Millions of women experience annoying period symptoms. And you may think that you’re someone who happens to experience especially bad ones.

There’s the heavy bleeding, pelvic pain and cramping, and there may be other irritating symptoms too. But extremely painful periods and pelvic discomfort could be the sign of an underlying condition like endometriosis.

If you’re starting to think that your symptoms are more than that of the typical period, keep reading to learn about endometriosis, how you can spot the symptoms, its causes and how it’s diagnosed.

What is endometriosis?

Endometriosis is a chronic condition that causes endometrial tissue to grow outside the uterus. It affects approximately 10% of reproductive-age girls and women.

What happens when someone has endometriosis

Your reproductive system includes many organs and tissues that work together. But one you may not know much about is the endometrium (endometrial tissue) in your uterus.

During your menstrual cycle, the endometrium – which is the innermost layer of lining in your uterus – thickens to prepare for possible implantation of a fertilized egg. If you don’t become pregnant, your uterus sheds this lining, which is the blood and discharge you pass during your period.

But unlike the healthy endometrial tissue growing in the uterus, endometriosis-related growths in other areas of the body don’t shed during your period. Instead, the tissue continues to build up and can lead to a lot of inflammation, cysts and scarring.

For those with endometriosis, the condition commonly affects the reproductive organs or the areas around them. This means endometrial tissue may also grow on the fallopian tubes, ovaries and the tissue lining the pelvis. In rare instances, endometriosis may spread to other nearby organs.

The amount and location of endometrial growths are two factors used to classify endometriosis into one of four stages.

Determining the severity of endometriosis

Doctors take several things into consideration when determining how severe endometriosis is: where the endometrial tissue is growing, how far it’s spread, how much there is, and whether cysts or scarring are present.

In the beginning stages, the tissue is found only in the pelvis and abdominal cavity. As endometriosis progresses, scar tissue can form around the fallopian tubes and ovaries. Finally, large cysts can be found on the ovaries with severe adhesions, causing organs to stick together.

You might think that more advanced stages of endometriosis mean the symptoms and pain are more severe, but that’s not necessarily true. It’s possible for women with more severe endometriosis to have fewer, if any, symptoms compared to those with a milder form.

Symptoms of endometriosis

Endometriosis can cause a range of different symptoms, both painful and non-painful. Keep reading to learn more about the most common signs and symptoms of endometriosis.

Painful periods

Usually, the first sign of endometriosis is intense pelvic pain, especially during menstruation. It’s the most common symptom, but pain can feel different for each person, and it can occur before and during your menstrual cycle.

Painful menstrual cramps may also travel from the pelvic area and lead to chronic pain in the lower abdomen – where the uterus is – or lower back. Women might also experience pain during urination and bowel movements, especially during their period.

Painful period symptoms, especially if you’ve noticed them getting more intense, are reason enough to see your primary care doctor or women’s health specialist.

Dyspareunia (genital pain before, during or after sex)

Endometriosis symptoms sometimes include genital pain before, during and after sex that causes abnormal levels of discomfort.

Bleeding or spotting between periods

There are many reasons why you may experience irregular bleeding or spotting between mensural periods. While spotting could occur with endometriosis, it may not be the only cause. Spotting is typically lighter than normal period bleeding, can show up as smalls spots, and can range in color from light pink to dark brown. If you often see spotting between your periods, talk with your primary care doctor or women’s health specialist.

Digestive symptoms

Those with endometriosis might also experience a range of gastrointestinal issues during their periods, including diarrhea, constipation, bloating or nausea. In fact, 83% of women with endometriosis experience bloating as a symptom. Endometriosis does not have to enter the bowel for women to experience gastrointestinal distress.


One of the symptoms of endometriosis can be infertility or the inability to get pregnant. While this won’t be apparent unless you’re actively trying to get pregnant, it may indicate a need for care if you’re noticing other symptoms along with difficulty getting pregnant.

Other conditions that share similar symptoms with endometriosis

Several acute and chronic conditions share similar symptoms with endometriosis, many of which can also impact female reproductive health.

Urinary tract infection

A urinary tract infection (UTI) is an infection that affects any part of the urinary system – the kidneys, bladder or urethra. They happen when bacteria from the skin or rectum enter the urethra and infect the urinary tract. The most common symptom of a UTI is pain or burning while urinating – a symptom it shares with endometriosis.

In UTIs, this symptom is acute, meaning it develops quickly and doesn’t last very long. In endometriosis, pain while urinating is a chronic symptom that often returns and can get worse.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of female reproductive organs. PID can occur for several reasons, including not treating an STD and having sex with more than one partner.

PID and endometriosis actually share quite a few symptoms. Both conditions can cause pain in the lower abdomen, pain during sex and urination, and bleeding between periods. But one of the big differences is that PID can also cause fever and unusual discharge from the vagina.

Uterine fibroids

Fibroids are noncancerous growths that develop on the walls of the uterus. Uterine fibroids can grow inside and outside the uterus, which is one of the reasons why they can share many similar symptoms with endometriosis.

Similar symptoms between the two conditions include abnormal bleeding between cycles, pelvic pain and cramping, pain during sexual intercourse and constipation. But some of the most telltale differences are that uterine fibroids can often cause heavy, longer-than-average periods or frequent urination.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a condition brought on by a hormonal imbalance in the ovaries, causing them to overproduce male sex hormones called androgens. This can prevent ovulation and cause ovaries to develop cysts – small pockets of tissue filled with air or fluids. PCOS doesn’t share many of the physical symptoms of endometriosis, but both conditions are linked to infertility.

