Endometriosis symptoms

The most common symptoms of endometriosis are severe period pain, pelvic pain that continues outside your period, deep pain during sex, bowel or urinary symptoms around your period and difficulty getting pregnant. Symptoms vary a great deal from person to person, and some people have none. No single symptom proves endometriosis, but having several together is a good reason to talk to a doctor.

Pain: the most common and most dismissed symptom

Pain is the main symptom of endometriosis and it is often brushed off with “period pain is normal”. These are the patterns worth paying attention to:

• Period pain (dysmenorrhoea) that disrupts daily activities, school or work.
• Pelvic or lower abdominal pain that continues outside your period.
• Deep pain during or after sex (dyspareunia).
• Pain spreading to the lower back, groin and legs.

The NICE guideline advises suspecting endometriosis in people with these kinds of symptoms, including young people under 17.

Bleeding

Very heavy periods and spotting before or between periods are commonly reported by people with endometriosis. The ESHRE guideline lists heavy menstrual bleeding among the risk factors associated with endometriosis in women who see a doctor. Bleeding problems have many other causes, so a doctor is needed to assess them.

Bowel and urinary symptoms

Symptoms that get worse around your period, or follow your cycle, matter:

• Pain when passing stool, constipation, diarrhoea, bloating.
• Blood in the stool.
• Pain when passing urine, needing to pass urine often.
• Blood in the urine.

These are easy to miss because they resemble other problems. Noting how they relate to your cycle helps your doctor a lot.

Difficulty getting pregnant

Besides pain, endometriosis is linked to difficulty getting pregnant. The ESHRE guideline describes pain and infertility as the two clinical hallmarks of the disease. If you are trying to conceive and finding it hard, it is important to discuss this with a doctor. See our article on endometriosis and pregnancy.

Fatigue and impact on daily life

The ESHRE guideline also lists fatigue among symptoms that should make a doctor consider endometriosis. The disease can affect school and work, sex life, relationships and mental health. These effects are not an exaggeration; guidelines recognise them as part of the disease.

When should I see a doctor?

See a doctor, ideally a gynaecologist, if any of these apply:

• Your period pain affects daily life or painkillers do not relieve it.
• You have pelvic pain outside your period.
• You have deep pain during sex.
• Bowel or urinary symptoms get worse around your period.
• You are trying to get pregnant and finding it hard.
• Your symptoms were dismissed as “normal” before, but they continue.

For sudden severe abdominal pain, a feeling of fainting or very heavy bleeding, go to an emergency department without waiting.

You can use the symptom checklist to organise your symptoms and print them for your next appointment. For the diagnostic path, read the diagnosis page.