Endometriosis presents differently in every woman, and symptom severity does not reliably reflect the extent of the disease. Some women with extensive endometriosis experience relatively mild symptoms; others with minimal visible disease are profoundly affected. This variability contributes significantly to diagnostic delay.
Endometriosis
Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the womb, most commonly on the ovaries, fallopian tubes, bladder, bowel, and the lining of the pelvis.
Overview
What Is Endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the womb, most commonly on the ovaries, fallopian tubes, bladder, bowel, and the lining of the pelvis. This tissue responds to the hormonal signals of the menstrual cycle in the same way as the uterine lining, thickening and breaking down each month, but with nowhere to go. The result is inflammation, the formation of adhesions and scar tissue, and, for many women, significant and debilitating pain.
Endometriosis affects an estimated one in ten women of reproductive age in the United Kingdom. Despite this prevalence, the average time from symptom onset to diagnosis remains approximately eight years, a figure that reflects not just a diagnostic failure but a cultural one, in which the normalisation of severe menstrual pain has become one of the most consequential barriers to timely clinical care.
At The Schoeman Clinic, we take endometriosis seriously as the complex, systemic condition it is. We investigate its hormonal, inflammatory, and functional drivers, coordinate with specialist surgical and gynaecological partners where required, and provide comprehensive, ongoing management that goes beyond pain control alone.
Symptoms
Symptoms of Endometriosis
Pelvic pain is the most widely recognised symptom, typically presenting as severe menstrual cramping that is disproportionate to what is considered normal, pelvic pain at other points in the cycle, and pain during or after sexual intercourse. Deep infiltrating endometriosis may also cause pain during bowel movements or urination, particularly around menstruation.
Menstrual irregularity, including heavy periods and spotting between cycles, is commonly reported. Bloating, which can be cyclical and significant, is a frequently overlooked feature of endometriosis and is sometimes the presenting complaint.
Fatigue is disproportionately prevalent in endometriosis and is believed to reflect the body's chronic inflammatory burden rather than simply the disruptive effect of pain on sleep. Many women report a level of exhaustion that is not explained by their symptoms alone.
Fertility difficulties affect a significant proportion of women with endometriosis. The mechanisms are multiple, including disruption to the pelvic anatomy, impaired ovarian reserve, and the hostile inflammatory environment that endometriosis creates within the reproductive system.
Causes
Causes and Contributing Factors
The precise aetiology of endometriosis is not yet fully understood, and it is likely multifactorial. Genetic predisposition plays a role, with women who have a first-degree relative with endometriosis at significantly elevated risk. Immune dysregulation is considered central to the development and progression of endometriosis, with evidence suggesting that a compromised immune response fails to clear endometrial cells that migrate outside the uterus.
Hormonal factors are fundamental. Endometriosis is an oestrogen-dependent condition, driven and maintained by oestrogen signalling, and influenced by the relative balance between oestrogen and progesterone throughout the cycle. Oestrogen dominance, whether absolute or relative, plays a significant role in symptom severity.
Systemic inflammation and gut health imbalance have been identified as contributing factors in the progression of endometriosis. Emerging research points to the role of the gut microbiome in oestrogen metabolism, intestinal permeability, and systemic immune function, all of which are relevant to endometriosis management.
Environmental and nutritional factors, including exposure to endocrine-disrupting chemicals, nutritional deficiencies, and dietary inflammatory patterns, are also considered contributing elements in susceptible individuals.
Diagnosis
How We Assess Endometriosis
A definitive diagnosis of endometriosis requires laparoscopic surgical investigation; this cannot be achieved through blood tests or imaging alone. However, clinical assessment, targeted hormonal and inflammatory testing, and where appropriate pelvic imaging, can meaningfully contribute to the clinical picture and inform management even before or alongside a surgical diagnosis.
At The Schoeman Clinic, your doctor conducts a thorough clinical consultation covering symptom history, menstrual history, fertility goals, previous investigations, and current management. Blood testing may include oestradiol, progesterone, testosterone, SHBG, LH, FSH, thyroid function, CA-125 where indicated, inflammatory markers including high-sensitivity CRP, full nutritional screen, and gut health markers.
Pelvic ultrasound is arranged where appropriate and coordinated through our imaging partnerships. Where surgical assessment or gynaecological specialist review is required, we refer to our gynaecological partner Miss Claire Mellon of Claire Mellon and Associates, a specialist in women's health.
Treatment
Our Approach to Endometriosis Treatment
-
Hormonal Regulation and Bioidentical Hormone Therapy
Because endometriosis is oestrogen-dependent, hormonal management is central to effective treatment. At The Schoeman Clinic, your doctor uses advanced training in bioidentical hormone therapy to develop a personalised hormonal strategy aimed at creating a hormonal environment less favourable to endometrial tissue growth and symptom progression. This may include targeted progesterone support, oestrogen modulation, and management of the relative hormonal balance throughout the cycle.
