From your first period, you were told that pain is part of being a woman. So you missed school, curled up with a hot water bottle, and later took leave from work two days a month without telling anyone why. If that sounds familiar, it is worth knowing the endometriosis symptoms, because period pain that stops your life is not something you simply have to put up with.
This guide explains what endometriosis is, the signs to look out for, why diagnosis often takes years, which tests doctors use, how it affects fertility, and how to describe your pain so a doctor takes it seriously.
What is endometriosis?
Endometriosis is a long-term condition in which tissue similar to the lining of the womb grows outside the womb, often on the ovaries, fallopian tubes, the outside of the womb, the bowel or the bladder. This tissue responds to your monthly hormones, which causes inflammation, pain and sometimes scar tissue.
WHO estimates that endometriosis affects about 10% of women and girls of reproductive age, around 190 million people worldwide. It usually starts with the first periods and can carry on until menopause, though it has also been found in teenagers and after menopause.
- of women of reproductive age have endometriosis, around 190 million worldwideSource: WHO
- About 10%
- the average time to diagnosisSource: WHO
- 4 to 12 years
- of women with infertility may have endometriosisSource: WHO
- 25 to 50%
What are the most common endometriosis symptoms?
The most common endometriosis symptoms are severe period pain that stops your normal activities, pelvic pain at other times of the month, pain during or after sex, pain when passing urine or stools (especially during a period), heavy periods, extreme tiredness and difficulty getting pregnant. Some women also feel bloated or sick.
Ordinary period cramps
- How bad
- A dull ache you can work, study or cook through
- Timing
- The first day or two of your period
- What helps
- Heat, rest, gentle movement and usual pain relief
- Over the years
- Stays about the same or eases
- Other pain
- None
- Flow
- Normal for you
Signs that need a check
- How bad
- Pain that keeps you in bed, off school or work, or makes you vomit or faint
- Timing
- Pain that starts days before, lasts beyond your period, or happens through the month
- What helps
- Little or no relief from the usual measures
- Over the years
- Gets worse year after year
- Other pain
- Pain during or after sex, or when you pee or poo
- Flow
- Heavy enough to change a pad every 1 to 2 hours
| Ordinary period cramps | Signs that need a check | |
|---|---|---|
| How bad | A dull ache you can work, study or cook through | Pain that keeps you in bed, off school or work, or makes you vomit or faint |
| Timing | The first day or two of your period | Pain that starts days before, lasts beyond your period, or happens through the month |
| What helps | Heat, rest, gentle movement and usual pain relief | Little or no relief from the usual measures |
| Over the years | Stays about the same or eases | Gets worse year after year |
| Other pain | None | Pain during or after sex, or when you pee or poo |
| Flow | Normal for you | Heavy enough to change a pad every 1 to 2 hours |
The amount of endometriosis does not always match the amount of pain. Some women with small patches have severe pain, while others with more extensive disease have few symptoms, which is one reason it is missed. For a broader look at cramps and what helps, see our guide to period pain relief.
Why does endometriosis take so long to diagnose?
WHO says the average time from first symptoms to diagnosis is between 4 and 12 years. The reasons are familiar to many Indian women: severe period pain is treated as normal at home and sometimes in clinics, women hesitate to talk about periods or painful sex, and the symptoms overlap with other conditions.
- "All girls have pain": families and schools often teach girls to bear pain quietly, so it is years before anyone sees a doctor.
- Overlap with other conditions: the NHS notes endometriosis symptoms can look like adenomyosis, fibroids, pelvic inflammatory disease or irritable bowel syndrome.
- Tests can look normal: a standard scan does not always show small patches, so a normal report does not rule it out.
- Confirmation can need surgery: a laparoscopy is not easily accessible to everyone.
How is endometriosis diagnosed?
Diagnosis usually starts with your history and an examination, followed by a pelvic ultrasound and sometimes an MRI. ACOG says a transvaginal ultrasound is the best first test for finding endometriosis, and that the only way to confirm it for certain is a laparoscopy, a keyhole operation in which a surgeon looks inside the pelvis with a camera.
Step 1: Your symptom story
The doctor asks about your pain, periods, bowel and bladder symptoms, sex and fertility. A diary of two or three cycles makes this far more useful.Step 2: Examination
This may include an internal examination. You can ask for a female doctor or a chaperone, and you can ask to stop at any time.Step 3: Scans
A pelvic ultrasound, often transvaginal, can show endometriosis on the ovaries and deeper disease. For teenagers or women who have not had sex, a different type of scan can be used. MRI helps in some cases.Step 4: Laparoscopy, if needed
This can confirm endometriosis, and patches can sometimes be removed during the same operation.
In the UK, the NICE guideline on endometriosis (updated in 2024) advises doctors to consider endometriosis in anyone with ongoing pelvic pain, period pain that affects daily life, deep pain during or after sex, or period-related pain with bowel or bladder symptoms, and says a normal scan or examination does not exclude it.
How to describe your pain so a doctor takes it seriously
The most useful thing you can bring is a clear record of how the pain affects your life: days missed, how bad it is out of 10, what you have tried, and the other symptoms that come with it. Specific details are harder to dismiss than "my periods are painful".
