Endometriosis is linked with tissue like the lining inside the uterus growing elsewhere in the body. It may cause pelvic pain or painful periods. Other signs may include pain during or after sex, bowel or bladder changes, and fertility problems. Symptoms vary widely.

Some people have severe pain, while others have few clear symptoms. A symptom list cannot confirm endometriosis or show how much tissue is present.

Pain linked with periods

Painful periods are a common sign. The pain may begin before bleeding and continue during or after it. It may affect the lower abdomen, pelvis, back, or legs.

Pain deserves assessment when it:

• Stops you from normal tasks.
• Causes missed work or school.
• Does not improve enough with usual self-care.
• Becomes stronger over time.
• Happens outside periods as well.

WHO lists severe period pain and long-term pelvic pain as common symptoms. The painful-period guide can help you describe pain clearly.

Pain during or after sex

Deep pain during or after vaginal sex can occur with endometriosis. Pain may also come with pelvic exams, inserting a tampon, or other penetration.

Pain during sex has several possible causes. You deserve respectful assessment, and you can stop any exam at any time. Do not feel pressure to continue sex that hurts.

Record where the pain is felt, when it starts, how long it lasts, and whether certain positions change it. Share only details you are comfortable discussing.

Bowel and bladder symptoms

Some people have pain when passing stool or urine. It may be worse around a period. Bloating, constipation, diarrhoea, or an urgent need to pass urine may also occur. Some people see blood in urine or stool.

These symptoms can have many causes. Blood in urine or stool should be discussed with a clinician and not assumed to be due to endometriosis.

The ACOG endometriosis guide explains that the location and timing of symptoms can help guide assessment.

Bleeding and fertility changes

Heavy periods or bleeding between periods can occur, though they are not specific to endometriosis. Use the heavy-period guide if flow is affecting daily life.

Endometriosis may be found during a fertility review. It can affect fertility in several ways. It does not mean pregnancy is impossible. Want to know more? Read endometriosis and fertility.

Other possible effects

Ongoing pain can lead to fatigue, poor sleep, low mood, anxiety, or difficulty with work and relationships. These effects are real and worth discussing even when earlier tests did not explain the pain.

Pain strength does not always match the amount or location of endometriosis. Mild symptoms do not prove there is little disease, and severe pain does not reveal an exact stage.

What should you track?

Choose a simple daily record for a few weeks or cycles. Note:

• Period and spotting dates.
• Pain location, strength, and duration.
• Pain during sex, urination, or bowel movements.
• Bowel and bladder changes.
• Bleeding amount and clots.
• Medicines used and whether they helped.
• Missed work, school, exercise, sex, or sleep.

Write clear facts. “Pelvic pain was 7 out of 10 and woke me twice” gives more context than “bad pain.” A missed day does not make the record useless.

How are possible signs assessed?

A clinician may ask about timing and family history. They may ask about past surgery, medicines, sex, bowel or bladder changes, and fertility goals. An exam or scan may be suggested. Your consent is needed.

Normal imaging does not always rule out endometriosis. The next step should reflect your symptoms and goals. Daily impact matters too. Read how endometriosis is assessed for more detail. Or start with the main endometriosis guide.

When to see a doctor

Book an appointment for period or pelvic pain that affects daily life. Also seek care for pain during sex or repeated bowel or bladder pain around periods. Heavy bleeding and fertility concerns deserve care too. Ask for another review if symptoms continue.

Mention any new pain. Tell them if pregnancy is possible. Also report fever, unusual discharge, or bleeding outside your normal pattern.

Seek care now: Get urgent medical help for sudden severe pelvic or abdominal pain, fainting, severe dizziness, fever with worsening pelvic pain, or heavy bleeding with weakness or trouble breathing. Contact local emergency services or go to the nearest emergency department.

Frequently asked questions

Can endometriosis cause pain between periods?

Yes. Some people have pain throughout the month or with sex, bowel movements, or urination.

Does severe pain show the stage of endometriosis?

No. Pain strength does not reliably show how much tissue is present.

Can normal imaging rule it out?

Not always. A clinician should interpret imaging with symptoms and the wider history.

Should pain that disrupts daily life be assessed?

Yes. Pain that limits normal activities deserves medical attention.