Pelvic floor disorders

Pelvic floor disorders (PFD) happen when the muscles of the pelvic area are weakened or tense. If you have a PFD, you’re more likely to be dealing with frequent urination or leaking urine, but some of the other symptoms it shares with endometriosis include pain during bowel movements, pain in the pelvic area and lower back, and painful intercourse.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a condition where your bowel movements cause abdominal pain and discomfort. IBS discomfort appears as sharp pains, cramping and bloating. While it shares all these in common with endometriosis, IBS can be noticeably different because it's often triggered by eating specific foods. Both IBS and endometriosis share diarrhea or constipation symptoms, but IBS symptoms may also include upper abdominal pain, mucus in bowel movements and nausea.

What causes endometriosis?

Doctors aren’t exactly sure what causes endometriosis, but there are a few theories:

  • Retrograde or reverse menstruation – During your period, menstrual blood flows out of the uterus through the cervix and exits the vagina. Some believe that at the same time, menstrual blood – which has endometrial cells – is also flowing back into the fallopian tubes and pelvic cavity. Because these cells are leaving the uterus, they have free reign to implant and grow in areas like the inside of your abdominal cavity and ovaries.
  • Genetics – Doctors have also considered whether endometriosis is related to genetics. Research indicates that if someone in your maternal lineage had it, you might develop it too, creating the theory that family history can increase the risks of getting it.
  • Other factors – There’s a theory that cells outside of the uterus can change and grow into cells that resemble endometrial tissue. It’s also possible for stem cells to spread through the body that can contribute to endometriosis. There are other potential factors that researchers have identified as well.

Risk factors for endometriosis

You may have a higher risk for endometriosis if you:

  • Have a direct relative (mother, sister or daughter) with endometriosis
  • Started your period before age 11
  • Have short monthly cycles of less than 27 days
  • Have heavy menstrual periods that last more than a week

You may have a reduced risk for endometriosis if you:

  • Have given birth
  • Started your period after 14 years old
  • Have breastfed or lactated

Does endometriosis cause infertility?

While doctors and researchers can’t say for sure that endometriosis causes infertility, they are related, and there’s a few reasons why this could be:

  • One theory is that endometriosis makes it more difficult for sperm to find your egg. Because of the buildup of scar tissue in the uterus caused by endometriosis, the shape of your uterus can change or areas can become blocked, making what was once a straight road to your egg seem like a maze.
  • Another theory is that endometriosis can affect implantation. In one of the fallopian tubes, sperm will fertilize the egg. This egg should travel down the fallopian tube and implant itself in the uterine lining. Endometriosis may prevent the uterine lining from proper development, preventing implantation.

However, it’s important to know that it’s still possible to get pregnant with endometriosis – and your doctor can help you understand your options for increasing your chances of conception.

How endometriosis is diagnosed

Since many conditions share similar symptoms with endometriosis, it’s important to talk with a primary care doctor, OB-GYN or women’s health specialist about the symptoms you’re experiencing. Depending on your symptoms, they may recommend one or more of the following exams or tests.

Pelvic exam

A bimanual pelvic exam is often the first step when diagnosing endometriosis. Your doctor will examine your vagina internally while also checking external areas of your body, like your pelvis and lower abdomen. This exam can help your doctor locate tender spots that are painful to touch, which may indicate the presence of scar tissue. Other common signs of endometriosis doctors might look for include a frozen pelvis or fixed uterus.

Diagnostic imaging

Imaging tests may help further confirm the presence of scar tissue or find something they missed. Sometimes lesions are too deep for doctors to find manually, so they turn to nonsurgical imaging tests. The three most common tests are:

  • Ultrasounds – Often the most common diagnostic test for endometriosis, they use sound waves and echoes to capture images of your reproductive organs, helping to reveal deep lesions and abnormal thickening of endometrial tissue.
  • CT scans – This test might be ordered if your doctor believes your kidneys or urethra are being affected, however they aren’t the most helpful in diagnosing endometriosis.


A laparoscopy is a minimally invasive procedure performed under general anesthesia where a slim fiber-optic scope (laparoscope) is inserted into a small incision made in the abdominal wall to see and record your internal organs on a video monitor. Doctors use this to make a visual diagnosis. During the procedure, your doctor might also do a biopsy where they take a sample of the tissue for further evaluation.

During a laparoscopy, doctors are looking for cysts and lesions caused by endometrial tissue buildup. If they discover that you do have endometriosis, they will note the location, size and severity of the lesions.

Does endometriosis go away on its own?

Endometriosis is a chronic condition and symptoms can worsen if left untreated. But the good news is that there are many treatment options for endometriosis. For example, long-active reversible contraceptives, intrauterine devices (IUDs) and birth control pills – likely the most helpful and common – can help relieve painful periods or other endometriosis symptoms. Your doctor can work with you to create a tailored treatment plan, taking into account your symptoms, pregnancy goals and more.

Talk with a doctor if you’re experiencing endometriosis symptoms

Pain is a sign that something’s not quite right in your body – don’t ignore it. So, if you’re experiencing painful periods, genital pain before, during or after sex, or any other possible endometriosis symptoms, talk to your primary care doctor, OB-GYN or another women’s health specialist.

They can help you figure out what may be causing your symptoms. Whether or not it is endometriosis, talking to your doctor puts you one step closer to relief and peace of mind.