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Treatment for endometriosis can bring relief, but some women continue to have pelvic pain even after hormone treatment or surgery. For those who have spent years seeking help, continuing pain can be distressing and difficult to understand.

Why does this happen? Sometimes endometriosis remains or returns. But pain can also involve other conditions and changes in how the nervous system responds to signals from the body. Understanding these different contributors can help guide further treatment.

Endometriosis affects an estimated one in 10 women of reproductive age worldwide. It happens when tissue similar to the lining of the uterus grows elsewhere in the body, commonly around the pelvic organs. This can cause inflammation, the body's response to injury or irritation, and scar tissue.

Symptoms can disrupt working life and intimate relationships. A study across 10 countries found that women with endometriosis lost working time through absence and reduced ability to work effectively while at their jobs. Interviews with women experiencing endometriosis-related sexual pain also described avoiding sex and strain on relationships. Treatments include painkillers, hormone medications and surgery to remove areas of endometriosis, but symptoms can persist or return.

The extent of endometriosis does not reliably predict pain severity. A study of 1,054 women undergoing surgery found only a weak and inconsistent relationship between disease stage, a classification of its extent, and the severity of pelvic pain symptoms.

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