Endometriosis can affect the body in more than one way.

It can create lesions, inflammation and tissue changes. Over time, some people may develop adhesions, scar tissue or cysts called endometriomas.

These words can sound frightening, especially if you see them on a scan report or hear them in an appointment. This guide explains what they mean in simple terms.

What are adhesions?

Adhesions are bands of scar-like tissue that can make organs or tissues stick together.

Inside the body, organs usually need to move smoothly against each other. For example, the bowel, bladder, uterus and ovaries all need some movement. Adhesions can reduce that movement or pull tissues into positions they would not normally be in.

Adhesions may involve:

  • ovaries
  • fallopian tubes
  • bowel
  • bladder
  • uterus
  • pelvic sidewall
  • abdominal wall
  • surgical scars
  • other tissues

They may be thin and filmy, or thicker and more dense.

Why can adhesions happen in endometriosis?

Endometriosis can cause inflammation. The body may respond by trying to heal or repair tissue. This healing process can create scar-like tissue.

Adhesions can also happen after surgery, infection, injury or other inflammation. In someone with endometriosis, adhesions may be linked to the disease itself, previous operations, or both.

This is why a person’s full history matters.

What can adhesions feel like?

Adhesions do not always cause symptoms, but they can contribute to pain or functional problems for some people.

Symptoms may include:

  • pulling or dragging pain
  • sharp pain with movement
  • pain in certain positions
  • pain during sex
  • pain when opening the bowels
  • constipation or bowel difficulty
  • bladder pressure or discomfort
  • pelvic tightness
  • pain after exercise
  • fertility difficulties in some cases

Some people describe adhesion-related pain as a pulling, stuck, tearing or tugging feeling. However, symptoms vary and cannot confirm adhesions on their own.

What is scar tissue?

Scar tissue is tissue the body creates as part of healing after inflammation, injury or surgery.

In endometriosis, scar tissue may develop around lesions, adhesions or areas of repeated inflammation.

Scar tissue can sometimes make tissues feel stiff, thickened or less mobile. It can also make future surgery more complex, depending on where it is and how dense it is.

Can scar tissue and adhesions affect organs?

They can.

If adhesions involve the bowel, bladder, ovaries, tubes, uterus or other structures, they may affect how these organs move or function.

For example:

  • bowel adhesions may contribute to bowel pain, constipation or pulling sensations
  • bladder adhesions may contribute to bladder pressure or discomfort
  • adhesions around ovaries or tubes may affect fertility for some people
  • pelvic sidewall adhesions may be linked with nerve irritation or deep pelvic pain

Not every adhesion causes symptoms, and not every symptom is caused by adhesions. Proper assessment is important.

What are endometriomas?

Endometriomas are cysts linked with endometriosis. They are usually found on the ovaries.

They are sometimes called “chocolate cysts” because they may contain old, dark blood.

Endometriomas are different from simple ovarian cysts. They are associated with endometriosis and may be part of a wider disease picture.

What symptoms can endometriomas cause?

Some people with endometriomas have symptoms. Others may not know they have one until it is found on a scan.

Symptoms may include:

  • pelvic pain
  • pain around periods
  • pain during or after sex
  • pain around ovulation
  • bloating or pressure
  • fertility difficulties
  • pain on one side
  • symptoms linked with wider endometriosis

Endometriomas may also be associated with adhesions or deep disease, so the wider picture matters.

Why do endometriomas matter?

Endometriomas matter because they can affect pain, ovarian tissue and fertility decisions for some people.

Treatment decisions should be individual. They may depend on:

  • symptoms
  • size of the endometrioma
  • whether it is growing
  • whether both ovaries are involved
  • fertility goals
  • ovarian reserve
  • previous surgery
  • age and life stage
  • other endometriosis findings
  • risk of complications
  • access to specialist care

It is important not to rush into a decision without understanding the options, risks and benefits.

Can adhesions or endometriomas be seen on scans?

Endometriomas are often visible on ultrasound or MRI.

Adhesions can be harder to see. Some signs, such as organs not moving normally or a “fixed” ovary, may suggest adhesions on specialist imaging, but not all adhesions are easy to identify before surgery.

Deep disease may be seen on specialist ultrasound or MRI, depending on the location and the experience of the person performing and reporting the scan.

A normal scan does not always rule out endometriosis.

How are adhesions and endometriomas treated?

Treatment depends on the person and their goals.

Options may include:

  • monitoring
  • pain management
  • hormonal treatment for symptom control
  • pelvic physiotherapy
  • fertility support
  • surgery in some cases
  • multidisciplinary care if bowel, bladder, ureter or other organ involvement is suspected

Surgery may involve removing endometriosis lesions, treating adhesions, or removing an endometrioma. However, surgery has risks, and repeat surgery can sometimes affect ovarian reserve or create further scar tissue.

Decisions should be made with a healthcare professional who understands endometriosis and can explain the risks and benefits clearly.

Questions to ask if adhesions or endometriomas are mentioned

You may want to ask:

  • What exactly was found?
  • Is it an adhesion, endometrioma, lesion or something else?
  • Where is it located?
  • Is one ovary or both ovaries involved?
  • Is there any sign of deep endometriosis?
  • Is bowel, bladder or ureter involvement suspected?
  • Would specialist ultrasound or MRI help?
  • What are the treatment options?
  • What happens if we monitor it?
  • What are the risks of surgery?
  • How could treatment affect fertility?
  • Would a multidisciplinary team be needed?
  • Should I see an endometriosis specialist?

When to seek urgent help

Seek urgent medical help if you have:

  • sudden severe pelvic or abdominal pain
  • fainting
  • fever
  • vomiting with severe pain
  • heavy bleeding that feels unsafe
  • shoulder tip pain with collapse or severe abdominal pain
  • chest pain or shortness of breath
  • new problems passing urine
  • new problems controlling bladder or bowel function

These symptoms may have causes other than endometriosis and should be assessed quickly.

Final reminder

Adhesions, scar tissue and endometriomas can sound frightening, but understanding the words can help you feel more prepared.

They are part of the way endometriosis can affect tissues and organs, but they do not tell the whole story on their own. Your symptoms, goals, imaging, history and specialist assessment all matter.

Use our Prepare for Appointment Tool to organise what you have been told, what you are experiencing and what questions you want to ask.