-
Functional Medicine Root-Cause Investigation
Endometriosis is not a condition that exists in isolation. Its severity is influenced by immune function, inflammatory load, gut health, nutritional status, and environmental toxic burden. Our functional medicine approach investigates each of these contributing systems, using advanced testing to identify specific drivers and incorporating targeted interventions into the overall treatment plan.
-
Inflammation Reduction
Managing systemic inflammation is a core component of endometriosis care at The Schoeman Clinic. This is addressed through targeted nutritional medicine, specific anti-inflammatory supplementation based on your test results, dietary guidance, and gut health restoration where dysbiosis is identified.
-
Oestrogen Detoxification and Liver Pathway Support
The liver's capacity to metabolise and clear oestrogen influences how much circulating oestrogen is available to drive endometrial tissue activity. We assess detoxification pathways and, where indicated, incorporate liver support and oestrogen clearance strategies into your treatment plan.
-
Nutritional and Lifestyle Support
Specific nutritional interventions have a meaningful evidence base in endometriosis management, including omega-3 fatty acid optimisation, micronutrient correction, gut-supportive dietary patterns, and reduction of dietary inflammatory triggers. Recommendations are based on your individual test results and dietary history rather than generic advice.
-
Specialist Referral and Coordination
Where surgical assessment, specialist gynaecological investigation, or interdisciplinary management is required, we coordinate referrals to appropriate specialist partners and remain involved in your care throughout.
Why us
Why Choose The Schoeman Clinic for Endometriosis Care?
The Schoeman Clinic offers women with endometriosis a level of clinical investigation and integrative management that is not routinely available in standard care settings. We do not treat endometriosis as a gynaecological problem alone. We treat it as the complex, systemic, hormonally and immunologically mediated condition it is, and we develop treatment programmes that address the full range of biological factors driving its severity.
Your doctor's combined expertise in general practice, functional medicine, and specialist hormonal medicine allows them to approach endometriosis from a breadth of clinical perspective that is rarely concentrated in a single practitioner, and the clinic's network of specialist referral partners ensures that patients have access to the full range of care they may require.
The Schoeman Clinic is CQC-registered and adheres to NICE guidelines (NG73), ESHRE endometriosis guidelines, IFM frameworks, WorldLink Medical protocols, and GMC guidance throughout all patient care.
Continue
Where to go next.
Questions
Frequently asked questions
If your question is not answered here, our patient office will take it personally.
Book a consultationSevere menstrual pain should always be taken seriously and properly investigated. Endometriosis is an important potential cause, but other conditions including adenomyosis, fibroids, and pelvic inflammatory disease can also produce significant dysmenorrhoea. A thorough clinical assessment is the appropriate first step in understanding the cause of your pain.
Yes, in many cases. While surgery is the only way to definitively diagnose endometriosis and to remove established endometrial deposits, medical and functional management can significantly reduce symptoms and slow progression. For women who are not seeking surgical intervention, or who are waiting for or recovering from surgery, a comprehensive hormonal and functional medicine programme can provide meaningful and sustained benefit.
Yes. Many of the women we see with endometriosis have already had laparoscopic surgery and are seeking more comprehensive ongoing management of their hormonal balance, inflammation, and overall health. We work with what you already know about your condition and build a management plan around your specific clinical picture.
Endometriosis can affect fertility through several mechanisms, including anatomical distortion of the pelvic structures, impaired ovarian reserve, and the inflammatory environment it creates within the reproductive system. However, many women with endometriosis conceive naturally or with fertility support. Where fertility is a concern, this is addressed explicitly as part of your care plan and specialist gynaecological referral is arranged where required.
Endometriosis is a chronic condition, but its severity and the impact it has on daily life can be significantly modified through appropriate treatment. Many women experience substantial and sustained improvement in their symptoms through a well-managed combination of hormonal, nutritional, and functional medicine interventions.
Next step
Book a
Consultation
If you are living with endometriosis, or suspect it may be the cause of your symptoms, we would welcome the opportunity to conduct a thorough assessment and develop a comprehensive management plan with you.
Clinics
96 Harley Street
London W1G 7HY
4 St Marks Place
Wimbledon, London SW19 7NP
Patient office
The Schoeman Clinic is a CQC-registered private medical clinic. All clinical content on this page has been written or reviewed by Dr Gina Schoeman MB ChB, MBA, Dip Derm, MRCGP, MBCAM, AFMCP. This page is intended for informational purposes and does not constitute individual medical advice. Please book a consultation to receive advice tailored to your specific circumstances.
