The symptoms of endometriosis

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Endometriosis causes severe pain and cramps in some women, while others only have a little discomfort or notice nothing at all. Women usually have endometriosis symptoms during their menstrual period, but may also experience them at other times. The severity of symptoms doesn't always depend on how much endometrial tissue a woman has in her body.

Endometriosis is a condition where the kind of tissue that normally lines the womb grows in other parts of a woman’s body too. These “growths” are known as endometrial implants. They do not always cause pain. Endometriosis can lead to various symptoms, depending on the extent of the disease. The most common symptoms are:

  • Very painful menstrual periods (dysmenorrhea): When a woman has her period (menstruation), the muscles in the wall of her womb repeatedly tighten and squeeze in order to shed the lining of the womb. This can cause period pain. Women who have endometriosis may have particularly severe pain and cramping during their period. Many girls and women think this is normal because things have always been that way for them. It never crosses their mind that their severe period pain might be caused by a medical condition.
  • Pain during sex (dyspareunia): This pain is usually described as burning or cramping pain. Sometimes women only feel it after they have finished having sex.
  • Abdominal (lower belly) pain: Various degrees of pain may be felt in different parts of the abdomen, sometimes radiating to the back or legs. The pain doesn't necessarily only occur when women have their period. Permanent (chronic) abdominal pain tends to be rare.
  • Gastrointestinal (stomach and bowel) problems: If endometriosis affects a woman’s bowel, she might feel full or have painful bowel movements. If it affects her bladder, passing urine might hurt.
  • Exhaustion: Severe and frequent endometriosis symptoms often lead to general exhaustion. This makes women less able to cope with physical and mental strain.

These symptoms can be caused by other things too, so endometriosis can't be clearly diagnosed based on them alone. It can only be diagnosed following a medical examination.

What does the pain feel like?

The severity of pain can't be measured objectively. Women are the best judges of how severe their symptoms are and how much the symptoms are affecting their quality of life. Some women describe their pain as very aggressive and distressing, for example “like being stabbed in the ovaries…,” or “stinging, burning, sharp...”

The pain can affect things like your performance at work and your ability to do sports and household chores. Women who have very severe pain often feel incapacitated and have to withdraw from everyday life for several days.

There is often no direct link between what doctors find when examining a woman (medical or clinical findings) and the severity of her symptoms. For instance, the number and size of her endometrial implants won't necessarily determine how bad her symptoms are. Small areas of endometriosis tissue can sometimes be very painful too. It's not always clear why that is.

Denny E. Women's experience of endometriosis. J Adv Nurs 2004; 46(6): 641-648.

Facchin F, Saita E, Barbara G et al. "Free butterflies will come out of these deep wounds": A grounded theory of how endometriosis affects women's psychological health. J Health Psychol 2018; 23(4): 538-549.

Grogan S, Turley E, Cole J. "So many women suffer in silence": A thematic analysis of women's written accounts of coping with endometriosis. Psychol Health 2018; 33(11): 1364-1378.

Hallstam A, Stalnacke BM, Svensen C et al. Living with painful endometriosis - A struggle for coherence. A qualitative study. Sex Reprod Healthc 2018; 17: 97-102.

Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ 2014; 348: g1752.

Jones G, Jenkinson C, Kennedy S. The impact of endometriosis upon quality of life: a qualitative analysis. J Psychosom Obstet Gynaecol 2004; 25(2): 123-133.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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Updated on March 24, 2021
Next planned update: 2024

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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