Health Conditions A-Z Reproductive Conditions Endometriosis Signs and Symptoms of Endometriosis It's normal to experience some cramps during your period. But, severe pain and changes to your menstrual cycle, among other symptoms, can be signs of endometriosis. By Emily Santora Emily Santora As a student at Arizona State University, Emily was a writer and editor for the Embryo Project Encyclopedia, where she researched, wrote, and published over 18 peer-reviewed encyclopedia articles. As a writer, Emily studied and wrote articles about the menstrual cycle. health's editorial guidelines Published on February 8, 2023 Medically reviewed by Cordelia Nwankwo, MD Medically reviewed by Cordelia Nwankwo, MD Cordelia Nwankwo, MD, is a board-certified gynecologist who has been in private practice for 8 years. learn more Share Tweet Pin Email In This Article View All In This Article Pelvic Pain and Cramps Infertility Changes in Your Menstrual Cycle Gastrointestinal (GI) Symptoms Fatigue Drazen Zigic / Getty Images Endometriosis is a condition that occurs when cells that are similar to the tissue that lines the inside of the uterus—known as the endometrium—grow outside of the uterus. Generally, the cells grow on or near your reproductive organs, but can appear anywhere, including your bladder and colon. As a result, you may experience painful periods and cramping throughout your menstrual cycle, among other symptoms. Endometriosis affects more than 10% of people who were born with a uterus. Unfortunately, the condition can be hard to diagnose because symptoms vary and can mimic the symptoms of other conditions. In fact, many people wait nearly 10 years before receiving an accurate diagnosis. Knowing the signs of endometriosis may encourage you to reach out to your healthcare provider if you notice symptoms and begin treatment sooner. 4 Stages of Endometriosis and What They Can Mean Pelvic Pain and Cramps Cramps during your period are a common symptom among those who menstruate. However, severe pain that limits your ability to function or forces you to skip school or work may be a sign of endometriosis. According to one study published in Frontiers in Cellular Neuroscience, researchers found that more than 60% of women with endometriosis said they had severe pelvic pain. Compared to people without the condition, women with endometriosis were 13 times more likely to report pelvic pain. Some people describe their endometriosis pain as a stinging or burning sensation, while others define it as sharp or throbbing. You might also experience different types of pain, including: Pain that travels to other parts of the body, such as the stomach, back, or legsPain during or after sexTrouble urinating or painful bowel movements It is also common for people with endometriosis to experience nausea and vomiting alongside their pain. Period Pain: Why It Happens and How To Manage It, According to OB-GYNs Infertility About 30% to 50% of people with endometriosis experience infertility. Infertility happens when you cannot become pregnant after one year of trying to conceive. While research on the link between endometriosis and infertility remains ongoing, some theories suggest that endometriosis can make it difficult for you to get pregnant due to: Structural damage in the tissue between the ovaries and pelvic wall, which can prevent an egg from releasing during ovulation and becoming fertilizedScarring on the fallopian tubesInflammation in the pelvis that can prevent the implantation of an embryoChanges in the quality and quantity of your eggsHormonal imbalance Changes in Your Menstrual Cycle Menstrual bleeding starts on the first day of the menstrual cycle. While everyone who menstruates experiences their period a little differently, a typical period lasts three to eight days and occurs every 21-35 days. However, people with endometriosis may experience changes in their menstrual cycle, including: Short menstrual cycles: Some people may notice more frequent periods than the average menstrual cycle length. Lengthy periods: In some cases, people with endometriosis can have periods that last longer than seven days. Heavy menstrual bleeding: Endometriosis can sometimes lead to heavier periods where you may notice more blood flow. Spotting between periods: You might also notice some bleeding between your periods, which is a symptom called spotting. Gastrointestinal (GI) Symptoms One study examined 109 people with endometriosis and 65 people without the condition. The researchers found that people with endometriosis had significantly more gastrointestinal (GI) symptoms than those without. GI Tract The gastrointestinal (GI) tract is a passageway in your digestive system that moves through several organs including the mouth, esophagus, stomach, intestines, and anus. While stomach pain is the most common GI symptom, other symptoms include: Nausea and vomitingDiarrheaConstipationPainful urinationBloating Additionally, endometriosis sometimes co-occurs with irritable bowel syndrome (IBS). IBS is a condition that causes pain and inflammation in the GI tract, specifically in the stomach and intestines. People with IBS typically have diarrhea, constipation, or cycles of both. Those with endometriosis are three times more likely to also develop IBS. Researchers are still studying the link between both conditions and why endometriosis increases your risk of IBS. However, it's important to note that endometriosis can often be misdiagnosed or underdiagnosed. While it's possible to have both conditions, healthcare providers can give people with endometriosis a misdiagnosis of IBS. Fatigue When you have endometriosis, your body produces cytokines—or, chemicals that cause inflammation. In response, your body’s immune system works hard to reduce inflammation, which can leave you feeling very tired. You might also feel fatigued because of the painful symptoms that endometriosis causes and the exhaustion of having to live with the condition. Fatigue can greatly affect your daily life, including your mood, relationships, school, and work—so, it's important to seek medical care if your symptoms begin to disrupt your daily life and well-being. Keep in mind: fatigue is not just feeling sleepy or tired. It's a state of constant exhaustion or lack of energy that can greatly diminish your overall quality of life. What to Do If You Think You Have Endometriosis When to See a Healthcare Provider Pain during your period is normal. However, if your cramps keep you from going to school or work or don’t go away after taking pain relievers, it's a good idea to visit your healthcare provider. Your provider can help you find out if your symptoms are due to endometriosis or another condition. Currently, the gold standard for diagnosing endometriosis is through laparoscopic surgery—a procedure performed under anesthesia that lets your provider examine your abdominal and pelvic organs. Therefore, the only way to know whether you have the condition is to see a healthcare provider. You may also want to see your healthcare provider if you're having trouble conceiving. While a variety of conditions can cause infertility, it's helpful to know if endometriosis is making it difficult for you to get pregnant. Your healthcare provider can also refer you to a fertility specialist and recommend certain treatments for infertility, such as medications, in vitro fertilization (IVF), and intrauterine insemination (IUI). A Quick Review Endometriosis occurs when the cells that are similar to the tissue that lines the inside of the uterus (called the endometrium) grow outside of the uterus. Most commonly, people with endometriosis have pelvic pain, cramping, and changes to their menstrual cycle. You might also experience stomach-related symptoms (like diarrhea), nausea or vomiting, fatigue, and infertility. If your periods are so painful that they interfere with your daily activities, a healthcare provider can help you find out whether you have endometriosis. Reaching out to a provider can get you an accurate diagnosis and help you start treatment sooner. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Maddern J, Grundy L, Castro J, et al. Pain in endometriosis. Front Cell Neurosci. 2020;14:590823. doi:10.3389/fncel.2020.590823 Mechsner S. Endometriosis, an Ongoing Pain-Step-by-Step Treatment. J Clin Med. 2022;11(2):467. doi:10.3390/jcm11020467 Institute for Quality and Efficiency in Health Care. The symptoms of endometriosis. In: InformedHealth.org. Institute for Quality and Efficiency in Health Care; 2017. 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