22 Symptoms of Endometriosis: The Checklist Every Woman Should See

When most people think of endometriosis, painful periods are usually the first thing that comes to mind. But the truth is, endo is so much more than that. It’s a chronic, whole-body condition where tissue similar to the uterine lining grows outside the uterus — often in the pelvis, but sometimes elsewhere too. Because of that, symptoms can vary wildly from person to person. No two experiences look exactly the same. Here are the most common signs of endometriosis to look out for.

Early signs and symptoms of endometriosis

Catching endometriosis early can make a big difference, but it’s not always easy. The condition often flies under the radar for years because its symptoms can mimic everything from bad period cramps to digestive issues. Understanding what’s normal for your body — and what’s not — is the first step toward getting the answers (and relief) you deserve.

Some of the most common symptoms include chronic pelvic pain, painful periods, pain during sex, heavy bleeding, bowel issues like cramping or diarrhea, and bladder symptoms such as pain when urinating or even blood in the urine.

Can symptoms of endometriosis come and go?

According to Dr. Tara Scott, OB-GYN, endometriosis symptoms can vary a lot from person to person — both in type and consistency. For some, flare-ups are tied to estrogen levels and tend to get worse when estrogen peaks, like around ovulation. Others might notice that their cramps come and go, or that symptoms seem to intensify over time. And for some, things may actually ease up after giving birth. “There’s really no rhyme or reason to how it can manifest,” says Dr. Scott.

Common symptoms of endometriosis

The symptoms someone experiences with endometriosis often depend on where those endometrial-like lesions are growing. Most of the time, they’re found around the pelvis — on the ovaries, fallopian tubes, or nearby organs. But according to Dr. Rachel Gelman, a pelvic floor physical therapist, researchers have also discovered endometrial lesions in unexpected places, from the brain and lungs to the digestive system.

Endometriosis can look completely different from one person to the next, which is part of why it often takes years to get diagnosed. Some people have symptoms that are hard to ignore, while others experience quieter signs that are easy to mistake for something else. Here are some of the most common ways endometriosis can show up in the body.

1. Is dysmenorrhea a symptom of endometriosis?

Painful periods, also known as dysmenorrhea, are one of the most common symptoms of endometriosis. Dr. Gelman explains that the tissue from endometrial lesions still responds to hormones, which is why endo is so often linked to period pain. During your period, the uterine lining sheds and leaves the body, but those lesions outside the uterus don’t have anywhere to go. That buildup can trigger inflammation, which is what makes periods so painful for many people with endometriosis.

2. Is bloating a symptom of endometriosis?

Bloating can definitely be a symptom of endometriosis. Many people with the condition experience what’s known as “endo belly,” or endometriosis-related bloating. It’s a type of intense, often sudden bloating that can make your stomach feel hard, swollen, or painful. It may come and go throughout your cycle, but it often gets worse around your period, when inflammation and bleeding from endometrial tissue increase, or after eating if lesions are affecting the intestines.

3. Is fatigue a symptom of endometriosis?

Fatigue is one of the most common symptoms of endometriosis. Many people with endo describe feeling constantly tired or drained, even when they’re getting plenty of rest. That exhaustion can come from a few different factors linked to the condition, including:

• Chronic inflammation: The body’s ongoing immune response to endometrial lesions releases inflammatory molecules called cytokines, which can leave you feeling wiped out.
• Pain and poor sleep: Ongoing pelvic pain, especially around your period, can make it hard to get restful sleep and lead to deep fatigue.
• Hormonal imbalances: Fluctuating estrogen and progesterone levels can take a toll on both your energy and your mood.

4. Are irregular periods a symptom of endometriosis?

Irregular periods aren’t usually considered a classic symptom of endometriosis, says Dr. Gelman, but they can happen for some people. Those with endo often describe long, heavy periods rather than irregular ones. That said, irregular cycles can still occur, especially if hormones are disrupted or if another condition is present alongside endometriosis, such as PCOS, thyroid issues, or hormonal imbalances linked to inflammation or certain treatments.

