20 Symptoms of Endometriosis and What the Pain Feels Like

Quick answer: what are the symptoms of endometriosis?

The main symptoms of endometriosis are pelvic pain, period pain that stops you from doing your usual activities, heavy periods, pain during or after sex, pain when you poo or pee, extreme tiredness, and difficulty getting pregnant. These are the classic signs.

Endometriosis is different for everyone. Some people have severe symptoms and others have none, and symptoms do not always match how much endometriosis there is. All of these symptoms can also have other causes, so the list below is a guide to what to raise with a doctor, not a way to diagnose yourself.

Endometriosis affects about 10% of women and girls of reproductive age worldwide. Long delays in diagnosis are common.

The 20 symptoms at a glance

Period symptoms

Period pain that stops you from doing your normal activities
Pain that starts in the days before your period
Heavy periods, or bleeding that goes on for longer than usual
Feeling faint or fainting during a period

Pelvic pain and sex

Pain in your lower tummy and back at any time of the month
Ovulation pain
Pain during or after sex
Bleeding after sex
Pain during an internal examination, such as a smear test

Bowel symptoms

Pain when you poo
Bleeding from the bottom during your period
Bloating
Symptoms like irritable bowel syndrome (IBS), such as nausea, diarrhoea, or constipation

Bladder symptoms

Pain when you pee
Needing to pee more often or more urgently
Blood in your pee

Other symptoms

Extreme tiredness (fatigue)
Chest pain, shortness of breath, or shoulder-tip pain during a period
Difficulty getting pregnant
Low mood or anxiety

Period symptoms

1. Period pain that stops your normal activities

Severe period pain that stops you from doing your normal activities is a symptom of endometriosis. Periods are often so painful that people take days off school, college, or work. Period pain with endometriosis often gets worse over time.

Period pain is common without endometriosis too. Read how the two compare in Endometriosis Pain vs. Normal Period Pain.

2. Pain that starts before your period

Endometriosis is often marked by pain in the days before a period begins. Ordinary period pain usually starts when bleeding starts.

3. Heavy or long periods

Heavy periods mean needing to change your pad or tampon every 1 to 2 hours, or bleeding through to your clothes. Prolonged bleeding is another sign.

4. Feeling faint during a period

Feeling faint or fainting during a period is also reported.

Pelvic pain and sex

5. Pelvic pain at any time of the month

Endometriosis can cause pain in the lower tummy and back at any time, not only during a period. Chronic pelvic pain is the most common symptom.

6. Ovulation pain

Ovulation pain is another symptom. Mild pain around ovulation is common and is not a sign of endometriosis on its own. It is worth noting if it is severe or comes with other symptoms on this list.

7. Pain during or after sex

Pain during or after sex is another symptom.

8. Bleeding after sex

Bleeding after sex is another sign. Always tell a doctor about bleeding after sex, because it can have other causes that need checking.

9. Pain during an internal examination

Pain during an internal examination, such as a smear test, is another symptom.

Bowel symptoms

10. Pain when you poo

Pain when you poo is a symptom. Extreme pain when having a poo is a symptom of endometriosis on the bowel.

11. Bleeding from the bottom during your period

Rectal bleeding during a period is a symptom of bowel endometriosis. Bleeding from the bottom always needs a doctor's check.

12. Bloating

Many people with endometriosis have significant bloating around their period. Bloating is common in people without endometriosis too, and bloating that does not go away can be a sign of other conditions. Read more in Endo Belly.

13. IBS-like symptoms

Digestive pain and symptoms similar to IBS, such as nausea, diarrhoea, and constipation, are another symptom. Endometriosis symptoms can be like those of IBS.

Bladder symptoms

14. Pain when you pee

Pain when you pee is another symptom.

15. Needing to pee more often or urgently

Needing to pee more often, an urgent need to pee, and trouble emptying the bladder are symptoms of bladder endometriosis.

16. Blood in your pee

Blood in your pee and frequent urinary tract infections are also reported. Blood in your pee always needs a doctor's check.

Other symptoms

17. Extreme tiredness

Extreme tiredness (fatigue) is a symptom. Fatigue also comes together with one or more of the other main symptoms.

18. Chest pain, shortness of breath, or shoulder-tip pain

Endometriosis in the chest is rare. It may cause shortness of breath and coughing up blood. Chest pain during a period and shoulder-tip pain are also reported. Get urgent help for chest pain, difficulty breathing, or coughing up blood.

19. Difficulty getting pregnant

Difficulty getting pregnant is a symptom. Up to 70% of people with endometriosis can get pregnant naturally.

20. Low mood or anxiety

People with endometriosis may have low mood or anxiety, and mental health support is available. Depression and anxiety are among the effects of endometriosis. If you feel low most days, tell your doctor.

What does endometriosis pain feel like?

People describe endometriosis pain in many ways. Common descriptions include:

Cramping, like period pain but stronger or longer
Sharp or stabbing pain that comes suddenly
A deep, heavy ache or a dragging feeling in the pelvis
Burning, or pain that shoots down into the bottom, vagina, or legs

The pain can be in the lower tummy, the lower back, the bottom, or inside the vagina. It can come with your period, around ovulation, during sex, when you poo or pee, or at any time. Read more about endometriosis on the sciatic nerve.

Endometriosis tissue responds to estrogen, and the tissue around it can become irritated, inflamed, and swollen. This is one reason pain is often worse before and during a period. After a long time in pain, the nerves and brain can start to create pain on their own. This helps explain why the pain does not always follow the cycle.

How to describe your pain to a doctor

Give your GP as much information about your symptoms as you can. A clear description helps a doctor decide which tests you need. For each symptom, try to say:

Where it is, and whether it spreads anywhere
What it feels like, for example cramping, stabbing, burning, or aching
When it happens in your cycle: before, during, or after your period, around ovulation, or at any time
How bad it is at its worst, on a scale from 0 to 10
What it stops you doing, such as work, school, sleep, sex, or exercise
What helps, and what you have already tried

Symptom records over two or three cycles make patterns easier to see. The Endolog symptom tracker app lets you log pain by body location alongside your cycle and export a report for your appointment. If you do not have a diagnosis yet, the endometriosis symptom quiz can help you put your symptoms in one place. Read more in The Pain Diary That Helps Your Doctor. To track on paper, print the free period and symptom tracker.

When to see a doctor

See a GP if:

You think you might have endometriosis
Your symptoms affect your everyday life, work, or relationships
You have had treatment from a GP but your symptoms do not get better, or get worse

Endometriosis symptoms can be like those of other conditions, such as adenomyosis, fibroids, pelvic inflammatory disease, and IBS. This is one reason diagnosis can take a long time. Read How to Get Diagnosed with Endometriosis for the steps.

FAQ: endometriosis symptoms

What are the first signs of endometriosis?

Period pain that stops you from doing your normal activities is often the first sign people notice. Pain that starts in the days before a period, and period pain that gets worse over time, are also common early signs.