20 Symptoms of Endometriosis to Keep on Your Radar

The symptoms of endometriosis are a way bigger deal than simply “bad periods.” The pelvic pain is often described as debilitating. “Deep, pulsating pain when the cramps hit, makes me double over,” one person on Reddit wrote. “Burning, knives being stabbed, unbearable, trapping, struggling to breathe and move,” wrote another.

Other signs of endometriosis can include diarrhea, constipation, bloating, trouble getting pregnant, and fatigue. Because these symptoms can overlap with those of so many other conditions—or simply be mistakenly considered “normal” menstrual discomfort—it may take between 4 and 11 years after symptoms start for someone with endometriosis to get the correct diagnosis.

Somewhat unexpectedly, how bad your symptoms are doesn’t necessarily predict how bad your endometriosis is. For example, you can have advanced endometriosis and only mild pain, or you may experience severe pain during the early stages of the disease. That’s why it’s important to track patterns in your symptoms from month to month and talk with a clinician about what you’re experiencing, rather than toughing it out.

But you might not always know what to track. Here, we’ll cover 20 endometriosis symptoms grouped by body system, how flares differ from everyday discomfort, and when it’s time to see a clinician.

What Endometriosis Is and Why Symptoms Show Up

Endometriosis is a condition that happens when tissue similar to the lining of the uterus grows outside of the uterus, where it doesn’t belong. An estimated 11% of American women between ages 15 and 44 have endometriosis, and it’s most common in your 30s and 40s. The name comes from the word “endometrium,” which is what that uterine lining tissue is called. 

When you have endometriosis, tissue can grow on the ovaries, fallopian tubes, outside of the uterus, vagina, cervix, bladder, rectum, and other sites.

These growths can then swell and bleed, just like the inside of your uterus does every month during a menstrual period. But if the growing and bleeding tissue is in an area where it isn’t supposed to be, it can cause inflammation and pain. It can even cause scar tissue that joins your organs together, leading to pain, digestion issues, and fertility issues. This inflammation can also irritate nearby peripheral nerves, or in some cases, a growth may direct affect a nerve itself. And in a cruel twist, this same inflammation may also alter how the brain processes pain signals, gradually making pain even more intense.

Because the growths can swell and bleed like a period, many people find their endometriosis symptoms are cyclical. But for others, signs of endometriosis are constant. Certain symptoms may occur at specific times, such as pain with intercourse or pain during bowel movements.

No matter when or how your endometriosis symptoms appear, they may shift over time as your hormones change. When you stop producing estrogen as you approach menopause, endometriosis growths might shrink, helping with pain. In fact, menopause is sometimes considered a “cure” for most people, due to the natural decline in hormone production. However, in about 4% of cases, menopausal women still experience symptoms of endometriosis, even without menstrual bleeding.

Pelvic and Period Pain Symptoms

Many of the most common, recognizable endometriosis symptoms are related to pelvic pain, such as:

• Painful periods: Also called dysmenorrhea, painful periods can happen with endometriosis because the endometrium-like tissue outside of the uterus grows and bleeds on a monthly cycle, just like the lining of the uterus. But when this swelling and bleeding happens with no room for the growths and/or nowhere for the blood to go, it can be painful. The pain is typically worse than menstrual cramps and doesn’t go away with safe doses of over-the-counter (OTC) pain relievers. It may make it hard for you to go to school or work.
• Chronic pelvic pain: Endometriosis pain isn’t confined only to your period. Some people with moderate to severe disease experience chronic pelvic pain, regardless of menstruation. That’s because the tissue growing has typically formed into cysts or adhesions, joining organs together with scar tissue. This can pull the ovaries or fallopian tubes into unnatural positions and put pressure on various internal organs, leading to constant pain.
• Painful sex: Pain during or after vaginal intercourse, called dyspareunia, can also be a sign of endometriosis, because penetrative sex can press on and inflame the growths of tissue. The pain may be more or less noticeable in different positions.
• Painful ovulation or mid-cycle twinges: Some people experience a twinge of pain lasting mere minutes around the middle of their menstrual cycle. For others, ovulation pain lasts for an entire day or so. This typically happens when the fluid-filled sac holding an egg stretches and then ruptures to release the egg, when ovulation occurs. If endometriosis has caused growths of tissue on or near your ovaries or fallopian tubes, this irritation and rupture may feel even worse. In fact, people with endometriosis report more or worse ovulation pain.
• Lower back pain: Scar tissue in your pelvis can pull on or otherwise irritate nerves that send pain radiating into your back.

