Let's Talk About Endometriosis and Pelvic Health

An often under recognized, and under explained condition, endometriosis can impact many aspects of an affected woman’s life. Endometriosis affects an estimated 1 in 10 women during their reproductive years, yet in Canada it takes an average of 5 years to diagnose. In that time, most women are treated for conditions they don't have, like UTIs, IBS, anxiety, while the real cause goes unaddressed.

Here, we are answering all your questions about endometriosis and its impact on pelvic health, including urinary health.

What Is Endometriosis?

During menstruation, the uterine lining sheds and regrows each cycle. In endometriosis, tissue similar to that lining grows outside the uterus: on the ovaries, fallopian tubes, pelvic lining, bowel, and in some cases, the bladder and urethra.

Unlike normal endometrial tissue, this displaced tissue has nowhere to go. It cannot exit the body during your period. Instead, it causes inflammation, scarring, and adhesions (where organs can gradually become stuck together).

How common is endometriosis?

• Affects approximately 190 million women worldwide

• 1 in 10 women of reproductive age ¹

• Endometriosis accounts for 50% of pelvic pain in Canadian women²

• 25 to 50% of women with infertility have endometriosis ¹

What are the symptoms of endometriosis?

• Heavy or very painful periods

• Chronic pelvic pain between periods

• Pain during or after sex

• Painful urination or frequent urge to urinate

• Bloating, nausea, diarrhea

• Back and leg pain

• Bladder pressure or discomfort

• Blood in the urine (in bladder endometriosis cases)

• Fatigue

• Fertility difficulties

Every one of these symptoms can point to something else, and this is why endometriosis can go undetected for so long.

How does endometriosis affect overall health and wellbeing?

The impact of endometriosis goes well beyond the physical symptoms. Women report missing work, withdrawing from social life, and experiencing anxiety and depression as a direct result of chronic, unresolved pain. Being dismissed, treated for infections that weren't there, or told that pain is just "part of being a woman" adds a significant psychological burden on top of the physical one.

Endometriosis also affects relationships, sexual health, fertility, and the ability to participate fully in daily life. It is not a minor condition. It is a systemic disease that deserves serious, specialist attention.

How do I know if I have endometriosis?

There is no simple test. Though signs may show up on ultrasound, definitive diagnosis has been typically done through laparoscopy, a minimally invasive surgical procedure in which a small camera is inserted into the abdominal cavity to directly visualize implants and scar tissue, confirmed by biopsy. New methods are emerging to make it easier to test and diagnose endometriosis, allowing it to be diagnosed in earlier stages.³

There are patterns worth paying attention to and raising with your doctor:

• Pain that is severe enough to affect your daily life or require time off work

• UTI-like symptoms that recur but urine cultures keep coming back negative

• Symptoms that are cyclical and worse before or during your period

• Pelvic pain during sex, bowel movements, or between periods

• Antibiotics that don't fully resolve symptoms, or symptoms that return quickly

If any of these are familiar, push for investigation. 

Why does it take so long to get diagnosed?

In Canada, it can take an average of 5 years to get a diagnosis.

The reasons are systemic. Endometriosis symptoms overlap with many other conditions. Health care providers may not have enough knowledge about endometriosis. Additionally, Imaging may not always show signs. ³ 

The stigma around women’s health and menstrual health continues and has a profound impact on how the condition is recognized and spoken about. Women may find it hard to talk about menstrual pain or may not know what they are experiencing is not normal menstrual pain. Period pain has historically been dismissed as normal, even when it is genuinely debilitating. And only 2% of medical research funding goes toward female reproductive health. Research also shows that Black women are 50% less likely to be diagnosed than white women.⁴

Endometriosis is most commonly mistaken for: UTIs, IBS, pelvic inflammatory disease, interstitial cystitis, pelvic floor dysfunction, sciatica, and uterine fibroids. When every diagnostic tool points elsewhere, it lengthens the road to a diagnosis.

Can you have endometriosis on your bladder?

Yes, it is called Bladder endometriosis. It exists in 2 forms:

Superficial: Lesions grow on the outer surface of the bladder.

Deep infiltrating: Lesions invade the bladder wall, affecting bladder function. This form can cause painful urination, urgency, frequency, and blood in the urine. Because it so closely resembles interstitial cystitis and chronic UTIs, it is frequently misdiagnosed or missed entirely.⁷

Can endometriosis cause UTIs?

Endometriosis can both mimic UTI symptoms and, in certain cases, increase the risk of UTIs.

The symptom overlap

The bladder, uterus, ovaries, and bowel all sit in close proximity in the pelvis. When endometrial lesions grow on or near the bladder or urethra, they cause irritation and inflammation that closely resembles a UTI: burning with urination, urgency, frequency, and pelvic pressure, without any bacterial infection present. 