Bring this to your appointment
- Period dates and pain scores for two or three cycles, from a notebook or our free period tracker
- Days you missed school, college or work because of pain
- Whether the pain starts before your period, lasts after it, or happens mid-cycle
- Pain during or after sex, or when you pee or poo
- How heavy your flow is: how often you change a pad on the worst day
- What you have tried, including heat and any pain relief a pharmacist or doctor suggested, and whether it helped
- Whether your mother or sister has endometriosis or very painful periods
If you feel dismissed, it is reasonable to ask "Could this be endometriosis, and how would we find out?", or to see a gynaecologist for a second opinion.
Can you get pregnant with endometriosis?
Yes, many women with endometriosis get pregnant, some naturally and some with treatment. Endometriosis can make it harder, and WHO notes that as many as 25 to 50% of women with infertility have it. If you have endometriosis or its symptoms and are trying to conceive, see a doctor sooner rather than later.
Surgery to remove patches, and fertility treatment, can both help depending on your situation. A gynaecologist or fertility specialist can explain the options for you.
What are the treatment options for endometriosis?
There is no cure yet, but endometriosis can be managed. Treatment usually starts with pain relief and hormonal treatments chosen by your doctor, and surgery to remove patches is considered if these do not help or if fertility is affected. Physiotherapy and psychological support can help with long-term pain.
- Pain relief: a doctor or pharmacist can advise what is suitable and how much for you.
- Hormonal treatment: lowers the hormones that drive the patches; not used if you are trying to get pregnant.
- Surgery: removes patches or cysts, usually by laparoscopy; symptoms can return.
- Supportive care: heat, gentle movement, pelvic physiotherapy, and support for anxiety or low mood.
Endometriosis often brings heavy periods too. On those days, a longer pad, or period panties at night, can make life easier while you wait for treatment to work. Our guide to heavy periods explains when the flow is too much.
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When to see a doctor about endometriosis symptoms
See a doctor if period pain stops you from your day, gets worse over time, or comes with pain during sex or when you go to the toilet. Get urgent help for sudden severe pelvic pain, pain with fever, or pain with fainting, especially if you could be pregnant.
- Very heavy bleeding: soaking through an XL+ pad (or a period panty) in under 2 hours for several hours in a row, or passing clots bigger than a ₹5 coin.
- Periods that last longer than 7 days, or that come less than 21 or more than 35 days apart once your cycle has settled.
- Severe period pain that stops you from your day, or that doesn't ease with the usual measures.
- Bleeding between periods, after sex, or ANY bleeding after menopause.
- Periods that stop for 3 months or more when you are not pregnant.
- Signs of infection: unusual discharge, a strong smell, itching, or burning when you pee.
- After childbirth: a fever, foul-smelling discharge, or very heavy bleeding that does not ease after the first week.
- No period by age 15, or no signs of puberty by age 13.
This is guidance, not a diagnosis. If something feels off, trust yourself and see a doctor or gynaecologist. Most causes are common and treatable.
Frequently asked questions
What are the first signs of endometriosis?
Often the first sign is period pain that is much worse than other people describe: pain that keeps you off school or work, does not ease with heat or usual pain relief, or gets worse each year. Pain during sex, pain when you pee or poo around your period, heavy periods and constant tiredness are other early signs worth mentioning to a doctor.
How do I know if my period pain is endometriosis?
You cannot tell at home, and only a doctor can diagnose it. But period pain that stops your normal life, starts before your period or lasts after it, comes with pain during sex or on the toilet, or keeps getting worse, deserves a proper check. Keep a pain diary for two or three cycles and take it to a gynaecologist.
Can an ultrasound detect endometriosis?
Often, yes. ACOG describes a transvaginal ultrasound as the best first test for finding endometriosis, and it can show cysts on the ovaries and deeper disease. Small patches may not show up, so a normal scan does not rule endometriosis out. A laparoscopy, a keyhole operation, is the only way to confirm it for certain.
Is endometriosis curable?
There is no cure yet, but endometriosis can be managed well. Pain relief, hormonal treatment and surgery to remove patches can all reduce symptoms, and physiotherapy and psychological support help many women live with long-term pain. A doctor will choose the plan with you, based on your symptoms and whether you want to get pregnant.
Can endometriosis cause infertility?
It can make getting pregnant harder, and WHO says as many as 25 to 50% of women with infertility have endometriosis. But many women with endometriosis conceive naturally or with treatment. If you have symptoms of endometriosis and are trying for a baby, talk to a doctor early instead of waiting a full year.
What is the difference between endometriosis and adenomyosis?
In endometriosis, tissue like the womb lining grows outside the womb. In adenomyosis, it grows into the muscle wall of the womb itself. Both can cause painful, heavy periods, and some women have both. Adenomyosis is more often found in women in their 40s or after childbirth. A gynaecologist can tell them apart with scans and examination.
Sources
Team Potent Hygiene
Written by the Potent Hygiene team in Jaipur, the people behind Ovy period care and Looway travel hygiene. Every article is checked against the public health sources listed with it.
- #Endometriosis
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- #Women'shealth
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