Endometriosis Symptoms: Common Signs & Types

Endometriosis symptoms commonly include severe pelvic pain, heavy menstrual bleeding, and difficulty getting pregnant. These symptoms occur when tissue similar to the uterine lining grows outside the uterus, affecting areas like the ovaries, bladder, or intestines.

Endometriosis symptoms can vary in intensity and may change from month to month, which can make diagnosis challenging. In addition to pain and heavy periods, symptoms may include pain during sex, bloating, bowel or urinary discomfort, and irregular bleeding.

Endometriosis symptoms can vary based on where the tissue is growing, and may involve the intestines, ovaries, or bladder. Diagnosis is usually confirmed with imaging tests such as a pelvic ultrasound. Although there is no cure for endometriosis, treatment can help control symptoms and improve quality of life.

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Main symptoms

The main symptoms of endometriosis are:

• Painful periods
• Pelvic pain or pain in the lower belly
• Cramps before your period
• Severe menstrual cramps that can interfere with daily activities
• Pain or discomfort during or after sex
• Heavy menstrual bleeding
• Bleeding outside your period
• Abdominal bloating
• Pain when having a bowel movement or urinating, before or during your period

Another possible symptom is difficulty getting pregnant. According to the World Health Organization, endometriosis can also cause chronic pelvic pain, bloating, nausea, fatigue, depression, anxiety, and infertility. Other symptoms may include lower back pain, diarrhea, or constipation.

Symptoms of endometriosis by type

The symptoms of endometriosis can vary depending on where the tissue grows in the body, and these locations are classified as different types of endometriosis. Based on ACOG guidance, symptom patterns and a physical exam can help determine whether further testing for endometriosis is needed.

1. Bowel endometriosis

The main symptoms of bowel endometriosis are:

• Constipation with very severe cramps
• Blood in the stool
• Pain that gets worse when having a bowel movement
• Feeling very bloated
• Persistent rectal pain
• Excess gas
• Rectal bleeding during menstruation
• Pelvic pain or lower back pain
• Diarrhea or constipation

Symptoms of bowel endometriosis occur when tissue similar to the uterine lining grows inside the intestines.

At first, your doctor may suspect a bowel condition such as irritable bowel syndrome, Crohn’s disease, or colitis. After a more detailed evaluation by a gastroenterologist, however, endometriosis may be considered instead, and you may be referred to a gynecologist for further assessment.

2. Endometriosis in the ovaries

The main symptoms of ovarian endometriosis, also known as an endometrioma, are:

• Pelvic pain between periods
• Irregular periods
• Severe cramps during menstruation
• Pain during sex (dyspareunia)
• Heavy menstrual bleeding
• Pain when having a bowel movement, if the endometrioma is attached to the bowel
• Feeling of pressure or heaviness in the abdomen
• Abdominal bloating
• Difficulty getting pregnant, in some cases

In many cases, an endometrioma, also known as a chocolate cyst, does not cause any symptoms and is found during a routine ultrasound.

Ovarian endometriosis is characterized by the growth of endometrial tissue around the ovaries. In these cases, symptoms are usually more general.

3. Endometriosis in the bladder

The main symptoms of bladder endometriosis are:

• Pelvic pain that gets worse when urinating;
• Pus or blood in the urine
• Severe pain during sex
• Frequent urge to urinate
• Feeling of a full bladder
• Bladder pain when the bladder is full
• Urgent need to urinate
• Lower back pain or pain near the kidneys
• Burning sensation when urinating (dysuria)

Some people may have only one or two of these specific symptoms, rather than all of them. As a result, bladder endometriosis can take longer to diagnose correctly, and it is often initially mistaken for a urinary tract infection (UTI). However, symptoms do not improve with antibiotics.

Confirming a diagnosis

A gynecologist may suspect endometriosis based on the symptoms described by the patient. However, a pelvic ultrasound is needed to confirm the diagnosis and rule out other possible causes, such as ovarian cysts.

The doctor may also order a tissue biopsy. This is done through a minor surgical procedure in which a small tube with a camera at the tip is inserted through a small cut in the skin, allowing the doctor to view the pelvic area from the inside and collect tissue samples for laboratory analysis.