If you’ve ever Googled endometriosis symptoms, you’ve probably stumbled across some dire statements: “Endo is progressive.” “It always gets worse.” “No doubt, your pelvic organs will fuse together in a knot of scar tissue.”

Cheery, right?

But what if that isn’t the whole story? What if — in many cases — endometriosis doesn’t just not get worse… but sometimes gets better? Let’s dig into what the science actually says about when endometriosis occurs, how it changes over time, and what this means for women’s health.

Endometriosis in Real Life

Endometriosis is a chronic condition that can affect fertility, reproductive organs, and everyday life. It happens when tissue similar to the endometrial tissue from the uterus — or endometrial-like tissue — grows where it doesn’t belong, often in the pelvic cavity, ovaries, or fallopian tubes but also, well, anywhere. This tissue responds to hormonal fluctuations of the menstrual cycle, sometimes triggering painful periods, pelvic pain, abdominal pain, or even ovarian cysts.

But here’s the thing I talk a lot about in my book: the common symptoms of endometriosis vary wildly. Some women experience symptoms like chronic pain or bowel movements that hurt, while others might confuse it with irritable bowel syndrome or bladder problems. Many women live with fatigue, infertility, or endometriosis pain that doesn’t match what’s seen on imaging tests.

Endometriosis diagnosis is often delayed because the disease can mimic other conditions. While doctors may use further tests or imaging, the only way to definitively diagnose endometriosis is laparoscopy and certain types of advanced imaging. That’s why so many women bounce between healthcare providers before they’re taken seriously in the process of an endometriosis diagnosis.

But here's the kicker: once you get diagnosed we hear "There's nothing that can be done, endo is progressive, and it will get worse if you don't go on birth control or have repeated surgeries." Or, at least that was what I was told.

So, is that the truth? Does endometriosis always get worse? The answer is a difinitive, and I mean difinitive, NO.

Don't believe me? Let's look at the studies so you don't think I'm some crazy health influencer spouting fake news ;)

The Studies: A Hopeful Look

Let’s go on a little time-travel through the research. (Spoiler: it’s surprisingly upbeat.)

A 2013 review of seven studies followed patients with laparoscopies before and after a treatment-free period. This means the women we’re looking at here weren’t doing anything special between laparoscopies. What we see is that:

29% had progression
42% had regression
29% remained stable

In total, that means 71% did not progress. Seventy-one percent! And, the earliest study we see here is from 1987, so yes, around 40 years ago they knew that endometriosis can regress or stabilize, showing this is not new information [1].

A 2000 study looked at infertile women with endo trying to get pregnant, some with painful periods or mild pelvic pain, although their biggest concern was getting pregnant. Half received medroxyprogesterone acetate (MPA), a progesterone drug, half placebo. Results were almost identical between the two groups in how their lesions fared:

46% had no change
5% had progression
49% had regression

Moreover, endometriosis was totally eliminated in 28% of the MPA group and 42% of the placebo group. Interestingly, stage I–II patients improved a little better often than severe cases in stage III–IV [2].

A 2004 study tracked pretty symptomatic women who underwent placebo surgery. Yes, this means they give a fake surgery to half the participants, and then 6 months later follow up with a real surgery. At six months, we saw in the placebo group (the ones who had the sham surgery) that:

45% showed lesion progression
33% were unchanged
22% had regression

Even here — with women in significant pain — 55% had stability or regression. As a note, the group that had the real excision had much better improvements in pain with sex and overall quality of life than the placebo group (80% of the surgery had improved symptoms versus 30% of the sham). So this isn’t to negate surgery, we see here that those with the real surgery were more improved than those without it. We simply see here that a substantial amount of women (55%) had stabilization or regression..[3]

Another 2004 study followed asymptomatic women (very few to no symptoms) with deep rectovaginal endometriosis for up to 9 years:

2% developed symptoms
5% had lesion growth without symptoms
93% showed no clinical change

That’s extraordinary stability [4].

A 2023 2-year study following women with moderate or severe endometriosis and mild (mostly pain) to few symptoms. They didn’t want to use medical intervention, so none were on contraceptives or having surgeries. Results showed that while 37% experienced progression, 13% saw regression, and 50% remained unchanged.

Interestingly, of the women with moderate disease at the beginning, 1 out of the 19 experienced progression to severe disease in her follow-up. She developed an additional nodule in the rectovaginal space with adhesions leading to complete obliteration of the pouch of Douglas, classifying the disease as severe. Wow, that’s fast, and demonstrates how aggressive some endo can be.
Among the 116 women with severe endometriosis, in one had their endo regress so much it was categorized as moderate at follow‐up, which was due to the reduction in size of the rectovaginal space nodules.
Two women with small solitary nodules in the rectovaginal space had complete disease resolution, so their endo was resolved by the body. Pretty cool[5].

The Pattern

Across these studies, stabilization or regression rates range from 55% to 93%, while progression sits between 7% and 45%.

We also see hints that less symptomatic cases may be less likely to progress, while severe cases may be harder — but not impossible — to stabilize or regress.

That’s not doom and gloom. That’s hope.

A Different Way to See Endometriosis

Here’s the shift: endometriosis isn’t just a noun, something static. It’s more like a verb. As I talk about in my best-selling book Heal Endo, if you have active lesions, you’re “endo-ing.” And verbs can change. They can slow, they can regress, they can stabilize.

