Endometriosis Symptoms: What to Know and When to See a Doctor

Endometriosis affects an estimated 1 in 10 reproductive-age women in the United States, according to the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Many women may go undiagnosed, and symptoms can vary widely.

Common endometriosis symptoms include pelvic pain, painful periods, pain during sex, pain with bowel movements or urination, heavy bleeding and difficulty becoming pregnant. Some people have severe symptoms, while others have few or none.

If pelvic pain or other symptoms interfere with your daily life or your plans for pregnancy, an evaluation can help determine what may be causing them.

Pacific Reproductive Center can help evaluate your symptoms and discuss your fertility options.

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue may grow on the ovaries, fallopian tubes, uterine ligaments and other areas of the pelvis. It can cause inflammation, pain and scar tissue.

Endometriosis affects each person differently. Some people have significant pain, while others have mild symptoms or no noticeable symptoms. The condition can also affect fertility, which may make evaluation especially important if you are trying to become pregnant.

Symptoms of Endometriosis

The most common symptom of endometriosis is pelvic pain, often related to menstruation.

Symptoms can occur before, during or after your period and may include pain, changes in menstrual bleeding, digestive or urinary symptoms, fatigue and difficulty becoming pregnant.

The type and severity of symptoms can vary significantly from person to person.

Common Endometriosis Symptoms Checklist

If you’re wondering whether your symptoms may be signs of endometriosis, consider whether you experience any of the following:

• Severe or persistent menstrual cramps
• Pelvic or lower abdominal pain
• Lower back pain
• Pain during or after sex
• Pain with bowel movements
• Pain with urination, especially during your period
• Heavy or irregular menstrual bleeding
• Bleeding or spotting between periods
• Bloating, constipation or diarrhea
• Nausea
• Fatigue
• Difficulty becoming pregnant

Having one or more of these symptoms does not mean you have endometriosis. Many of these symptoms can have other causes, so a healthcare provider can help determine whether you need further evaluation.

Symptoms That Are Often Overlooked or Misattributed

Endometriosis can be difficult to identify because some symptoms overlap with other conditions.

Bloating, constipation or diarrhea, for example, may be mistaken for a digestive problem.

Pain with urination may seem like a urinary condition, while severe period pain may be dismissed as a normal part of menstruation.

Keeping track of your symptoms can help your healthcare provider understand what you’re experiencing. Consider noting:

• When your symptoms occur
• Whether they follow your menstrual cycle
• How severe they are
• Whether they interfere with work, school, exercise, sleep or other activities
• Any changes in your menstrual bleeding
• How long you have been experiencing them

When to See a Doctor

Talk with a healthcare provider if pelvic or period pain is becoming more severe, persists over time or interferes with work, school, sleep, exercise or other daily activities.

Evaluation may also be appropriate if your symptoms are affecting your quality of life or you are having difficulty becoming pregnant.

If you have been trying to conceive for 12 months and are under age 35, or for six months if you are 35 or older, a fertility evaluation is generally recommended. However, you do not necessarily need to wait that long if you have symptoms or a known or suspected condition that could affect fertility.

Pacific Reproductive Center offers fertility testing services to help evaluate and diagnose whether you may have endometriosis or other factors that may affect your ability to become pregnant.

Red-Flag Symptoms That Warrant Prompt Evaluation

Some symptoms require prompt medical attention and should not automatically be attributed to endometriosis.

Seek prompt medical evaluation for:

• Sudden or severe pelvic or abdominal pain
• Bleeding that is unusually heavy for you, particularly with weakness or dizziness
• Fainting
• Severe weakness
• Other symptoms that are sudden, severe or concerning

If symptoms are severe or appear suddenly, seek urgent medical care rather than waiting for a routine endometriosis evaluation.

Causes and Risk Factors of Endometriosis

The exact cause of endometriosis is unknown. Researchers believe genetic, hormonal and immune factors may play a role.

Having a close family member with endometriosis may increase your risk. Some menstrual and reproductive factors may also be associated with a higher risk of developing the condition.

Having a risk factor does not mean you will develop endometriosis. Likewise, not having a known risk factor does not rule it out.

If you’re experiencing symptoms, an appropriate medical evaluation is more useful than trying to determine whether a particular lifestyle choice caused them.

How Endometriosis Is Diagnosed

There is no single test that can diagnose every case of endometriosis. Your provider may consider your symptoms, medical history, physical examination and reproductive goals when determining which imaging or other evaluations may be appropriate.

Diagnostic Tests for Endometriosis

Depending on your symptoms and medical history, evaluation may include:

• A review of your symptoms, menstrual cycle and medical history
• A pelvic exam, when appropriate
• Ultrasound, including transvaginal ultrasound, to look for ovarian cysts and other findings
• Magnetic resonance imaging (MRI) in some cases to provide more detailed images
• Laparoscopy, a minimally invasive surgical procedure that allows a surgeon to look inside the pelvis and, when appropriate, treat endometriosis

The Role of Imaging and Laparoscopy in Diagnosis

Ultrasound and MRI can help identify certain forms of endometriosis and provide information that may guide treatment planning. Laparoscopy may be considered when additional evaluation or surgical treatment is appropriate.

