20 symptoms of endometriosis

20 Symptoms of Endometriosis

Endometriosis is a common but often under-recognized condition in which tissue similar to the uterine lining grows outside the uterus. It affects up to 10% of reproductive-age women and can take years to diagnose (Arruda et al., 2003). Below are 20 symptoms of endometriosis you should know about. If you suspect you’re experiencing any of these, consider doing a free, online symptom check for your peace of mind—and speak to a doctor about anything serious.

1. Painful Periods (Dysmenorrhea)

Many women with endometriosis report menstrual cramps that worsen over time. Unlike typical period pain, this discomfort:

• Begins a few days before bleeding starts
• Persists throughout menstruation
• May respond poorly to standard over-the-counter pain relief

2. Chronic Pelvic Pain

Pelvic pain between periods can be dull, aching or sharp:

• May last for days or weeks
• Can interfere with daily activities
• Often intensifies during menstruation

3. Painful Intercourse (Dyspareunia)

Pain during or after sex is common:

• Often felt deep in the pelvis
• May discourage intimacy and impact relationships

4. Painful Urination (Dysuria)

If endometriosis involves the bladder or ureters, you may notice:

• Burning or stinging when you pee
• Pain that peaks during your period

5. Painful Bowel Movements (Dyschezia)

Endometrial implants on the bowel cause pain during stools:

• Often worst on heavy-bleeding days
• May be accompanied by rectal pressure or spasm

6. Heavy or Irregular Bleeding

Endometriosis can lead to:

• Menorrhagia (heavy menstrual bleeding)
• Spotting between periods
• Bleeding that lasts longer than a week

7. Infertility or Difficulty Conceiving

Up to 30–50% of women with endometriosis experience fertility issues (Giudice, 2010):

• Endometrial tissue may block fallopian tubes
• Inflammation can affect egg quality

8. Fatigue

Chronic inflammation and pain often lead to:

• Persistent tiredness despite adequate sleep
• Difficulty concentrating (“brain fog”)

9. Gastrointestinal Upset

Endometriosis implants on the intestines can cause:

• Bloating and gas
• Nausea or occasional vomiting
• Fluctuating appetite

10. Lower Back Pain

Pain may radiate from the pelvis into the lower back:

• Often worse during menstruation
• Can feel like muscle strain

11. Painful Ovulation (Mittelschmerz)

Spot pain around mid-cycle can be more intense than typical ovulation twinges:

• Lasts several hours to days
• May mimic appendicitis if severe and one-sided

12. Leg Pain or Sciatica

Endometrial implants on the pelvic nerves can trigger:

• Shooting pain down one or both legs
• Numbness or tingling in the thigh

13. Pain During Exercise

High-impact activities may worsen pelvic discomfort:

• Running, jumping or heavy lifting can flare pain
• Some women shift to gentler workouts

14. Painful Pelvic Exam

Women with endometriosis often feel severe tenderness when the doctor palpates the pelvis.

15. Rectal Bleeding or Mucus

If lesions involve the rectum:

• You might see streaks of blood during your period
• Mucus discharge may accompany bleeding

16. Urinary Frequency or Urgency

Bladder implants can lead to:

• Needing to pee more often than usual
• Feeling an urgent need to urinate, even with little urine

17. Constipation or Diarrhea

Bowel involvement can cause alternating bowel habits:

• Constipation from scarring or adhesions
• Diarrhea triggered by inflammation

18. Mood Changes, Anxiety or Depression

Chronic pain and fertility worries may contribute to:

• Mood swings around your cycle
• Feelings of sadness or anxiety

19. Abdominal Cramps Outside Your Period

Cramps can occur:

• During ovulation
• With bowel movements
• At seemingly random times

20. Pelvic Swelling or Bloating

Some women describe a “pregnant” belly feeling during menstruation:

• Bloating may persist beyond your period
• Can mimic symptoms of ovarian cysts

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Why Early Recognition Matters

Endometriosis often goes undiagnosed for 7–10 years (Arruda et al., 2003). Early recognition of these 20 symptoms of endometriosis can help you:

• Seek timely care
• Explore pain-management strategies
• Discuss fertility preservation

Next Steps

• If you have several of the symptoms listed, you might consider a free, online symptom check for extra insight.
• Keep a symptom diary noting pain patterns, bleeding changes and bowel or bladder signs.
• Speak to a doctor about any new, worsening or life-threatening symptoms. Only a healthcare professional can provide a definitive diagnosis and tailor treatment to your needs.

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References:

• Giudice LC. (2010). Clinical practice. Endometriosis. N Engl J Med. PMID: 20647251.
• Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. (2003). Time elapsed from onset of symptoms to diagnosis of endometriosis. Hum Reprod. PMID: 12673393.
• Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet. PMID: 24581641.