That perspective is powerful. It reframes endometriosis from an inevitable decline into something dynamic — something the immune system, nervous system, and endocrine system can influence. My question is, what if we support those systems through complementary treatments? Would we be able to support regression and stabilization even more, as we see in the animal models?

Luckily, we’ll have lots of answers soon on this as imaging is allowing studies to be undertaken today where we can try things like diet, lifestyle, and alternative care options and see how lesions behave in real time! Pretty exciting stuff.

A New Perspective: Lesions as a Wound That Won’t Heal

If you’re curious how lesions can regress when we’ve been told, like, forever (and falsely), they can only progress, know that it’s not magic. It’s biology. While there is no one exact cause of endometriosis (theories like retrograde menstruation, immune dysfunction, and genetics swirl together in a convoluted soup), one analogy helps us understand how endometriosis can stabilize or regress: imagine it as a wound that won’t heal.

When you cut your finger, inflammation, estrogen, and immune factors hit the scene until the body calms down. But with endometriosis, it’s like that wound never closes. Lesions release growth factors like VEGF and TGF-β, fuel oxidative stress, and keep the body stuck in endless healing mode.

This explains both why endometriosis pain can feel relentless and why regression is possible. Just as a cut heals through the body’s systems, lesions can regress when those same systems recalibrate.

Endometriosis and Mental Health: Why Hope Matters

Living with endometriosis is challenging, but there is hope. This image highlights how healing, support, and new approaches can bring relief, stability, and a brighter future for those navigating chronic pain. — Hope is an essential ingredient for getting better with any illness, including endometriosis

Living with endometriosis doesn’t just affect the pelvic region — it wrecks mental health, too. Chronic pain, painful periods, experience fatigue that seeps into your bones, or even overlapping conditions like irritable bowel syndromecan make normal activities feel impossible.

And when every article insists your disease only worsens, hopelessness creeps in. But hope isn’t false optimism — it’s survival. The studies proving stabilization and regression show that endometriosis doesn’t always progress. That knowledge alone is mental health medicine.

With hope, it becomes easier to pursue a treatment plan, explore treatment options, and connect with a healthcare provider or support groups. Without hope, endometriosis feels like a death sentence. With hope, it becomes something you can face — even with fertility problems or the increased risk of pain returning.

Treatment Options and Hope

Of course, hope doesn’t mean doing nothing. Endometriosis is a chronic condition, and management matters. Some women need excision surgery, hormone therapy, hormonal birth control, or hormonal therapies. Others benefit from physical therapy, nonsteroidal anti inflammatory drugs, or complementary treatments.

A healthcare provider might suggest further tests or imaging tests to rule out other symptoms, and support groupscan help many women manage symptoms day-to-day. The point isn’t that endometriosis always heals itself — it’s that it doesn’t always get worse.

There are many effective treatments available to treat endometriosis, and while no single option works for everyone, combining approaches can often relieve pain and improve quality of life.

Endometriosis Support and Resources: Why Learning Matters

One reason so many myths persist is that endometriosis is misunderstood. Misinformed doctors and frustrated patient voices can distort the picture, leaving you thinking it’s a completely different disease than it is.

Learning the truth is crucial. Endometriosis can affect fertility, pelvic organs, and reproductive organs — but it’s not only progressive, and it’s not only about scar tissue. The more you understand, the better equipped you are to ask the right questions, explore endometriosis treatment, and spot certain symptoms early.

Knowledge doesn’t just empower you — it protects your hope.

Final Thoughts

Heal Endo is a practical, compassionate guide to endometriosis healing. This book combines nutrition, lifestyle, and nervous system support to help women reduce pain, calm inflammation, and reclaim their lives beyond endo

Endometriosis can impact fertility, reproductive organs, and daily life. But the old idea — that it’s only progressive — isn’t the full story.

Lesions aren’t invincible. Just as the immune system can heal a wound, it can sometimes suppress or even regress endometriosis activity. That doesn’t mean surgery, medical treatment, or other interventions aren’t necessary — for many of us, they absolutely are. And it doesn’t mean we should cling to false hope or pretend endo is an “easy fix.”

What it does mean is that patients deserve the full truth: endometriosis behaves in different ways. Sometimes it progresses. Sometimes it stabilizes. And sometimes, yes, it regresses. Knowing this gives us more than statistics — it gives us perspective. It helps us understand why recovery can look different for each person, why comprehensive care matters, and why there is always space for hope alongside treatment.

If you want to understand more about endometriosis, including lesion behavior (the specifics behind progression, regression, symptoms, and more), check out my book Heal Endo: An Anti-Inflammatory Approach to Healing From Endometriosis.

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1) Evers, J.L.H. (2013). Is adolescent endometriosis a progressive disease that needs to be diagnosed and treated? Human Reproduction, 28(8), 2023. https://doi.org/10.1093/humrep/det298

2) Efficacy of medroxyprogesterone treatment in infertile women with endometriosis: a prospective, randomized, placebo-controlled study. Harrison, Robert F et al. Fertility and Sterility, Volume 74, Issue 1, 24 - 30

3) Abbott JA, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004 Nov;82(5):878-84. doi:10.1016/j.fertnstert.2004.03.046. PMID: 15482763

4) Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N. Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol 2004b, 191:1539-1542. doi: 10.1016/j.ajog.2004.06.104. PMID: 15547522

5) Knez J, Bean E, Nijjar S, Tellum T, Chaggar P, Jurkovic D. Natural progression of deep pelvic endometriosis in women who opt for expectant management. Acta Obstet Gynecol Scand. 2023 May 15. doi: 10.1111/aogs.14491.