What is ovarian endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. When this tissue develops on or inside the ovary, it is referred to as ovarian endometriosis. Over time it can form a cyst filled with old blood — this is why it is sometimes called a chocolate cyst or endometrioma.
Ovarian involvement is significant because the ovaries play a central role in hormonal function, ovulation, and fertility. Endometriomas do not always cause obvious symptoms and are sometimes discovered during an ultrasound scan done for another reason entirely.
How common is it — and what causes it?
Endometriosis is one of the most common gynaecological conditions, affecting roughly one in ten women of reproductive age. When it involves the ovary it forms the cysts known as endometriomas, or chocolate cysts. Importantly, endometriosis is not cancer, it is not an infection, and it cannot be passed on to anyone else.
The exact cause is not fully understood. Current thinking is that it is driven by a combination of hormones — particularly oestrogen — and inflammation, and it is often found to run in families. Because the symptoms overlap with other conditions, many women wait years before a diagnosis is made, which is why noticing the signs early and arranging a pelvic scan can make a real difference.
More likely if you have
- A mother or sister with endometriosis
- Periods that started at an early age
- Menopause at a later age
- Delayed childbearing or never having been pregnant
Reassuring to know
- It is not cancer and not contagious
- Many women have mild or no symptoms
- It is a manageable, treatable condition
- Early assessment leads to clearer, faster decisions
Common symptoms
Symptoms of ovarian endometriosis often overlap with other gynaecological conditions, which is one reason many women wait a long time before receiving a diagnosis. The most frequently reported symptoms include:
Pain-related symptoms
- Severe, cramping period pain that interferes with daily life
- Persistent pelvic or lower abdominal pain between periods
- Pain during or after sexual intercourse
- Pain when urinating or opening bowels, especially around periods
Other warning signs
- Heavy or irregular menstrual bleeding
- Unexplained bloating, especially cyclical
- Fatigue that worsens around menstruation
- Difficulty getting pregnant despite trying
Why ultrasound matters for diagnosis
Pelvic ultrasound is one of the first and most useful imaging tools when ovarian endometriosis is suspected. An experienced radiologist can identify features consistent with an endometrioma, assess the size and location of any cyst, and help determine whether further investigation is needed.
Ultrasound does not replace a full gynaecology consultation or, in some cases, laparoscopy — but it plays an essential role in the diagnostic journey for most women. Early imaging helps avoid unnecessary delays in getting a plan in place.
- Can detect endometriomas and describe their characteristics
- Helps assess ovarian size and follicular activity
- Guides decisions about referral and further care
- Non-invasive and widely available
What to expect during your scan
For many women, the idea of a pelvic ultrasound feels uncertain. In practice it is a straightforward, non-invasive appointment. Knowing what happens beforehand helps most patients feel far more at ease.
Two types of view
- Transabdominal: a probe is moved gently over the lower abdomen, usually with a comfortably full bladder
- Transvaginal (TVS): a slim internal probe gives a closer, clearer view of the ovaries and is done with an empty bladder
On the day
- The scan typically takes about 15 to 20 minutes
- It is painless, though mild pressure may be felt
- At Nitara Scans every scan is performed personally by a female radiologist
- Findings are explained clearly and a report is provided
Ovarian endometriosis and fertility
Fertility difficulty is one of the most significant concerns associated with endometriosis. Ovarian endometriosis can affect the ovarian environment, disrupt ovulation, and complicate access to follicles during fertility treatment. Research consistently shows a higher prevalence of endometriosis among women seeking fertility evaluation.
This does not mean all women with endometriomas will be unable to conceive naturally or with assistance. Many women with ovarian endometriosis go on to have successful pregnancies. What matters most is timely evaluation, individualised planning, and decisions made in partnership with a specialist.
Treatment options explained simply
Treatment depends on your symptoms, age, fertility goals, cyst size, and overall health. There is no single approach that suits every patient. Options may include:
- Pain relief and anti-inflammatory medicines are commonly used first for symptom management in women not currently trying to conceive.
- Hormonal treatments such as the contraceptive pill or progestins can help suppress endometriosis activity and reduce pain.
- Surgery may be considered for large cysts, severe pain, or difficult access to follicles during IVF — but ovarian reserve is an important concern and surgery is not automatically recommended for all endometriomas.
- Fertility-focused management may include early access to assisted reproductive technology rather than surgery, depending on age and ovarian reserve.
When to seek medical advice
You should seek medical evaluation if you experience any of the following on a recurring or worsening basis:
- Period pain that requires you to take time off work, school, or normal activities
- Pelvic pain that continues outside of your period
- Pain during sex on a regular basis
- Difficulty getting pregnant after trying for six to twelve months
- A previous scan that showed an ovarian cyst that has not been reviewed
For many women, the right starting point is a pelvic ultrasound combined with a gynaecology consultation. Getting clarity early supports better and faster decision-making about what to do next.
Common questions
Is ovarian endometriosis the same as a regular ovarian cyst?
No. An endometrioma is a specific type of cyst associated with endometriosis and is managed differently from simple functional cysts. Getting a proper assessment rather than assuming all ovarian cysts are the same is important.
Can pelvic ultrasound detect ovarian endometriosis?
Yes. Pelvic ultrasound is an important first imaging step. An experienced radiologist can identify features consistent with an endometrioma, guide further evaluation, and help build a clearer picture of the condition.
Does every patient with ovarian endometriosis need surgery?
No. Treatment is highly individualised. For many patients, especially those with fertility concerns, conservative approaches or assisted reproduction may be considered before surgery. Your gynaecologist will advise based on your specific situation.
Is ovarian endometriosis a form of cancer?
No. Endometriosis is not cancer, it is not an infection, and it is not contagious. It is a common, benign condition — but it still deserves proper assessment and management because of its effect on pain and fertility.
Can endometriosis come back after treatment?
Endometriosis can recur after medical or surgical treatment in some patients. This is why long-term follow-up, monitoring, and a clear plan for managing any recurrence are part of good endometriosis care.
Pelvic ultrasound for women in HSR Layout, Bengaluru
Nitara Scans and Diagnostics offers pelvic ultrasound, follicular study, fertility-focused imaging, and women's health ultrasound in HSR Layout, Bengaluru. All scans are personally performed by Dr. Nayana N Sunku — DMRD, DNB Radiology, Fetal Medicine Fellow — in a private, calm setting.