Vascular Endometriosis: Understanding a Lesser-Known Driver of Pain
Endometriosis is often described as “tissue growing where it shouldn’t.” But this simplified explanation misses what actually drives symptoms for many women+ — especially persistent or severe pain.
One emerging area of research focuses on vascular endometriosis, where endometriosis lesions interact closely with blood vessels.
Understanding this can help explain why endometriosis behaves so differently from person to person.
What is vascular involvement in endometriosis?
In endometriosis, lesions don’t exist in isolation. They actively interact with surrounding tissues — including nerves, immune cells, and blood vessels.
Research shows that some endometriosis lesions stimulate the growth of new blood vessels through a process called angiogenesis. These vessels can:
supply lesions with oxygen and nutrients
fuel inflammation
increase sensitivity of nearby nerves
contribute to bleeding and tissue irritation
This vascular support can allow lesions to persist and, in some cases, become more painful.
Why blood vessels matter for pain
Blood vessels play a key role in how pain is experienced.
Vascular involvement may help explain:
deep, aching, or pressure-like pelvic pain
pain that worsens around menstruation or with increased blood flow
pain during exercise, arousal, or prolonged standing
severe symptoms despite minimal findings on imaging
Because blood vessels and nerves often grow together, increased vascularisation can heighten nerve sensitivity — amplifying pain signals to the brain.
Why this complicates diagnosis and treatment
Standard imaging doesn’t always detect vascular or microscopic disease. This can lead to:
delayed diagnosis
underestimation of disease severity
frustration when symptoms don’t match test results
It also helps explain why some people don’t respond to first-line treatments — not because the pain isn’t real, but because the underlying mechanisms haven’t been fully addressed.
What this means for care
Not everyone with endometriosis has vascular involvement — but recognising that it exists reinforces an important truth:
Endometriosis is a whole-body, inflammatory condition — not a one-size-fits-all disease.
Effective care requires:
believing pain reports
understanding multiple biological drivers
individualised treatment approaches
early and thorough investigation of persistent symptoms
The Elgin House perspective
At Elgin House, we approach endometriosis through a broader lens — acknowledging the roles of inflammation, hormones, the nervous system, immune response, and vascular health.
When we understand why pain behaves the way it does, we move closer to care that is compassionate, precise, and effective.
Persistent pain is not something to normalise.
It’s something to understand.
References & Further Reading
Human Reproduction Update — Angiogenesis and lesion persistence in endometriosis
Frontiers in Medicine — Vascular and neural mechanisms in endometriosis-related pain
Journal of Minimally Invasive Gynecology — Biological behaviour of endometriosis lesions
Pain Reports — Central and peripheral pain drivers in chronic pelvic pain