12 Common Endometriosis Symptoms You Should Never Ignore

Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age worldwide. This condition occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, and the tissue lining the pelvis. Understanding the symptoms of endometriosis is crucial for early detection and management, as many women suffer for years before receiving a proper diagnosis.

The symptoms of endometriosis can vary significantly from person to person. Some women experience severe pain that interferes with daily activities, while others may have minimal symptoms despite having extensive endometriosis. Recognizing these signs early can help you seek appropriate medical attention and improve your quality of life.

1. Pelvic Pain

Pelvic pain is the hallmark symptom of endometriosis and the most common complaint among women with this condition. This pain typically occurs in the lower abdomen, pelvis, and lower back region. Unlike normal menstrual cramps, endometriosis pain tends to be more severe and can be chronic, lasting throughout the entire menstrual cycle rather than just during menstruation.

The pain occurs because endometrial-like tissue growing outside the uterus responds to hormonal changes during the menstrual cycle, causing inflammation, scarring, and adhesions. The intensity of pain doesn’t always correlate with the severity of endometriosis—some women with minimal endometriosis experience excruciating pain, while others with extensive disease may have little to no discomfort.

The pain may be described as:

• Sharp, stabbing sensations
• Deep, aching discomfort
• Cramping that radiates to the lower back and legs
• Continuous or intermittent pain that worsens during certain activities

2. Painful Periods (Dysmenorrhea)

Dysmenorrhea, or painful menstruation, is one of the most prominent symptoms of endometriosis. Women with this condition often experience menstrual cramps that are significantly more severe than typical period pain. The pain usually begins before the period starts and may extend several days into menstruation.

This pain is caused by endometrial implants bleeding during menstruation, leading to inflammation and irritation of surrounding tissues. The severity can be debilitating, forcing many women to miss work, school, or social activities. Some women report that over-the-counter pain medications provide little to no relief, which is a red flag that warrants medical evaluation.

Characteristics of endometriosis-related period pain include:

• Pain that progressively worsens over time
• Cramping that starts before bleeding begins
• Pain that doesn’t respond well to typical pain relievers
• Discomfort that interferes with daily functioning

3. Heavy Menstrual Bleeding (Menorrhagia)

Heavy menstrual bleeding is a common symptom experienced by many women with endometriosis. This may involve soaking through pads or tampons every hour for several consecutive hours, passing large blood clots, or having periods that last longer than seven days.

Menorrhagia in endometriosis occurs due to hormonal imbalances and the presence of endometrial-like tissue in abnormal locations. This tissue bleeds during menstruation just like the uterine lining, but the blood has nowhere to go, leading to inflammation and potentially heavier overall bleeding. The excessive blood loss can lead to anemia, causing additional symptoms like fatigue, weakness, and shortness of breath.

Women should track their menstrual flow and consult a healthcare provider if they notice:

• Needing to change sanitary products every one to two hours
• Passing blood clots larger than a quarter
• Bleeding that lasts more than seven days
• Signs of anemia such as extreme fatigue or dizziness

4. Pain During Intercourse (Dyspareunia)

Painful intercourse, medically known as dyspareunia, affects many women with endometriosis and can significantly impact intimate relationships and quality of life. The pain may occur during penetration or deep penetration, and can persist for hours or even days after sexual activity.

This symptom occurs when endometrial implants are located behind the vagina or on the lower uterus, areas that are directly affected during intercourse. The stretching and movement during sex can irritate these sensitive areas, causing sharp or deep aching pain. Some women describe it as a stabbing sensation in the pelvic region or lower abdomen.

The pain associated with intercourse in endometriosis can:

• Occur with deep penetration
• Be felt in specific positions
• Continue after intercourse has ended
• Lead to anxiety or avoidance of intimacy
• Vary in intensity depending on the time of the menstrual cycle

5. Painful Bowel Movements or Urination

When endometrial tissue grows on or near the bowel or bladder, it can cause significant pain during bowel movements or urination, particularly during menstruation. This symptom is more common in women with deeply infiltrating endometriosis that affects the rectum, sigmoid colon, or bladder.

The pain occurs because hormonal changes during the menstrual cycle cause the endometrial implants to swell and bleed, creating pressure and inflammation in these areas. Women may experience sharp, cramping pains when passing stool or emptying their bladder, and some describe the sensation as feeling like they’re passing razor blades.

