What happens when we know something is wrong with our bodies, but appointment after appointment ends without an answer? For Olivia Culpo, the answer involved 12 years of symptoms, at least a dozen doctors, and periods that eventually became so painful she could not go about her day.
Olivia joins Dr. Thais Aliabadi and Mary Alice Haney to talk about her deeply personal experience and the questions we hear constantly: Which period symptoms deserve a closer look? Can endometriosis affect fertility? What does treatment look like after surgery? And how do we keep advocating for ourselves when we are exhausted from explaining our pain?
We spoke with Olivia about the diagnosis that changed her life, the support she found in Christian McCaffrey and online communities, and why she continues to share details that once felt too embarrassing to say aloud. We also put the medical questions to Dr. Thaïs Aliabadi, or Dr. A, so we can turn that experience into a practical guide.
Medical note: This conversation is for education, not a substitute for individualized medical advice. We should discuss symptoms, testing, and treatment decisions with a qualified healthcare professional.
Table of Contents
- Olivia’s path to an endometriosis diagnosis
- What we need to know about endometriosis
- Fertility, treatment, and an ongoing plan
- Support makes self-advocacy possible
- Life beyond the diagnosis
- Questions we still hear about endometriosis
Olivia’s path to an endometriosis diagnosis
When did the symptoms begin?
We often picture a health problem beginning on one memorable day. Olivia’s story was not like that. She recalls unusual, intimate symptoms from her very first period. At that age, she felt embarrassed and did not even want to tell her parents what was happening.
As she got older, the pain became more severe. By her late twenties, it could interrupt ordinary life completely. Some days, leaving the house was not realistic. Olivia describes feeling frightened not only by how much it hurt, but by the absence of an explanation.
That combination matters. When a symptom begins early and worsens gradually, we can start treating each new level of pain as our normal. We might organize our lives around it. We might hesitate to mention bowel or bleeding symptoms because they feel private. None of that makes the symptoms less worthy of care.
Olivia has described her disease as rectovaginal endometriosis, with symptoms concentrated toward the back of her pelvis. She did not report painful sex, even though it is a common symptom for other people with endometriosis. Her experience is an important reminder that we do not need to check every box on a symptom list to deserve an evaluation.
What happened when she sought help?
By the time Olivia reached Dr. A, she had seen at least 12 doctors. She recalls being asked whether she was wiping correctly, whether her symptoms were real, and whether her pain was truly as bad as she said. She was told painful periods were normal. She was offered birth control without always feeling that someone had investigated what was causing the pain.
We want to be clear about the distinction: Hormonal birth control can be a useful endometriosis treatment. The problem is not the treatment itself. The problem is dismissing someone’s questions, overlooking symptoms, or presenting a prescription as the end of a conversation the patient has barely been allowed to start.
When Dr. A met Olivia, she reported period pain at the highest end of the scale. An ultrasound identified an endometrioma, an endometriosis-related cyst on her ovary. That finding helped explain what Olivia had been trying to communicate for years.
We should not have to arrive at a crisis before someone takes our pain seriously. If we leave an appointment feeling unheard, advocating for ourselves at the doctor can mean clearly describing how symptoms affect daily life, asking what else might explain them, and seeking another opinion when the answers do not add up.
What changed after diagnosis and treatment?
Olivia underwent surgery for her more advanced disease and has since used a progesterone IUD to help suppress symptoms. She describes the experience of being able to go about her day without that pain as a remarkable relief. It also made her want to help someone else reach an answer sooner.
But she is careful not to suggest that one operation erased endometriosis forever. She thinks about it as an ongoing condition that needs a plan, particularly as her plans for pregnancy change. That is a much more useful picture of treatment than the idea that we simply have surgery, recover, and never think about it again.
What we need to know about endometriosis
What is endometriosis, in plain English?
We can begin with the uterus. During a menstrual cycle, hormones stimulate its inner lining, called the endometrium. If pregnancy does not occur, that lining sheds during a period.
