Adhesions are fibrous bands of scar tissue that can form bonds between nearby tissues or organs. In endometriosis, adhesions usually occur in the pelvic cavity. The fallopian tubes (tubes connecting the ovaries to the uterus), the muscle layer of the uterus, the ovaries, the bladder, and the ureter are commonly affected by adhesions. An adhesion may, for instance, bind an ovary to the side of the pelvic wall.

Scars from surgery may also cause adhesions. Surgeries that can commonly lead to pelvic adhesions include a myomectomy or the removal of fibroids, hysterectomy, and C-section.

Endometriosis is a known cause of adhesions. Many women with endometriosis undergo surgery to treat the condition, which further increases their risk of developing adhesions.

How endometriosis causes adhesions

Endometriotic lesions lead to local inflammation. This inflammation can cause the formation of scar tissue. When the tissue comes in contact with a nearby inflamed area during the scar-forming process, it may form a band of scar tissue, a so-called adhesion.


Symptoms are very individual, and depend on the location and severity of the adhesions. They frequently cause pain, which is different from endometriosis-related pain. It may feel like something is pulling on nerves, and affected women often describe it as sharp, stabbing, and sickening.

But adhesions do not always cause pain and may go unnoticed.


The best way to diagnose adhesions is via a biopsy. This is done using a surgical procedure known as laparoscopy. It is performed by making a small incision in the abdomen near the belly button. A small device is then inserted through that incision to take a tissue sample.


Adhesion-associated pain can be managed with pain relief medication, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs).

If the symptoms cannot be sufficiently controlled with pain medication, a resection surgery to remove the scar tissue might be recommended. Again, this is usually done via laparoscopy. This procedure has a smaller risk of causing further adhesions than other surgeries.


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