Menstrual and Bleeding Symptoms

Several common symptoms of endometriosis have to do with menstrual bleeding and shouldn’t be ignored as a “bad period,” including:

• Heavy menstrual bleeding: Some people with endometriosis have heavier than normal menstrual bleeding, called menorrhagia, including passing large blood clots during periods. “Heavy bleeding” may be defined as bleeding that lasts more than 7 days or soaks through a tampon or pad every hour for several hours, for example.
• Bleeding between periods: Called spotting, light bleeding between periods is another endometriosis symptom to watch for. That said, spotting can be due to a number of different causes (and it may be nothing to worry about), so it’s not a guarantee that you have the condition.  
• Irregular or unusual bleeding: If your period is relatively regular and then changes, it’s usually a red flag to talk with a clinician. Bleeding that’s different from your usual menstrual cycle—whether it’s sooner, longer, heavier, or no longer on a schedule—can all be signs of endometriosis. (Because this symptom is less common than pelvic pain or severe menstrual cramps, your clinician will likely evaluate you for a structural issue such as fibroids or polyps too.)

Digestive and “Endo Belly” Symptoms

Endometriosis can trigger chronic inflammation, irritating your gastrointestinal (GI tract) and making your gut more sensitive. Endometriosis lesions can also grow anywhere in your pelvis, including directly on your intestines. As a result of these two possible effects, some women experience digestive or bowel endometriosis symptoms, including:

• Severe bloating: Abdominal distension is sometimes called endo belly. This discomfort is often cyclical and worse before periods. As the growths swell before a period, your stomach may be seriously bloated, much more so than during a period or after a big meal.
• Nausea: Endo growths near the intestines are associated with nausea and vomiting. 
• Constipation or diarrhea: Both can flare up around the menstrual cycle in people with endometriosis. Endometriosis is often mistaken for irritable bowel syndrome (IBS) because of these and other digestion-related symptoms (though it’s also possible to have both endo and IBS). 
• Painful bowel movements: Also called dyschezia, pain when pooping is another common sign of endometriosis, particularly when lesions are on or near your rectum. This is also more common during your period.

Bladder and Urinary Symptoms

Other endometriosis signs affect your urinary habits, which means they can be confused with more common issues, like a urinary tract infection (UTI). If you have any signs of an infection—such as burning when urinating, an urgent need to urinate, or pink- or red-colored urine—talk with a healthcare professional about appropriate testing and treatment rather than assuming you have endometriosis. 

Urinary endometriosis symptoms typically get worse around your period. Here’s what to watch for:

• Painful urination: Called dysuria, pain when peeing is a common endometriosis symptom. Lesions may be on or near the bladder or urethra. Like dyschezia, dysuria is also more likely during your period.
• Frequent or urgent urination: This feeling can be similar to a UTI. It can occur due to endometriosis lesions pressing on your bladder or other nearby organs and tissues.
• Blood in the urine: While it’s rare, some people with endometriosis may notice blood in their urine. Blood in your urine is called hematuria. While it’s relatively common and often nothing to worry about, it’s worth talking with a clinician anytime you notice pink or red pee to rule out serious causes.

Fertility and Reproductive Symptoms

Many people with endometriosis have difficulty getting pregnant. In fact, this is a symptom of endometriosis that sparks many people to seek medical care. Sometimes it’s discovered for the first time during a fertility workup.

• Fertility concerns: Endometriosis is a leading cause of infertility, clinically defined as not conceiving after 12 months of trying, or 6 months if you’re over 35. or difficulty getting pregnant. That’s because the tissue growing where it doesn’t belong can interfere with conception. Up to half of women with infertility have endometriosis. Conceiving may be more difficult, but it’s not impossible. Both endometriosis and fertility treatments can help many women with endometriosis still get pregnant.

Whole-Body and Easy-to-Miss Symptoms

Rounding out this list of 20 symptoms of endometriosis are a few that can be trickier to identify. The symptoms below are often easy to miss because they can be signs of so many other conditions:

• Persistent fatigue: In today’s always busy world, many of us get used to some level of fatigue. But unexplained, persistent fatigue that doesn’t have anything to do with how much sleep you’re getting, how packed your work and social lives are, or how much exercise you’ve been doing could be a sign that something is up. Endometriosis-related fatigue usually shows up alongside other symptoms like chronic pelvic pain or painful periods, rather than on its own. It feel like complete exhaustion, and it may come on extra strong right before a flare-up of your other symptoms. In one study, more than 50% of women with endometriosis reported feeling fatigue, compared with 22% of women without endometriosis. Experts think the fatigue is caused by how hard your immune system is working to fight the endometriosis.
• Leg, hip, or sciatica-type pain: Like with endometriosis-related back pain, lesions can pull on, irritate, or damage the sciatic nerve, which runs from your lower back through your hips and butt and down your legs. This can cause pain in any of these areas, including when walking.
• Mental health changes: Endometriosis and its many symptoms can have a serious toll on your mental health. More than two thirds (68%) of women with endometriosis have elevated stress levels, and the condition is also associated with higher levels of depression and anxiety.
• Chest or shoulder pain: It’s rare, but endometriosis lesions can grow in your chest cavity, including on your diaphragm and lungs, called thoracic endometriosis. Studies estimate this happens in fewer than 5% of women with endometriosis. It can cause chest or shoulder pain, difficulty breathing, or even coughing up blood around your period. These symptoms can all be due to a number of other causes and are all reasons to talk with a clinician. Very rarely, endometriosis can also cause painful skin nodules—most often near the belly button, known as a Villar’s nodule—that may bleed during your period.