With endometriosis, tissue similar to that lining is found outside the uterus. It may be around the ovaries or fallopian tubes, behind the uterus, or elsewhere in the pelvis. Dr. A explains that these areas can respond to hormonal changes and contribute to inflammation, scarring, and pain.
Two related terms often come up in this conversation:
- Endometrioma: An endometriosis-related cyst in an ovary. This is what Dr. A identified on Olivia’s ultrasound.
- Adenomyosis: A condition in which tissue similar to the uterine lining is present within the muscular wall of the uterus. It can contribute to heavy, painful periods and calls for a different treatment discussion.
Dr. A emphasizes that endometriosis is common, affecting roughly one in ten women. Common does not mean trivial. It means we should be better at recognizing when symptoms call for investigation. For a fuller explanation of the condition and its treatment options, we can consult Dr. A’s endometriosis patient guide.
Which symptoms should prompt us to ask about endometriosis?
Severely painful periods are the symptom Dr. A most wants us to stop dismissing. Menstrual discomfort can happen, but pain that repeatedly disrupts school, work, sleep, or everyday life deserves medical attention. We should not be told to accept debilitating pain as the price of having a period.
Other symptoms Dr. A asks about include:
- Chronic pelvic pain, including pain outside the days of a period.
- Heavy or particularly painful periods.
- Pain during sex, especially with deep penetration.
- Marked bloating that comes with pain around a period.
- Pain with bowel movements or urination.
- Recurring bladder symptoms, particularly when a presumed urinary tract infection has not been confirmed by a positive culture.
Symptoms vary with the person and with where disease is located. Olivia, for example, describes striking pain toward her lower back and rectal area, but not painful sex. Some people first seek help for pelvic pain; others come to a fertility clinic after difficulty getting pregnant.
We also need to avoid the opposite mistake of diagnosing ourselves from one symptom. Not every painful period is caused by endometriosis. The point is to have persistent or severe pain evaluated and to make sure endometriosis is considered, rather than ruled out because the pain has become familiar.
Why can the diagnosis take so long?
Olivia’s years of appointments show how many barriers can accumulate. Symptoms may feel embarrassing to describe. A clinician may not recognize the pattern. A short visit may not leave room for the full history. And if we have repeatedly heard that period pain is normal, we may begin to question our own judgment.
Dr. A argues that listening closely is essential. Where does the pain occur? Does it follow the menstrual cycle? Is it getting worse? Does it interfere with daily life? Are bladder or bowel symptoms part of the picture? We cannot answer those questions with a quick reassurance that everything is fine.
There is an emotional cost to that delay. Dr. A says many patients cry when they finally receive an explanation, not simply because of the diagnosis, but because they feel believed. We should not underestimate what it means to have a clinician take a long history of pain seriously.
Will an ultrasound always show endometriosis?
No. An ultrasound can reveal an endometrioma, as it did for Olivia, but many people with endometriosis have an ultrasound that appears normal. Disease in other locations may not show up on a routine scan. A normal result should not automatically end the conversation when symptoms remain concerning.
Laparoscopy, a minimally invasive operation, can allow a surgeon to examine the pelvis and obtain tissue for confirmation. Dr. A also makes a crucial distinction: We do not need to have surgery solely to begin discussing treatment. A clinician may recommend symptom-directed hormonal treatment when endometriosis is suspected and decide with us whether surgery is appropriate later.
Surgical experience matters when an operation is needed. Dr. A recalls a case in which lesions looked like faint white scarring rather than the dark spots another surgeon expected. Tissue removed from the area confirmed endometriosis. Her point is that disease can be difficult to identify even when someone is looking directly into the pelvis.
Fertility, treatment, and an ongoing plan
How can endometriosis affect fertility?
We do not want anyone to hear “endometriosis” and assume pregnancy is impossible. Olivia’s story is a hopeful example of why individualized assessment matters. At the same time, Dr. A takes fertility questions seriously because endometriosis can affect the reproductive system in several ways.
