflow of bleeding through the fallopian tube that seeds tissue in the pelvic cavity. There are theories around immune modulation or dysregulation, where a malfunctioning immune system fails to clear endometrial tissue, allowing for implantation and growth. There are also theories that involve changes in early fetal cells.¹³ But the bottom line is that we don’t know, exactly, what causes endometriosis. As a result, we don’t have a definitive prevention protocol.

Dr. Haq: There is some evidence that lifestyle factors can affect risk.¹⁴ For example, since endometriosis is an inflammatory condition, we know that anything that decreases inflammation is likely helpful: This can include exercising regularly, and limiting alcohol, caffeine, and processed, pro-inflammatory foods. These same lifestyle factors can help ease pain for many people living with endometriosis.

Dr. Haq: Far and away, the most common symptom is pain,¹⁵ particularly around menstrual periods. Because the endometrial tissue can deposit in the lower pelvic area, there is sometimes pain with intercourse. Frequent or painful urination is often a symptom, as are difficult or painful bowel movements. The degree and severity of pain can be significant enough to cause people to miss work or school, or make it hard to keep up with day-to-day functioning.

Fatigue is another very common symptom. 

There are non-physical symptoms, too. Mental health issues are far more prevalent among individuals with chronic pain conditions,¹⁶ and we do see significantly increased rates of both depression and anxiety in patients who have endometriosis.¹⁷ On average, it takes five to 10 years for someone to get a diagnosis for endometriosis.¹⁸ It’s a painful condition, and not having an answer or a treatment plan certainly can affect someone’s mental health, as well as their functioning.

Dr. Haq: The most reliable, gold-standard way to diagnose endometriosis is to identify it during surgery. But obviously, surgery on everyone who has painful periods is really difficult, and also inappropriate as an initial way to make a diagnosis.

Often, the endometrial tissues don’t show up on an ultrasound; sometimes, they don’t even appear on an MRI. That means we’re often making a clinical diagnosis, which is a diagnosis based on a pattern of symptoms alone, without additional supportive tests. And that can be really difficult, because the symptoms of endometriosis can overlap with symptoms of other conditions. 

In addition, many practitioners may not be as comfortable or familiar with assessing and treating endometriosis. This is, in part, due to lack of understanding about the pathophysiology of this condition and difficulty in having clear criteria to make the diagnosis.

Dr. Haq: Self-advocacy is very important. It’s fully appropriate to ask questions of your clinician’s experience with conditions like endometriosis: How many patients do they see with symptoms similar to theirs? Are they comfortable assessing, diagnosing, and treating endometriosis? If so, can you explore what that looks like together? If not, can they refer you to an expert?

These questions can be uncomfortable, but they can help you find the best path of care. 

Dr. Haq: It can be difficult to gauge, especially for women who have always had painful periods, or for younger women who don’t have a long history with menstruation. Documenting symptoms – in terms of timing and severity – can help you make relative comparisons and identify emerging patterns that might otherwise not be obvious. Is the pain getting worse over time? Is it 15 per cent worse than it was five years ago? Is it 50 per cent worse? Or 100 per cent worse? There are online tools and apps available now that can help with this.

As a general rule, if your symptoms are severe enough to prevent you from doing things you’d normally want to do – if, for example, you have to cancel plans for dinner with friends because you’re in too much pain – it’s a bit of a red flag that the situation warrants attention.

Dr. Haq: From a lifestyle perspective, we’re aiming to decrease pain and inflammation. Exercising regularly, eating well,¹⁹ and limiting caffeine can help with that. There’s some evidence that pelvic floor physiotherapy can be helpful,²⁰ especially for women who have significant pelvic symptoms or pain with intercourse. Acupuncture can also help with pain management.²¹

From a medication standpoint, for some individuals, effective treatment can be as simple as over-the-counter anti-inflammatories.  Hormonal contraception, such as an IUD (intrauterine device), can also help: Estrogen-decreasing therapies, such as progestin-only hormonal therapies, have proven benefit for reducing symptom severity in women with endometriosis.²²

Then there are surgical options, for which there are two broad categories. There is what we call conservative treatment, which involves leaving the uterus in place and treating the endometrial tissues to try to remove as much as possible. And there is more definitive treatment, which means removing the uterus, in addition to any seeded endometrial tissue within the pelvic cavity. 

What patients choose depends on preference, availability, other underlying medical conditions, and additional considerations, including potential fertility journeys. 

Dr. Haq: First, know that you’re better able to support someone when you have an understanding of what they’re experiencing. I recommend learning about what endometriosis is, what it means, and what to expect – even at a high level. There are educational platforms available specifically dedicated to endometriosis. Having that understanding can help you validate your loved one’s experiences and understand the symptoms.

Second, depending on how close you are, attending medical appointments together can be helpful. That allows you to hear the dialogue between the person affected and their clinician, get a sense of the overall game plan, and help advocate for their needs.

Because endometriosis is a chronic pain condition, it often doesn’t only affect the person who has it: It can also indirectly affect partners, children, and friends. So, education, advocacy, and support from those in the circle of care can be really helpful. 

This article is for informational purposes only. It is not intended to diagnose or treat a condition. If you have questions or concerns about your specific situation or are seeking medical advice, contact your medical doctor or your healthcare provider.


A note about gender:

While we use the terms "women," "female," and "men" and "male" in this article, we recognize that these terms are not inclusive of all gender identities and that the health 

Cleveland Clinic Canada
Manulife is proud to have Cleveland Clinic Canada on board as Medical Director for our Group Benefits operations. Cleveland Clinic Canada has a wealth of global health care expertise and shares our goal to help Canadians live longer, healthier, and better lives. Cleveland Clinic is a nonprofit organization that has been at the forefront of modern medicine since 1921. In recent years, Cleveland Clinic has worked with progressive companies in Canada and around the world to prioritize the health and well-being of their employees, customers, and communities.