Endometriosis Symptoms

Quick Glance: Common Endometriosis Symptoms

Endometriosis symptoms may occur mainly during periods, but can continue at other times of the month. They can vary from person to person. Common symptoms of endometriosis include:

• Severe period pain

• Ongoing or recurring pelvic pain

• Pain during or after sex

• Painful bowel movements, especially around periods

• Pain while passing urine, particularly during periods

• Heavy menstrual bleeding

• Fatigue

• Difficulty becoming pregnant

The intensity of symptoms does not always reflect the extent of endometriosis. Some people with more extensive endometriosis may have few symptoms, while others may experience significant pain despite having less extensive disease.

Endometriosis Symptoms That Should Not Be Ignored

Severe or persistent symptoms should be assessed, particularly when they affect daily activities or repeatedly occur around periods. The table below explains symptoms of endometriosis that may warrant medical evaluation and what they could indicate:

These symptoms do not confirm endometriosis on their own. A healthcare professional can assess the symptoms, consider other possible causes and recommend appropriate investigations.

Why Do Endometriosis Symptoms Occur?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. It most commonly affects the pelvis and can involve areas such as the ovaries, fallopian tubes and the tissue lining the pelvis. In some cases, endometriosis can also affect areas outside the pelvis, including the bowel, bladder or chest.

The endometriosis tissue responds to hormonal changes during the menstrual cycle. The lesions can trigger inflammation and irritation in surrounding tissues, which may contribute to painful periods, pelvic pain and pain during sex.

Repeated inflammation may also lead to the formation of scar tissue and adhesions. These bands of scar-like tissue can cause organs and tissues that normally move freely to stick together. As a result, the patient experiences pelvic pain and discomfort during bowel movements or sex.

Endometriosis Symptoms That Require Immediate Medical Attention

Immediate medical attention is required for:

• Sudden, severe or rapidly worsening abdominal or pelvic pain

• Severe pain accompanied by repeated vomiting

• Fainting, collapse or severe weakness

• Heavy bleeding accompanied by dizziness or faintness

• Severe abdominal swelling with persistent pain

• Inability to pass stool or gas with severe abdominal pain

• Sudden chest pain or difficulty breathing

• Coughing up blood, particularly when accompanied by chest pain or shortness of breath

Rare forms of endometriosis affecting the chest can cause symptoms such as chest pain, shortness of breath or coughing up blood. Sudden or severe chest or breathing symptoms require urgent medical assessment.

Symptoms of Endometriosis Based on Type

The table below presents the symptoms of different types of endometriosis:

Symptoms of Endometriosis-Specific Conditions

The table below explains how symptoms of endometriosis may vary depending on the organ or area affected:

Symptoms can overlap with other bowel, urinary or chest conditions. Thus, they should not be assumed to be caused by endometriosis without a medical assessment.

Symptoms of Endometriosis in Children

Endometriosis can begin during adolescence, particularly after periods start. Severe period pain that affects school, sleep or normal activities should not automatically be considered a normal part of menstruation.

Endometriosis symptoms in children that may need medical assessment include:

• Severe period pain affecting school or daily activities

• Pelvic pain during or between periods

• Painful bowel movements around periods

• Pain while passing urine around periods

• Nausea or other digestive symptoms associated with menstrual pain

Persistent or severe symptoms in adolescents should be discussed with a healthcare professional. NICE recommends assessing suspected endometriosis in young people, including those aged 17 and under, based on their symptoms and clinical findings.

Can You Have Endometriosis Without Symptoms?

Yes, endometriosis can occur without noticeable symptoms. Some people may discover they have endometriosis while being investigated for fertility problems or another pelvic concern.

The intensity of pain does not always reflect the extent of endometriosis. Someone with more extensive endometriosis may have few symptoms, while another person with less extensive disease may experience significant pain.

When Can Endometriosis Symptoms Become Life-Threatening?

The table below explains rare emergency conditions associated with endometriosis and why they require urgent medical attention:

These complications are uncommon. Sudden severe pain, collapse, chest pain or significant breathing difficulty requires urgent medical assessment.

How are Endometriosis Symptoms Diagnosed?

Doctors consider the pattern of symptoms, menstrual history and examination findings before deciding which investigations are appropriate. Symptoms alone cannot confirm endometriosis.

The table below explains the main assessments and investigations that may be used when endometriosis is suspected:

NICE recommends offering a transvaginal ultrasound to people with suspected endometriosis, even when the pelvic or abdominal examination is normal. A normal ultrasound does not rule out endometriosis, and laparoscopy is not necessarily required before a diagnosis or treatment plan is made.