Inflammation and scar tissue can affect the fallopian tubes and the pelvic environment around the ovaries. An endometrioma can involve an ovary. Dr. A also discusses concerns about egg quantity and quality in some patients. The details differ from person to person, which is why she does not want us waiting until we are ready to conceive before we ask what our current health picture looks like.
Dr. A discusses checking ovarian reserve, including an anti-Müllerian hormone, or AMH, blood test and an ultrasound count of ovarian follicles. These tests can inform a fertility conversation. They do not diagnose endometriosis, and no single result can promise or rule out a future pregnancy. We should interpret them with a clinician who understands our age, medical history, and goals.
For someone concerned about fertility, the practical questions are straightforward: Do we need an ovarian reserve assessment? Should we speak with a fertility specialist? Is egg freezing worth discussing? There is no universal answer, but getting information while we still have options can make a difficult decision less overwhelming.
Does endometriosis always require surgery?
No. Dr. A describes starting with less invasive options and adjusting the plan to symptoms and circumstances. Hormonal approaches she discusses include low-dose combination birth control pills, progesterone-only pills, progesterone injections, and progesterone IUDs. She also mentions medications that lower the body’s estrogen as options for some people when initial treatment is not enough.
Olivia’s progesterone IUD is part of her plan after surgery. Dr. A favors that option for some patients because it provides local hormonal treatment while also functioning as contraception. That does not make it the right choice for everyone. Our treatment needs to account for pain, side effects, the presence of an endometrioma or adenomyosis, and whether we want to become pregnant.
We should allow time for a treatment to be assessed with our clinician. Dr. A notes that hormonal treatment is not a light switch and that improvement may take months. We also should not keep waiting without follow-up if pain remains severe or continues to interfere with life.
She raises a specific contraception question worth discussing when periods are already very painful: A copper IUD may make bleeding and cramping heavier for some people. It does not provide the hormonal suppression she is seeking when treating endometriosis symptoms. Before choosing any IUD, we should explain our menstrual history and ask how that choice might affect it.
When is surgery considered, and what happens afterward?
Surgery may enter the conversation when symptoms remain difficult to control, when an endometrioma needs attention, or when a specialist identifies another reason to operate. Olivia already had an endometrioma when she met Dr. A, so they addressed it surgically.
Dr. A describes laparoscopic excision, in which a surgeon identifies and cuts out endometriosis lesions rather than simply burning their surface. Because lesions can be subtle and can occur near structures such as the bowel, bladder, ovaries, and tubes, she urges us to ask about a surgeon’s experience with endometriosis specifically.
Equally important is the plan after surgery. Dr. A has met patients who underwent repeated operations without an effective suppression plan between them. Olivia wants people to understand that surgery is not necessarily a permanent finish line. We may need continued hormonal treatment, follow-up, and a new discussion whenever pregnancy plans or symptoms change.
What does Olivia’s pregnancy plan look like?
Olivia and Christian spoke about starting a family while planning their wedding. At the time of this conversation, Dr. A felt encouraged by Olivia’s situation: Her symptoms had been controlled, she had been using hormonal suppression, and her ovarian reserve assessment was reassuring.
Dr. A’s proposed approach was to keep the IUD in place until Olivia was ready to try to conceive, rather than remove it months before she intended to start. They would then reassess and make the next decision based on what happened. It is a plan tailored to Olivia, not a timeline we should copy for ourselves.
Olivia puts it beautifully in practical terms: She has a road map. She knows that removing hormonal suppression may bring symptoms back, and she knows she can return to the treatment conversation after pregnancy. We cannot control every step of a fertility journey, but we can ask for a plan that reflects both our present quality of life and our future hopes.
Support makes self-advocacy possible
How did Christian support Olivia through the worst pain?
Olivia met Christian McCaffrey through mutual friends. She noticed how close he was with his family, something that mattered to her because she is close with hers. As their relationship grew, her pain became impossible to keep separate from everyday life.
