WHAT ARE THE MOST COMMON SIGNS
AND SYMPTOMS OF ENDOMETRIOSIS?

It involves a lot more than just bad cramps

Symptoms of endometriosis include: painful bowel movements, painful urination, bleeding or spotting between periods, heavy menstrual bleeding, bloating, fatigue, feeling sick or faint, or vomiting during your period, pain in the lower back, abdomen, or groin, difficulty participating in day-to-day activities because of excessive pain, exhaustion, or weakness

Remember the three P's:

Endometriosis is more than just bad cramps. The most common symptoms are:


1 Painful periods:

Doctors call this dysmenorrhea (DIS-men-uh-REE-uh). Period pain, or menstruation pain, usually begins right before a woman’s period starts and then continues throughout her period.

2 Pelvic pain in between periods:

Doctors call this non-menstrual pelvic pain. This pain can be intermittent (on and off again), or it can be constant throughout the month. It can often be described as dull, throbbing, or even sharp.

3 Pain with sex:

Doctors call this dyspareunia (DIS-puh-ROO-nee-uh). The pain can occur as soon as sex begins, during sex, or even after it ends. And it can sometimes last for up to several hours later.


Other possible symptoms

Women with endometriosis can experience a variety of symptoms, where some can experience none at all. Symptoms can vary, but may reflect the area where endometriosis is located. Some other possible endometriosis symptoms include:

  • Painful bowel movements
  • Painful urination
  • Bleeding or spotting between periods
  • Heavy menstrual bleeding
  • Bloating
  • Fatigue
  • Feeling sick or faint, or vomiting during your period
  • Pain in the lower back, abdomen, or groin
  • Difficulty participating in day-to-day activities because of excessive pain, exhaustion, or weakness


Endometriosis Symptom Quiz

Take the short quiz below to find out if you have symptoms that may be associated with endometriosis. This quiz is not meant to diagnose women with endometriosis. Talk to your doctor about your results.

1. Do you often experience pelvic or lower back pain before or during your period? Only answer “Yes” if this pain limits your day-to-day activities or requires medication.

2. Do you often experience pelvic or lower back pain in between your periods? Only answer “Yes” if this pain limits your day-to-day activities or requires medication.

3. Do you often experience pain with sex?

4. Do you sometimes avoid sex to avoid pain?

5. Do you often have painful bowel movements before or during your period?

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Endometriosis Symptom Quiz Results

If you answered “Yes” to 1 or more of these questions, you could have endometriosis. Even if you answered “No” to all these questions, it is still important to talk to your doctor or healthcare provider about all your symptoms and your medical concerns.




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Bring your results to your next doctor appointment to help talk about your symptoms. These aren't the only symptoms associated with endometriosis. To learn more about symptoms, click here. This can help your gynecologist identify whether or not you have endometriosis.



Not sure how to start the conversation with your gynecologist?

This guide can help explain your pain symptoms in a way your doctor can understand.





There can be overlapping symptoms or associated conditions with endometriosis

If you have any of these other conditions, speak with your doctor, because the symptoms of these other conditions could also be signs of endometriosis.


Uterine fibroids (UF):

  • Uterine fibroids (UF) are generally noncancerous growths located in the uterus. Uterine fibroids can vary in size and number
  • Many symptoms of UF are similar to symptoms of endometriosis, such as heavy bleeding or painful periods, and pain with sex
  • Some women who have endometriosis can also have UF. In one study, 86% of women were diagnosed with both UF and endometriosis.* If you know you have UF, you may also have endometriosis

*Based on a retrospective study in a tertiary university medical center of 131 patients with diagnosed uterine fibroids between September 2002 and January 2006.