The right approach depends on your symptoms, examination findings and reproductive goals.

If you’re concerned about fertility as well as your symptoms, you can explore Pacific Reproductive Center’s fertility testing services to learn more about the evaluation process.

Endometriosis and Pregnancy

Endometriosis can make becoming pregnant more difficult for some people. If you have symptoms of endometriosis and are having difficulty conceiving, an evaluation can help identify factors that may be affecting fertility.

How Endometriosis Can Affect Fertility

Endometriosis is associated with an increased risk of infertility. Inflammation, scar tissue and changes to the pelvic anatomy may affect the reproductive process.

Endometriosis may affect fertility through:

• Scar tissue and adhesions
• Inflammation
• Changes to pelvic anatomy
• Changes that may affect the ovaries or fallopian tubes

Having endometriosis does not mean you cannot become pregnant. If you’re having difficulty conceiving and have symptoms of endometriosis, a fertility evaluation can help identify possible factors affecting conception.

Endometriosis and Pregnancy Complications

If you become pregnant with endometriosis, your obstetric provider can discuss your individual pregnancy and any monitoring that may be appropriate.

Endometriosis does not mean you cannot have a healthy pregnancy. Your care team can consider your medical history and pregnancy needs when determining your care plan.

Treatment Options for Endometriosis

Treatment for endometriosis depends on your symptoms, the extent of the condition, your overall health and whether you are trying to become pregnant.

Treatment may include medication, surgery or a combination of approaches. Your reproductive goals are an important part of choosing a treatment plan.

Medical Treatments and Hormonal Therapy

Medications may help manage endometriosis-related pain and bleeding. Depending on your needs, treatment may include:

• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage pain
• Birth control pills to help manage menstrual bleeding and pain
• Progestin therapy to help control symptoms
• GnRH medications that affect estrogen levels and may reduce endometriosis-related symptoms

Hormonal treatments are generally used to manage symptoms and are not used to achieve pregnancy while you are taking them. Your provider can discuss which options may be appropriate based on your symptoms and reproductive goals.

Surgical Treatments for Endometriosis

Surgery may be considered when symptoms are severe, medication is not effective, or additional evaluation or treatment is needed.

Potential surgical approaches include:

• Laparoscopy to identify and, when appropriate, remove or treat endometriosis
• Laparotomy in certain cases when more extensive surgery is needed

Surgery is not necessary for everyone with endometriosis. When surgery is recommended, the approach depends on the location and extent of the condition, your symptoms and your reproductive goals.

Learn more about surgical treatment for endometriosis.

Supportive Approaches

Some people also use supportive approaches to help manage pain and improve quality of life. Depending on your needs, these may include:

• Acupuncture
• Regular physical activity
• Stress-management techniques
• Physical therapy
• Other supportive approaches recommended by your healthcare provider

These approaches may complement medical treatment but should not replace an evaluation or treatment plan from a qualified healthcare provider.

If you’re having difficulty becoming pregnant, your fertility specialist can also discuss treatment options, including the IVF treatment process, when appropriate.

Frequently Asked Questions

What are the earliest signs of endometriosis?

Early signs may include painful menstrual cramps, pelvic or lower back pain, pain during or after sex, pain with bowel movements or urination and heavy or irregular bleeding. Symptoms vary, and some people have no noticeable symptoms.

Can you have endometriosis with no symptoms?

Yes. Some people have endometriosis without noticeable symptoms. It may be discovered during an evaluation for infertility or during surgery for another reason.

How do I know if my pelvic pain is normal or a sign of endometriosis?

Pelvic pain that is severe, persistent or interferes with your daily activities should be evaluated. Period pain can have many causes, so a healthcare provider can help determine whether endometriosis or another condition may be responsible.

When should I see a fertility specialist about endometriosis symptoms?

Consider talking with a fertility specialist if you have symptoms of endometriosis and are having difficulty becoming pregnant. If you have been trying to conceive for 12 months and are under age 35, or for six months if you are 35 or older, a fertility evaluation is generally recommended. Earlier evaluation may be appropriate if you have a known or suspected condition that may affect fertility.

Is endometriosis diagnosed with a blood test?

No. There is no blood test that can diagnose endometriosis on its own. Your healthcare provider may use your symptoms, medical history, physical examination and imaging to evaluate for the condition. In some cases, laparoscopy may be recommended.

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Pacific Reproductive Center is dedicated to providing personalized treatment and comprehensive endometriosis testing for conditions impacting fertility.

If you’re facing fertility challenges, contact our team to explore your treatment options. We are ready to help alleviate your pain and discomfort and achieve a healthy pregnancy.

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