She credits Christian’s mother with teaching her sons to care for someone having a difficult period. When Olivia was hurting, Christian would run a bath, bake cookies, and ask what she needed. He also tried to connect her with people who might help when she was struggling to find an answer.
None of those gestures replaces medical care. Their value is that Olivia did not have to prove her pain to her partner before receiving kindness. When we are frightened and exhausted, being believed at home can give us the strength to keep seeking help.
Where did Olivia find support when she felt dismissed?
She found it online. During some of the hardest days, Olivia searched YouTube, Reddit, Instagram, and Facebook for people describing experiences that sounded like hers. Their stories helped her recognize a possible explanation and, just as importantly, feel less alone.
We should treat an online community as a source of connection and questions, not a replacement for a diagnosis. Yet there is real value in finding words for symptoms we have struggled to explain. We may arrive at an appointment better prepared to describe the pattern, ask about endometriosis, and request a plan.
That is why Olivia uses her own platform to speak about symptoms she once kept private. If sharing her experience helps even one person seek care earlier, she considers that meaningful. We can learn more about Olivia’s endometriosis advocacy and treatment journey as part of that wider conversation.
What does being your own health advocate actually mean?
It does not mean we have to arrive with a perfect diagnosis or convince every doctor we meet. It means we can take our symptoms seriously even when someone else does not. Olivia kept looking for help despite being told, repeatedly, that her pain was ordinary or exaggerated.
We can make that persistence more concrete:
- Describe the impact, not just the sensation. Tell a clinician when pain prevents us from leaving home, working, sleeping, or following our usual routine.
- Share the whole pattern. Mention bowel, bladder, bleeding, bloating, and pelvic symptoms, even when they feel awkward to discuss.
- Ask what a test can and cannot show. A normal ultrasound does not answer every endometriosis question.
- Ask for a follow-up plan. If we try a treatment, we should know when to reassess it and what happens if it does not help.
- Seek experienced care when we need it. If symptoms remain severe or our concerns are dismissed, a second opinion is reasonable.
Dr. A wants us to remember one distinction above all: We do not need to know for certain that endometriosis is causing our pain to ask a clinician to investigate it. We simply need to know that pain interfering with our lives deserves an answer.
Life beyond the diagnosis
What has Olivia learned about relationships and gratitude?
Olivia has spoken openly about a past relationship she describes as toxic. She recalls reaching a moment when she could finally recognize how frightening the situation had become and remove herself from it. She is proud that she did.
We cannot assume that leaving a harmful relationship is simple or that everyone reaches the same turning point. What Olivia shares is that difficult chapters shaped her appreciation for the supportive relationship she has now. We care about this alongside the medical story because it is hard to tend to our health when we do not feel safe, supported, or able to trust ourselves.
She also does not ask us to be grateful for pain while we are in the middle of it. Her perspective is that a hard period of life is a chapter, not the whole book. We can hold onto the possibility of something better without pretending the present is easy.
What was happening with the wedding and fashion?
At the time of our conversation, Olivia and Christian were planning an early-summer wedding. She was working with a designer on her dress but was not ready to share the name. Naturally, we were eager to talk style, too.
Mary Alice remembered Olivia wearing pieces from her Haney brand early on, including a red jumpsuit for a Hamptons event, a look she wore in Paris, and another outfit for a Rolling Stones event. One of the Paris photos even caught Céline Dion’s attention. Those memories are a lovely reminder that Olivia’s public life includes fashion and celebration as well as the health experience she has chosen to share.
There is another side of Olivia that surprised Mary Alice: She has played the cello since she was six. Her parents are musicians, and she grew up as one of five children in a household where everyone played an instrument. Our lives are rarely defined by one role, one relationship, or one diagnosis.
How does Olivia approach everyday self-care now?
