How to Recognize the Symptoms of Endometriosis

Content medically reviewed by Dana Skonseng, MD

If you have extremely painful periods, you might brush it off, thinking this happens to many women during their menstrual cycle. However, it could be a sign of a condition called endometriosis, which may affect more than 11% of women between the ages of 15 and 44. By recognizing the symptoms of endometriosis, you can know when it’s time to see your health care provider.

“Endometriosis is most common for women in their 30s and 40s, and it can affect your quality of life,” said Dr. Dana Skonseng, OB/GYN with Essentia Health. “The good news is that treatments are available that can help.” 

What Is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus (called endometrium) grows outside of the uterus and in other areas of the body. Patches of endometrial tissue can form on the – 

• Fallopian tubes
• Outer surface of the uterus
• Ovaries
• Tissues that keep the uterus in place

Less common areas for endometriosis to appear include the – 

• Bladder
• Bowel
• Cervix
• Rectum
• Vagina
• Vulva

Experts aren’t sure exactly what causes endometriosis. But, researchers believe contributing factors may include issues with menstrual flow, problems with hormones or the immune system, and/or genetics may play roles in the condition.

Some people are also more likely to develop endometriosis than others. You could be at higher risk if you –

• Have a mother, daughter, or sister with the condition
• Started your period before age 11
• Have monthly menstrual cycles of fewer than 27 days
• Have heavy periods that last longer than seven days

You may be at lower risk if you have been previously pregnant, you had your first period later in adolescence, or you have breastfed.

Symptoms of Endometriosis

Endometriosis growths can swell and bleed similar to how the uterine lining sheds during your period. This can lead to a variety of problems, such as cysts in the ovaries and painful scar tissue. That’s why the most common symptom of endometriosis is pain. The condition can cause different types of discomfort –

• Extremely painful menstrual cramps that can get worse over time
• Chronic lower back or pelvic pain
• Painful sex
• Pain in the lower abdomen or intestines
• Painful bowel movements or urination, most often during your period

Other symptoms include –

• Very heavy periods and additional bleeding between periods
• Digestive problems such as constipation, diarrhea, nausea, or bloating, especially during your period
• Fatigue
• Difficulty getting pregnant 

Getting a Diagnosis

If you experience symptoms of endometriosis, make an appointment with your women’s health provider. They will talk to you about your symptoms and will likely do a pelvic exam and imaging tests, such as an ultrasound to look for ovarian cysts that could be caused by endometriosis. Your provider, ultrasonographer or diagnostic ultrasound technician will move a scanner across your abdomen or insert a wand-shaped instrument into your vagina to perform the ultrasound, which uses sound waves to take internal pictures of your pelvic organs.

If your provider sees no evidence of ovarian cysts, the next step may be to prescribe hormonal medicine, such as –

• Birth control pills, which can ease pain from menstrual periods
• Gonadotropin-releasing hormone (GnRH) agonists, which prevent the menstrual cycle and lower the estrogen hormone in your body

If hormone therapy lessens your pain, your provider will probably conclude that you have endometriosis. The only way to know for sure is through laparoscopic surgery that allows your provider to see inside your pelvic area. 

Treatments for Endometriosis

While no cure exists for endometriosis, treatment can help control symptoms and related problems. The treatment your provider recommends will depend on the severity of your symptoms and whether you are trying to get pregnant. Options include –

• Hormonal birth control: If you do not want to become pregnant, this is usually the first step. Options include extended-cycle birth control, in which you only have a few periods per year, or continuous-cycle birth control, in which your periods stop. These medicines can lessen pain and control bleeding.
• Hormonal intrauterine device (IUD): This is a small device inserted directly into your uterus, where it releases hormones to prevent pregnancy. 
• GnRH agonist: Your provider might prescribe this medicine for endometriosis if you are trying to become pregnant. While you take the medication, your body will stop producing the hormones that cause endometriosis to grow, the same hormones responsible for menstruation. You will go into temporary menopause, but after you stop taking the medicine, you could have an improved chance of getting pregnant.

For mild symptoms, you can also try over-the-counter pain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.

For severe symptoms that do not go away with hormone therapy or if you are unable to get pregnant due to endometriosis, surgery is another option. In some cases, the surgery is laparoscopic, but sometimes it is major surgery. The surgeon removes the patches of endometriosis and sometimes cuts nerves in the pelvis. Unless you are trying to get pregnant, you might also start hormone therapy again after surgery to control the regrowth of endometriosis.

Living With Endometriosis

“Having endometriosis can affect your daily life as well as cause distress for women who want to have a baby,” Dr. Skonseng said. “But it’s important to note that it’s not impossible for people with endometriosis to become pregnant. Remember that you are not alone. Talk to your provider about the best treatment options for you.”

In addition, some women find relief from pain and other symptoms using complementary and alternative medicine (CAM). This includes treatments such as – 

• Acupuncture, where a provider inserts fine needles into the skin to help relieve pain
• Chiropractic care for back pain
• Herbs, such as licorice root or cinnamon twig, which can help with pain relief 
• Supplements, including vitamin B1, omega-3 fatty acids, or magnesium.

Be sure to talk to your provider before making any changes to your treatment plan.