Additional bowel and urinary symptoms may include:

• Rectal pain or pressure
• Painful defecation (dyschezia)
• Constipation or diarrhea during menstruation
• Frequent urination
• Feeling of incomplete bladder emptying
• Blood in urine or stool during periods

6. Chronic Fatigue

Chronic fatigue is a frequently overlooked but significant symptom of endometriosis. Many women with this condition report feeling constantly tired, even after adequate sleep, and this exhaustion can be both physical and mental. The fatigue often interferes with work performance, social activities, and overall quality of life.

The causes of fatigue in endometriosis are multifactorial. Chronic pain is physically and emotionally draining, the inflammatory response triggered by endometrial implants requires substantial energy, and heavy menstrual bleeding can lead to iron-deficiency anemia. Additionally, the hormonal imbalances associated with endometriosis can disrupt sleep patterns and contribute to feelings of exhaustion.

Characteristics of endometriosis-related fatigue include:

• Persistent tiredness that doesn’t improve with rest
• Worsening fatigue during or before menstruation
• Lack of energy to complete daily tasks
• Mental fog or difficulty concentrating
• Need for frequent naps or extended sleep periods

7. Infertility or Difficulty Getting Pregnant

Infertility is one of the most distressing complications of endometriosis, affecting approximately 30-50% of women with the condition. Many women first discover they have endometriosis when they seek medical help for difficulty conceiving. Endometriosis is found in 20-50% of women experiencing infertility.

Endometriosis can impair fertility through several mechanisms: it can distort pelvic anatomy, create adhesions that block the fallopian tubes, affect egg quality, impair fertilization, or interfere with implantation. The inflammatory environment created by endometrial implants can also be hostile to sperm and embryos. However, it’s important to note that many women with endometriosis can and do conceive naturally or with fertility assistance.

Women with endometriosis trying to conceive should be aware that:

• Earlier diagnosis and management may improve fertility outcomes
• The severity of endometriosis doesn’t always predict fertility problems
• Various fertility treatments are available and can be effective
• Consulting a fertility specialist may be beneficial after six months of trying to conceive

8. Gastrointestinal Issues

Gastrointestinal symptoms are common in endometriosis, particularly when endometrial tissue grows on or near the bowel. These symptoms are often cyclical, worsening during menstruation, but some women experience them throughout the month. The symptoms can sometimes be misdiagnosed as irritable bowel syndrome (IBS).

Endometrial implants on the bowel cause inflammation and can lead to various digestive problems. The tissue responds to hormonal changes during the menstrual cycle, causing swelling and irritation of the intestinal wall. This can affect normal bowel function and cause significant discomfort.

Common gastrointestinal symptoms include:

• Bloating and abdominal distension, especially during periods
• Nausea and vomiting
• Alternating constipation and diarrhea
• Cramping and abdominal pain
• Changes in bowel habits coinciding with the menstrual cycle
• Feeling of fullness after eating small amounts

9. Lower Back and Leg Pain

Lower back pain and leg pain are frequently reported by women with endometriosis, though these symptoms are often overlooked or attributed to other causes. The pain typically radiates from the pelvis down through the lower back, buttocks, and legs, and may worsen during menstruation or ovulation.

This pain occurs when endometrial implants or adhesions affect nerves in the pelvic region, particularly the sciatic nerve. The inflammatory response and scarring associated with endometriosis can put pressure on these nerves, causing radiating pain. Some women describe the sensation as similar to sciatica, with shooting pains down the back of the legs.

Characteristics of back and leg pain in endometriosis include:

• Deep, aching pain in the lower back and sacral area
• Shooting or burning sensations down one or both legs
• Pain that worsens with prolonged sitting or standing
• Numbness or tingling in the legs or feet
• Pain that intensifies during menstruation
• Difficulty finding a comfortable sleeping position

10. Spotting Between Periods

Irregular bleeding or spotting between menstrual periods is another symptom that some women with endometriosis experience. This intermenstrual bleeding can occur at any time during the cycle but is often noticed around ovulation or in the days leading up to menstruation.

The spotting occurs due to hormonal imbalances associated with endometriosis. The presence of endometrial-like tissue outside the uterus can disrupt normal hormonal regulation, leading to breakthrough bleeding. Additionally, endometrial implants themselves may bleed at different times than the uterine lining, contributing to irregular bleeding patterns.

Women should monitor and report:

• Light bleeding or brown discharge between periods
• Spotting that occurs consistently at the same time each cycle
• Irregular bleeding that disrupts normal cycle patterns
• Any unexplained vaginal bleeding

11. Abdominal Bloating

Abdominal bloating, sometimes referred to as “endo belly,” is a distressing symptom characterized by severe abdominal distension that can make women look pregnant. This bloating can appear suddenly and may be so severe that clothes no longer fit comfortably. It’s often cyclical, worsening during menstruation, but some women experience it throughout the month.