Olivia speaks about self-care with more flexibility than she once allowed herself. She likes circuit training and enjoys exercising with a friend. For her skin, she pays attention to sleep, happiness, and not cleansing so aggressively that her skin feels dried out. She likes a cleansing balm or lotion-based cleanser and mentions retinol as part of her routine.
Her approach to food has softened, too. She says she used to follow strict rules and is happier now that she does not. She tries to eat in a way that helps her feel good while leaving room for the food she enjoys. If she wants chocolate cake, she has some. Her focus is moderation rather than an impossible standard of perfection.
We would not confuse a skincare routine, a workout, or a diet with endometriosis treatment. The connection is quality of life. After years of organizing days around pain, Olivia can make more ordinary choices about movement, food, and rest without pretending that health requires flawless habits.
Questions we still hear about endometriosis
Can bladder or digestive symptoms be part of the picture?
Yes, and we should tell a clinician about them. Dr. A asks about recurring urinary symptoms, particularly when someone has repeatedly been treated for a UTI but cannot find a positive urine culture. She also asks about bloating, pain with bowel movements, and pain with urination.
Digestive symptoms can have more than one possible cause. Dr. A discusses patients who have been evaluated for small intestinal bacterial overgrowth, or SIBO, while endometriosis symptoms remain unaddressed. We should not assume every episode of bloating is endometriosis or SIBO. We should make sure the clinician assessing us understands when it happens, whether it follows our cycle, and what other pain comes with it.
How is endometriosis different from PCOS?
We hear these conditions discussed together because both can affect reproductive health, but they are not the same diagnosis. Endometriosis involves tissue similar to the uterine lining outside the uterus and can cause inflammation and pelvic pain.
Polycystic ovary syndrome, or PCOS, involves a different pattern of ovarian and hormonal changes. Dr. A describes symptoms that can include irregular periods, acne, weight gain, hair loss, and increased facial or body hair. A person can have both conditions, so a PCOS diagnosis should not automatically end an investigation into severe period or pelvic pain.
Does endometriosis end at menopause?
Dr. A explains that symptoms often become less active after menopause as estrogen levels fall. She still considers each person’s circumstances, including pelvic symptoms and any hormone therapy. We should not assume that a previous diagnosis makes every new symptom harmless, nor that everyone needs the same treatment indefinitely.
What message does Olivia most want us to remember?
We do not have to accept being told we are imagining pain that repeatedly stops us from living our lives. Olivia kept asking questions until she found someone who investigated hers. Now she shares her story because she wants other people to experience both the relief of an answer and the possibility of days without debilitating pain.
Dr. A’s message sits beside it: Painful periods that disrupt our lives should not simply be dismissed as normal. We may not know the cause when we first ask for help. We can still ask for careful evaluation, an explanation of our options, and a clinician willing to keep looking with us.
Concerned About Your Health? Talk to Dr. Aliabadi
Dr. Aliabadi is an expert OB/GYN who is knowledgeable in all aspects of women’s health and well-being. Dr. Aliabadi and her caring, supportive staff are available to support you through PCOS, endometriosis, menopause, childbirth, infertility, or routine gynecological care. We invite you to establish care with Dr. Aliabadi. Call us at (844) 863-6700 or
Frequently asked questions
Does a normal ultrasound rule out endometriosis?
No. An ultrasound can show some findings, such as an endometrioma, but many people with endometriosis have a normal ultrasound. Persistent symptoms still deserve discussion with a qualified clinician.
Is surgery the only treatment for endometriosis?
No. Depending on our symptoms and goals, a clinician may discuss hormonal treatments, including birth control pills or a progesterone IUD. Surgery may be appropriate in some circumstances, and follow-up care remains important afterward.
Can we have endometriosis without painful sex?
Yes. Symptoms vary. Olivia reported severely painful periods and symptoms toward the back of her pelvis, but she did not report painful sex.
Is every painful period a sign of endometriosis?
No. Painful periods can have different causes. Severe, worsening, or disruptive pain should be evaluated, with endometriosis among the possibilities considered.
