Endometriosis is a chronic, estrogen-driven condition that’s estimated to affect 10% to 15% of reproductive-aged females.1 Despite its prevalence, endometriosis is extremely misunderstood and underdiagnosed. Although the term endometriosis translates to “disease inside of the uterus,” this is technically a misnomer. It consists of endometrial-like tissue that exists outside the uterine lining. Endometriosis lesions have been found in the fallopian tubes, ovaries, uterosacral ligaments, bladder, bowel, diaphragm, lungs, brain, and even the wrist.1,2
These lesions trigger local and systemic inflammation.3 For dental hygienists, understanding and awareness of this condition is necessary as it causes systemic inflammation, chronic pain, fatigue, increased risk for autoimmune diseases, and has possible oral-systemic connections.
Causes and symptoms of endometriosis
There are many hypotheses for the cause of endometriosis, but none fully explain the variations in the condition, which also occurs rarely in men.3 Currently, surgical visualization of endometriosis lesions is needed for a definitive diagnosis.4 Noninvasive detection methods such as ultrasounds and MRIs are typically unreliable.3 Recognizing symptoms may be the best starting place for diagnosis. Hygienists are at an advantage for recognizing symptoms as they routinely review medical histories and have more time to interview patients.
Patients with endometriosis often have a myriad of seemingly unconnected symptoms. However, universal symptoms are pelvic pain (both menstrual and nonmenstrual) and pain during intercourse, known as “dyspareunia.”1,4
Abdominal bloating, sometimes referred to as endo belly, is another common sign, along with increased risk of infertility.1,4,5 Beyond pelvic and reproductive concerns, many patients experience gastrointestinal and genitourinary issues, autoimmune diseases, and chronic fatigue. Symptoms may be cyclical, which can make them difficult to track and report on a health history.
Systemically, there are many concerns for patients with endometriosis. Chronic inflammation, immune system dysregulation, and impaired healing are all possible risks of endometriosis and may make periodontal disease management difficult.3 There are also potential connections between the inflammatory pathways of endometriosis and periodontal disease, but research is currently limited. Beyond systemic concerns, dental hygienists must be knowledgeable about potential oral concerns and care modifications.
How to treat endometriosis
The first line of treatment for endometriosis is hormonal medications. These may exacerbate gingival inflammation, increase periodontal destruction, and contribute to poorer periodontal health in susceptible patients.6 Patients may also be using analgesics for pain management.
Nonsteroidal anti-inflammatories are commonly used for pain reduction, and this class of medication may cause a slight increase in gingival bleeding.7 Patients may also be taking opioids for pain management. These lead to risks for xerostomia and dependence but can also mask dental pain and lead to a delay in treatment.7
How this disease can affect dental practices
Endometriosis significantly impacts lifestyle and mental health. Patients may be struggling with chronic pain, fatigue, and mental health conditions, which can make it difficult to maintain a structured daily routine.8 These factors can affect the patient’s ability to manage oral hygiene and maintain oral health. Patients with endometriosis may be more likely to reschedule or no-show appointments due to pain, fatigue, or heavy menstrual cycles. Being mindful of these considerations when scheduling can help them feel supported and build trust with the provider.
Endometriosis often takes five to 12 years to receive a proper diagnosis.3 During this prolonged period, ongoing inflammation may progress, potentially impacting both oral and overall systemic health.
Dental hygienists are in a unique position not only to identify early intraoral changes, but also to recognize how those findings may connect to broader systemic conditions. With thorough health histories and intentional patient interviews, dental hygienists can play a meaningful role in empowering more women to seek screening and earlier evaluation for endometriosis.
References
1. Tsamantioti ES, Mahdy H. Endometriosis. StatPearls Publishing; Updated January 23, 2023.
2. Luscombe GM, Markham R, Judio M, Grigoriu A, Fraser IS. Abdominal bloating: an under-recognized endometriosis symptom. J Obstet Gynaecol Can. 2009;31(12):1159-1171. doi:10.1016/S1701-2163(16)34377-8
3. As-Sanie S, Mackenzie SC, Morrison L, et al. Endometriosis: a review. JAMA. 2025;334(1):64-78. doi:10.1001/jama.2025.2975
4. Ding Y, Gibbs J, Xiong G, Guo S, Raj S, Bui MM. Endometriosis mimicking soft-tissue neoplasms: a potential diagnostic pitfall. Cancer Control. 2018;24(1):83-88. doi:10.1177/107327481702400114
5. Blanco LP, Salmeri N, Temkin SM, Shanmugam VK, Stratton P. Endometriosis and autoimmunity. Autoimmun Rev. 2025;24(4):103752. doi:10.1016/j.autrev.2025.103752
6. Rojo MG, Lloret M, Gironés JG. Oral manifestations in women using hormonal contraceptive methods: a systematic review. Clin Oral Investig. 2024;28:184. doi:10.1007/s00784-024-05573-x
7. Haveles E. Applied Pharmacology for the Dental Hygienist. 9th ed. Elsevier; 2023.
8. Wang Y, Li B, Zhou Y, et al. Does endometriosis disturb mental health and quality of life? A systematic review and meta-analysis. Gynecol Obstet Invest. 2021;86(4):315-335. doi:10.1159/000516517