Endometriosis Flare-Ups vs. Everyday Discomfort

Endometriosis flares are periods of time when your symptoms are significantly worse than usual. 

Endometriosis flare-up symptoms can include any of the symptoms above escalating in severity. These are distinct from ordinary premenstrual syndrome (PMS) or period pain, although they may happen cyclically. They can also be triggered by factors like stress, more physical activity than usual, sex, and bumpy movements.

There are a few things you can do to treat flares when they strike. Your clinician may recommend NSAIDs (nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen), acetaminophen, or in some cases, a short course of prescription pain medication, along with supportive care. To reduce the frequency of endometriosis flares, they may also recommend escalating your hormonal treatment—for example, switching from a cyclic birth control pill to a continuous regimen, or in some cases to a GnRH agonist (like leuprolide/Lupron) or GnRH antagonists (like elagolix) to completely suppress ovulation.

In some research, women report finding help for flares from social media and support groups. But your clinician should be aware of your flare-up symptoms and your potential triggers, too. They may be able to share advice about limiting your exposure to certain triggers or managing the increase in your symptoms with particular medications. They may also ask you to track your flares to try to identify patterns and trends.

How Endometriosis Is Diagnosed and When to See a Clinician

Even if you have frequent or severe signs of endometriosis, it’s a hard condition to diagnose because the symptoms can be mistaken for many other conditions. On average, it takes 7 to 10 years to get an endometriosis diagnosis after symptoms start.

But you don’t have to wait to talk with someone. If your symptoms interfere with your daily life and OTC pain medications don’t help, reach out to a healthcare professional, like a Midi clinician, about what’s going on. Even if you don’t have endometriosis, that’s not normal period pain.

During an evaluation for endometriosis, you can expect a few things:

• Pelvic exam: Your doctor will feel for cysts or scar tissue.
• Imaging test: They may do an internal or external ultrasound or an MRI scan to look for endometriosis growths.
• Prescription medications: You might be asked to try hormonal medications, such as birth control or gonadotropin-releasing hormone agonists, to see if they help your symptoms. While improvement can bring relief and help paint a fuller picture, it doesn’t definitively confirm an endometriosis diagnosis, as other conditions can respond similarly to these medications.
• Laparoscopic surgery: If imaging tests are inconclusive and you’ve tried medical management for 3 to 4 months without relief, your clinician may refer you to an in-person gynecologic surgeon for this minimally invasive procedure. It allows the surgeon to look inside your pelvis for the presence of endometriosis tissue. If they find growths, they may be able to treat you at the same time so you don’t need a second surgery.

Midi clinicians can help assess midlife pelvic pain, heavy bleeding, and other potential endometriosis symptoms and coordinate next steps toward a diagnosis and the best treatment plan for you.

Key Takeaways

• Symptoms of endometriosis are often overlooked as bad period pain, but the condition can be debilitating, disrupting daily life and making it hard to get pregnant.
• Signs of endometriosis can include pelvic pain, irregular menstrual bleeding, severe bloating, back pain, fatigue, and more.
• Consider tracking your symptoms and talking with a clinician about the patterns and trends you spot. They can help determine whether you might have endometriosis and what the best course of treatment might be for you.

Frequently Asked Questions (FAQs)

What are the 4 stages of endometriosis?

The four stages of endometriosis refer to the severity of the disease, as follows:

• Stage 1: minimal disease with superficial growths
• Stage 2: mild disease with more and deeper growths
• Stage 3: moderate disease with many deep growths and small cysts on one or both ovaries
• Stage 4: severe disease with many deep growths and large cysts on one or both ovaries

Is endometriosis curable?

There is currently no definitive cure for endometriosis. Many people with the condition are treated with a combination of surgery, hormonal birth control, pain medication, and supportive lifestyle habits like diet and exercise. However, reaching menopause will provide relief for most people, due to the natural decline of hormone production.

What are the dos and don’ts for managing endometriosis?

Do take any medication regularly and as recommended by your clinician. Do exercise regularly. Do manage stress and get plenty of rest.

Don’t ignore or shrug off your symptoms. Don’t eat excessive amounts of red meat or trans fats. 

Can endometriosis symptoms appear after menopause?

It’s unlikely. Typically if you have symptoms of endometriosis after menopause, it’s because you already had the condition before menopause. For most people, menopause “cures” endometriosis symptoms, due to the drop in hormone production, though about 4% of menopausal people will still experience symptoms. 

What’s the difference between endometriosis and PCOS symptoms?

Polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome, or PCOS) can also cause ovarian cysts, irregular periods, and fertility concerns, like endometriosis, but they are different conditions. One key difference is ovulation: PMOS involves ovulatory dysfunction, so cycles are often irregular or absent. With endometriosis, ovulation typically occurs regularly, and it’s this natural cycle that contributes to the pain.