The increased infection risk

Beyond mimicking symptoms, endometriosis can also raise actual UTI susceptibility. First, research indicates endometriosis suppresses the immune response systemically, reducing the body's ability to fight off bacterial infection. Second, in cases of deep infiltrating bladder endometriosis, lesions that penetrate the bladder wall can disrupt the normal mucosal barrier, creating a more favourable environment for an infection. Women with bladder endometriosis do often experience recurrent UTIs, not just overlapping symptoms.⁵

Research also found women with endometriosis were nearly 4 times more likely to develop interstitial cystitis, a condition that itself is associated with increased UTI risk due to a compromised bladder lining.⁶

For women navigating both endometriosis and recurring urinary symptoms, knowing whether an infection is actually present can be very helpful. UTI diagnostic test strips detect leukocytes and nitrites in the urine, giving a clearer picture of whether symptoms are likely to be caused by a bacterial infection. This helps avoid unnecessary prescriptions. 

For women who do experience confirmed recurrent UTIs alongside endometriosis, a prevention plan can reduce how often infections occur and relieve some of the anxiety that comes with managing both conditions at once.

Research supports cranberry extract supplements containing a minimum of 36mg of PACs (proanthocyanidins), measured by DMAC/A2 (the same method used in the clinical studies) as an effective option for recurrent UTI prevention. Utiva UTI Control is formulated to this standard.

What is the difference between a UTI, interstitial cystitis, and endometriosis?

UTI: 

• Caused by bacteria entering the urinary tract.

• Produces burning, urgency, frequency, and pelvic pain.

• Responds to antibiotics.

• Urine culture confirms bacterial infection.

Interstitial Cystitis (IC): 

• Chronic bladder pain and pressure without infection.

• Urine cultures come back negative. 

• Symptoms are persistent. 

Endometriosis affecting the bladder: 

• Inflammatory tissue on or near the bladder causing UTI-like symptoms. 

• Cyclical pattern, often worsening around menstruation. 

• Urine cultures come back negative. 

• Will not respond to antibiotics.

Does endometriosis get better at menopause?

Yes it often does, but not always.

Endometriosis is estrogen-dependent, so as estrogen declines after menopause, symptoms frequently ease. However, existing lesions do not disappear. Bladder lesions in particular can continue causing irritation long after periods stop. Though rare, some postmenopausal women continue to experience endometriosis symptoms.

During perimenopause, endometriosis can worsen. Unpredictable estrogen fluctuations during this transition can trigger symptom flares, making the perimenopausal years particularly challenging for women with endometriosis.⁸

Can I take HRT if I have endometriosis?

Yes, in some cases. Clinical evidence shows that estrogen-only HRT carries a risk for women with endometriosis. A systematic review published in PMC found that all confirmed endometriosis recurrences in one randomized trial occurred in the HRT arm, with unopposed estrogen specifically associated with disease reactivation. Combined estrogen-progestogen HRT is generally considered lower risk.⁹

Women in perimenopause or postmenopause with a history of endometriosis do have options, however. It is important to discuss with your healthcare provider what your options are, including non-hormonal menopause symptom support.

What are the treatment options for endometriosis?

Treatment depends on symptom severity and personal goals. Options include:

Hormonal therapy: Birth control pills, progestins, or GnRH agonists to suppress endometriosis activity and reduce estrogen-driven inflammation.

Anti-inflammatory medications: NSAIDs such as ibuprofen or naproxen for pain management.

Pelvic floor physiotherapy: Particularly helpful when muscle dysfunction is contributing to urinary symptoms, urgency, or pain.

Surgery: Laparoscopic surgery can remove lesions, adhesions, or deep infiltrating tissue. Hysterectomy may also be considered for women who do not respond to other treatment methods.¹

References

1. World Health Organization. (2023). Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis

2. Society of Obstetricians and Gynaecologists of Canada. (n.d.). Endometriosis. https://sogc.org/en/en/content/events/HUB-Pages/Endometriosis.aspx

3. Endometriosis Network Canada. (n.d.). Paths to diagnosis. https://endometriosisnetwork.com/paths-to-diagnosis/

4. Mustafa, T. (2024, January). Women Are Being Told Their Endometriosis Is A UTI – What’s Going Wrong?. Refinery29. https://www.refinery29.com/en-gb/2024/01/11638053/endometriosis-misdiagnosis-uti-symptoms

5. Rosati, M., Conti, F., Di Michele, S., & Bramante, S. (2026). Endometriosis can increase susceptibility to infections. International Journal of Infection, 10(1), 23–26. https://www.biolife-publisher.it/iji/endometriosis-can-increase-susceptibility-to-infections/

6. Namugosa, M., El Haraki, A., Ritts, R., Ferrara, K., Badlani, G., Evans, R., & Walker, S. J. (2025). Prevalence and clinical correlates of endometriosis in patients with interstitial cystitis/bladder pain syndrome. Urogynecology. https://pmc.ncbi.nlm.nih.gov/articles/PMC11753943/

7. Hodgdon, K. (n.d.). Can endometriosis cause UTI symptoms? Rescripted. https://rescripted.com/posts/can-endometriosis-cause-uti-symptoms

8. Endo Excellence Center. (n.d.). Understanding menopause: Effects on endometriosis pain relief. https://endoexcellencecenter.com/understanding-menopause-effects-on-endometriosis-pain-relief/

9. Gemmell, L. C., Webster, K. E., Kirtley, S., Vincent, K., Zondervan, K. T., & Becker, C. M. (2017). The management of menopause in women with a history of endometriosis: A systematic review. Human Reproduction Update, 23(4), 481–500. https://pmc.ncbi.nlm.nih.gov/articles/PMC5850813/