Painful bladder syndrome (Interstitial cystitis):

  • Painful bladder syndrome is a chronic inflammatory condition of the bladder. It is a disorder that can get worse if left untreated.
  • The symptoms of painful bladder syndrome include:
    • An extreme need to urinate and urinating more often
    • Pelvic pain
    • Pain with sex without presence of infection
  • Painful bladder syndrome is a condition that can cause symptoms similar to endometriosis

Adenomyosis:

  • Adenomyosis occurs when tissue similar to the lining of the uterus (endometrium) grows into the muscular wall of the uterus, where it doesn’t belong   
  • It can cause the uterus to double or triple in size   
  • Some symptoms of adenomyosis are similar to endometriosis—such as painful, heavy periods and pelvic pain in between periods
  • Risk factors include a past uterine surgery (such as a C-section or fibroid removed), childbirth, or being middle aged  

Polycystic ovary syndrome (PCOS):

  • Polycystic ovary syndrome (PCOS) is a hormonal imbalance. Women with PCOS often have higher levels of certain male hormones
  • Some symptoms of PCOS are similar to symptoms of endometriosis, such as pelvic pain and heavy periods

Pelvic inflammatory disease (PID):

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs in the pelvic area. PID is a condition that can cause chronic pelvic pain and other symptoms, similar to endometriosis.


Irritable bowel syndrome (IBS):

Irritable bowel syndrome (IBS) is a common condition that affects the large intestine. Some symptoms of IBS can be similar to endometriosis.


Patients who have trouble getting pregnant (infertility) may also have endometriosis

  • Women who have trouble getting pregnant may also have endometriosis. In fact, studies suggested that about 25% to 50% of infertile women also have endometriosis
  • There are theories as to why women who experience infertility may also have endometriosis, but nothing has been proven for sure. It’s possible that the reasons could vary from one woman to the next


References: 1. American College of Obstetricians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223-236. 2. Giudice LC. Clinical practice: endometriosis. N Engl J Med. 2010;362(25):2389-2398. 3. Fischer JR. APGO Educational Series on Women’s Health Issues. Diagnosis & management of endometriosis: pathophysiology to practice. Association of Professors of Gynecology and Obstetrics; 2012. 4. American College of Obstetricians and Gynecologists. Frequently asked questions. FAQ013. Gynecologic problems. https://www.acog.org/~/media/For%20Patients/faq013.pdf?dmc=1. Updated October 2012. Accessed January 8, 2020. 5. D’Hooghe TM. Endometriosis. In: Berek JS, ed. Berek and Novak’s Gynecology. 15th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:505-556. 6. Fourquet J, Sinaii N, Stratton P, et al. Characteristics of women with endometrosis from the USA and Puerto Rico. J Endometr Pelvic Pain Disord. 2015;7(4):129-135. 7. US Department of Health and Human Services, Office on Women’s Health. Uterine fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids. Updated April 1, 2019. Accessed January 16, 2020. 8. Huang JQ, Lathi RB, Lemyre M, Rodriguez HE, Nezhat CH, Nezhat C. Coexistence of endometriosis in women with symptomatic leiomyomas. Fertil Steril. 2010;94(2):720-723. 9. Kilpatrick CC. Merck Manuals. Professional Version. Gynecology and obstetrics. Uterine adenomyosis. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/uterine-adenomyosis.Updated May 2019. Accessed January 8, 2020. 10. Mayo Foundation for Medical Education and Research. Patient care & health information. Diseases & conditions. Adenomyosis. https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138. Accessed January 8, 2020. 11. Mayo Foundation for Medical Education and Research. Patient care & health information. Diseases & conditions. Polycystic ovary syndrome (PCOS). https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Accessed January 8, 2020. 12. National Institute of Child Health and Human Development. National Institutes of Health. What are the symptoms of PCOS? https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms. Accessed February 19, 2020. 13. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion [published correction appears in Fertil Steril. 2015;104(2):498]. Fertil Steril. 2014;101(4):927-935. 14. Mayo Foundation for Medical Education and Research. Patient Care & Health Information. Diseases & Conditions. Irritable Bowel Syndrome. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016. Accessed January 16, 2020. 15. American Society for Reproductive Medicine. ASRM Patient Information Series. Endometriosis—a guide for patients; revised 2012. 16. Wood R. Infertility. World Endometriosis Research Foundation. http://endometriosis.org/endometriosis/infertility. Accessed January 9, 2020.