The bloating in endometriosis results from multiple factors: inflammation caused by endometrial implants triggers fluid retention, gastrointestinal involvement can cause gas buildup, and the immune response to the condition contributes to swelling. The bloating can be accompanied by a feeling of pressure or fullness in the abdomen and may be painful.

Endo belly typically involves:

• Rapid abdominal swelling that can change throughout the day
• Visible distension that’s more than typical bloating
• Discomfort or tightness in the abdomen
• Worsening with certain foods or during menstruation
• Relief that’s difficult to achieve with dietary changes alone

12. Emotional and Mental Health Symptoms

The physical symptoms of endometriosis often take a significant toll on mental and emotional health. Living with chronic pain, fatigue, and other debilitating symptoms can lead to depression, anxiety, and decreased quality of life. The impact on relationships, career, and daily functioning can be profound, and the average delay of 7-10 years in diagnosis can exacerbate these mental health challenges.

Chronic pain affects brain chemistry and can lead to mood disorders. The uncertainty and frustration of dealing with a chronic condition, potential infertility concerns, and feeling dismissed by healthcare providers can contribute to psychological distress. Additionally, hormonal imbalances associated with endometriosis may directly affect mood regulation.

Mental health symptoms associated with endometriosis include:

• Depression and persistent sadness
• Anxiety, particularly related to pain episodes or fertility
• Social isolation and withdrawal
• Feelings of frustration or hopelessness
• Stress related to managing symptoms and medical appointments
• Body image concerns
• Relationship difficulties

It’s important for women experiencing these symptoms to seek support from mental health professionals who understand chronic pain conditions, in addition to receiving appropriate medical care for endometriosis.

What Causes Endometriosis?

Despite being a common condition, the exact cause of endometriosis remains unknown. However, researchers have identified several theories and risk factors that may contribute to its development:

Retrograde Menstruation: This is the most widely accepted theory, proposing that menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. These cells then implant and grow on pelvic organs. However, while retrograde menstruation occurs in many women, not all develop endometriosis, suggesting other factors are involved.

Genetic Factors: Endometriosis tends to run in families, with women having a first-degree relative with the condition being 7-10 times more likely to develop it themselves. Researchers have identified several genes that may increase susceptibility to endometriosis.

Immune System Dysfunction: Problems with the immune system may prevent the body from recognizing and destroying endometrial-like tissue growing outside the uterus. Women with endometriosis often show altered immune function and increased inflammatory markers.

Hormonal Factors: Endometriosis is estrogen-dependent, meaning it thrives in the presence of estrogen. Hormonal imbalances, particularly elevated estrogen levels, may promote the growth and survival of endometrial implants.

Cellular Metaplasia: This theory suggests that cells outside the uterus can transform into endometrial-like cells, possibly triggered by hormones or immune factors.

Lymphatic or Vascular Spread: Endometrial cells may travel through blood vessels or the lymphatic system to other parts of the body, similar to how cancer cells spread.

Environmental Factors: Exposure to certain environmental toxins, particularly dioxins and other endocrine-disrupting chemicals, has been linked to increased risk of endometriosis in some studies.

Risk factors that may increase the likelihood of developing endometriosis include:

• Never having given birth
• Starting menstruation at an early age
• Going through menopause at an older age
• Short menstrual cycles (less than 27 days)
• Heavy menstrual periods lasting more than seven days
• Low body mass index
• Family history of endometriosis
• Reproductive tract abnormalities

Prevention of Endometriosis

Unfortunately, because the exact cause of endometriosis is not fully understood, there is no guaranteed way to prevent the condition from developing. However, certain lifestyle choices and factors may help reduce your risk or potentially slow the progression of the disease:

Hormonal Considerations: Since endometriosis is estrogen-dependent, reducing estrogen exposure may be beneficial. Some studies suggest that long-term use of hormonal birth control, particularly continuous or extended-cycle regimens that reduce the number of menstrual periods, may lower the risk of developing endometriosis or slow its progression.

Maintain a Healthy Weight: Excess body fat can increase estrogen production, potentially contributing to endometriosis development or progression. Maintaining a healthy body mass index through balanced nutrition and regular exercise may help regulate hormone levels.

Regular Physical Activity: Regular exercise, particularly aerobic activity, may help lower estrogen levels and reduce the risk of endometriosis. Aim for at least 150 minutes of moderate-intensity exercise per week. Exercise also helps manage pain and improve overall well-being for those already diagnosed with the condition.

