Endometriosis Symptoms: The Signs to Look For

What is endometriosis?

Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the uterus, most often on the ovaries, the lining of the pelvis, and around the bowel and bladder. This tissue causes inflammation, scarring and pain.

It’s common. Worldwide, around one in ten women and people assigned female at birth of reproductive age are affected. An Australian study that linked national health data found that about one in nine women had been diagnosed by their early forties.

Endometriosis symptoms

Pain

• Painful periods that stop you going to work or school, or don’t respond to usual pain relief
• Pelvic pain at other times of the month, or most of the time
• Deep pain during or after sex
• Pain with bowel movements, especially during periods
• Pain passing urine, especially during periods
• Lower back or leg pain around periods
• Pain around ovulation

Other symptoms

• Fatigue
• Bloating, sometimes called “endo belly”
• Bowel changes such as constipation or diarrhoea, which can be mistaken for irritable bowel syndrome
• Difficulty getting pregnant
• Low mood or anxiety, which often comes with long-term pain

Some people have few or no symptoms and are only diagnosed during fertility investigations.

Does more pain mean more endometriosis?

Not necessarily. Studies have found that the amount of endometriosis seen at surgery doesn’t closely match how much pain someone has. People with small amounts can have severe pain, and vice versa. See endometriosis stages.

Why does diagnosis take so long?

Many people wait years between first symptoms and a diagnosis. Reasons include period pain being dismissed as normal, symptoms overlapping with bowel and bladder conditions, and the belief that surgery is always needed to diagnose it. Guidelines now support diagnosing and treating endometriosis based on symptoms and imaging, without waiting for surgery. See how endometriosis is diagnosed.

Is it endometriosis or adenomyosis?

Adenomyosis is a related condition in which the lining grows into the muscle wall of the uterus. It causes heavy, painful periods and often occurs alongside endometriosis. See endometriosis vs adenomyosis.

When to see a doctor

See a GP if period pain affects your daily life, if pain-relief medicines from the pharmacy aren’t enough, or if you have pain with sex, bowel movements or passing urine. Get urgent help for sudden severe pelvic pain, pain with fever or fainting, or pain when you could be pregnant.

References

1. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256.
2. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.
3. Rowlands IJ, Abbott JA, Montgomery GW, et al. Prevalence and incidence of endometriosis in Australian women: a data linkage cohort study. BJOG. 2021;128(4):657-665.
4. Vercellini P, Fedele L, Aimi G, et al. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod. 2007;22(1):266-71.
5. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852.
6. RANZCOG. Endometriosis Clinical Practice Guideline.
7. healthdirect. Endometriosis.