What endometriosis is
In endometriosis, tissue similar to the lining of the womb grows outside the womb, where it causes inflammation and scarring. The WHO estimates that about 10% of women of reproductive age are affected, around 190 million worldwide. There is currently no cure, but the symptoms can be treated.
Typical symptoms
The WHO lists above all:
- severe pain during periods
- heavy menstrual bleeding
- pelvic pain that doesn't go away outside your period
- pain during sex, bowel movements or urination
- difficulty getting pregnant
- bloating and nausea
Not everyone affected has all of these. Mental health often suffers too, for example through depression or anxiety.
Why it takes so long
According to the WHO, diagnosis takes 4 to 12 years on average. A 2025 systematic review found times between a few months and 12 years in studies since 2018. Its conclusion: the delay arises mainly on the doctors' side.
What the 2025 guideline changes
The German-language guideline of the specialist societies of Germany, Austria and Switzerland was revised in April 2025. It bases diagnosis and treatment more closely on each person's symptoms. Transvaginal ultrasound is now the central examination. As the first treatment it recommends hormone therapy; surgery and other approaches are added depending on the symptoms.
Surgery is no longer required for a diagnosis. According to the WHO, endometriosis can also be diagnosed from symptoms and imaging such as ultrasound or MRI, and treatment can start without surgery first.
Among the treatments, the WHO lists painkillers, hormonal medicines and, for some, surgery. It mentions physiotherapy and cognitive behavioural therapy as part of care involving several specialties.
What you can bring
Notes over a few cycles make the conversation more concrete: when the pain comes, how strong it is, whether it is linked to your period. In Rhythmus you can log cramps and tiredness daily; after a few cycles, “Your pattern” in History shows whether something keeps coming back at the same point. It doesn't replace a diagnosis.