Limit Alcohol and Caffeine: Some research suggests that high alcohol consumption may increase the risk of endometriosis by raising estrogen levels. Similarly, high caffeine intake has been associated with increased risk in some studies, though research is inconclusive.

Avoid Excessive Dioxin Exposure: Dioxins are environmental pollutants that have been linked to endometriosis. While complete avoidance is impossible, you can minimize exposure by eating organic foods when possible, choosing low-fat dairy and meat products, and avoiding the use of plastics in food storage and heating.

Early Pregnancy: Women who have their first child at a younger age and those who breastfeed may have a reduced risk of developing endometriosis, likely due to the prolonged periods of amenorrhea and lower estrogen exposure during pregnancy and lactation.

Monitor Your Menstrual Health: Being aware of your menstrual patterns and seeking early medical attention for symptoms such as severe period pain, heavy bleeding, or other concerning symptoms can lead to earlier diagnosis and management, potentially preventing progression of the disease.

It’s important to note that even with these preventive measures, endometriosis can still develop, as many factors contributing to the condition are beyond individual control. Early recognition of symptoms and prompt medical evaluation remain the most important steps in managing endometriosis effectively.

Frequently Asked Questions

How is endometriosis diagnosed?

Endometriosis is definitively diagnosed through laparoscopy, a minimally invasive surgical procedure where a camera is inserted through a small incision to visualize endometrial implants. However, doctors may suspect endometriosis based on symptoms, pelvic exams, ultrasound, or MRI findings. A thorough medical history and physical examination are the first steps in diagnosis.

Can endometriosis go away on its own?

Endometriosis is a chronic condition that typically does not go away on its own, though symptoms may naturally improve after menopause when estrogen levels decrease. During reproductive years, the condition usually requires management through various approaches. Some women may experience temporary symptom relief during pregnancy due to hormonal changes.

At what age does endometriosis typically start?

Endometriosis most commonly develops during the reproductive years, typically between ages 25-35, though it can occur in any woman who menstruates. Many women report having symptoms since their teenage years, but diagnosis is often delayed by several years. It’s rare but possible for endometriosis to occur in adolescents or postmenopausal women.

Does endometriosis mean I can’t have children?

No, having endometriosis does not automatically mean you cannot have children. While endometriosis can affect fertility in 30-50% of cases, many women with the condition conceive naturally. Various fertility treatments and assisted reproductive technologies are available to help women with endometriosis who are having difficulty conceiving. Early diagnosis and appropriate management can improve fertility outcomes.

Is endometriosis pain constant or does it come and go?

Endometriosis pain varies greatly between individuals. Some women experience cyclical pain that worsens during menstruation, while others have chronic pain throughout the month. The pain may be intermittent or constant and can change in intensity. Pain patterns often correspond with the menstrual cycle but can also be triggered by certain activities like intercourse, exercise, or bowel movements.

Can endometriosis affect organs other than reproductive organs?

Yes, while endometriosis most commonly affects reproductive organs, it can occur on the bowel, bladder, diaphragm, and rarely, in distant sites like the lungs or surgical scars. When endometriosis affects these areas, it can cause symptoms related to those organs, such as painful bowel movements, urinary symptoms, or even cyclical shoulder pain or coughing up blood in rare cases.

Will losing weight help with endometriosis symptoms?

Weight management may help some women with endometriosis symptoms, particularly if they are overweight, as excess body fat can increase estrogen production. However, endometriosis affects women of all body types, and weight loss alone is not a treatment for the condition. A comprehensive approach including diet, exercise, stress management, and medical care is typically most effective.

Can stress make endometriosis worse?

While stress doesn’t cause endometriosis, it can exacerbate symptoms and affect how you perceive pain. Chronic stress can trigger inflammatory responses, weaken the immune system, and disrupt hormonal balance, potentially worsening endometriosis symptoms. Stress management techniques such as meditation, yoga, or counseling can be beneficial as part of a comprehensive management approach.

Should I see a specialist for endometriosis?

If you suspect you have endometriosis or have been diagnosed with the condition, seeing a specialist can be very beneficial. Gynecologists who specialize in endometriosis or reproductive endocrinologists have expertise in diagnosing and managing the condition. For complex cases, particularly those involving bowel or bladder endometriosis, a multidisciplinary team approach may be recommended.

References:

• Mayo Clinic – Endometriosis
• American College of Obstetricians and Gynecologists (ACOG) – Endometriosis
• National Institute of Child Health and Human Development – Endometriosis
• NHS – Endometriosis
• Johns Hopkins Medicine – Endometriosis
• Office on Women’s Health – Endometriosis