5. Is nausea a symptom of endometriosis?

Nausea can definitely be a symptom of endometriosis. Many people with endo experience queasiness or even vomiting, especially during their period or around ovulation. There are a few possible reasons for this, including:

• Pelvic inflammation and pain: The body’s inflammatory response to endometrial lesions can upset the digestive system and trigger nausea.
• Pain response: Intense pelvic or back pain can directly cause feelings of nausea.
• GI lesions: When endometrial lesions grow on or near the intestines or other abdominal organs, they can lead to digestive problems that make you feel sick.
• Hormonal changes: Fluctuations in estrogen and prostaglandins, the chemicals that play a role in your period, can also affect your stomach and gut, increasing nausea.

6. Pelvic pain

Pelvic pain is one of the most common and defining symptoms of endometriosis. People often describe it as a deep, aching, or sharp pain in the lower abdomen or pelvis, and sometimes as burning, stabbing, or cramping. It can feel like a constant soreness or pressure, even outside of your period. For some, the pain follows their cycle, while others feel it almost every day. There are a few reasons this pain can happen with endometriosis:

• Inflammation: Endometrial lesions trigger an inflammatory response by releasing substances that make nearby nerves more sensitive to pain.
• Nerve irritation: Lesions can attach to or trap pelvic nerves, causing irritation and discomfort.
• Adhesions and scar tissue: Dr. Gelman explains that lesions can lead to adhesions, a sticky tissue that causes organs to stick together or move less freely, creating a pulling or tugging pain.
• Muscle tension: Chronic pain can cause the pelvic floor muscles to tighten or spasm, adding another layer of discomfort.

7. Dyspareunia (pain during or after sex)

Dyspareunia, or pain during sex, is a common symptom of endometriosis and often feels like deep pelvic pain during penetration. People describe it as sharp or stabbing pain during sex, aching or cramping that lingers afterward, or a sense of pressure or soreness in the lower pelvis that can last for hours or even days. Endometriosis can cause this type of pain for several reasons, including:

• Lesions and adhesions in the pelvis: Endometrial tissue can grow on areas that move or stretch during sex, such as the vagina, uterosacral ligaments, and cul-de-sac. When these areas are pulled or pressed, it can cause sharp, deep pelvic pain.
• Inflammation and nerve sensitization: Inflammatory chemicals make pelvic nerves more sensitive over time, which can cause pain even with gentle movement or touch.
• Scar tissue and adhesions: These can cause organs like the uterus, ovaries, and rectum to stick together, limiting movement and making certain positions painful.
• Pelvic floor muscle tension: Chronic pelvic pain can make the pelvic floor muscles tighten or spasm without you realizing it, leading to entry pain and deeper pelvic discomfort.

8. Pain with urination (dysuria)

This is another common symptom of endometriosis and can give doctors clues about where endometrial lesions might be growing. Pain with urination often happens when endometrial tissue forms on or near organs in the lower pelvis, such as the bladder, urethra, or ureters. When these tissues react to menstrual hormones, they can cause inflammation, swelling, and even small bleeds that irritate nearby organs and nerves.

Dysuria from endometriosis often feels like burning, stinging, or aching while peeing, especially during your period. It can also show up as:

• Frequent or urgent urination without a UTI
• Pain as the bladder contracts after peeing
• Occasionally, blood in your urine if lesions affect the bladder lining

9. Heavy menstrual bleeding and anemia

Menorrhagia, or unusually heavy or long periods, is a common symptom for people with endometriosis. Those who experience it often notice very heavy bleeding, soaking through pads or tampons in an hour or less, or periods that last longer than a week. The blood may also contain larger clots, often bigger than a quarter. Endometriosis can lead to heavier periods for a few reasons, including:

• Inflammation: The inflammatory chemicals released by lesions can increase uterine contractions, which may cause heavier bleeding.
• Hormonal imbalance: Estrogen dominance, which happens when there’s more estrogen than progesterone, can make the uterine lining thicker. That thicker lining means more blood when it sheds.

One of the most common complications of heavy periods is iron deficiency or anemia. Anemia occurs when your body doesn’t have enough red blood cells or hemoglobin, the iron-rich protein that helps carry oxygen in your blood. Losing too much blood during your period can deplete these levels, leading to fatigue, weakness, and dizziness.

10. Infertility or difficulty conceiving

Research suggests that around 30 to 50% of people with endometriosis have some difficulty getting pregnant. Endometriosis can affect fertility in several ways, including:

• Anatomical changes: Endometrial lesions can form adhesions that block or change the shape of the fallopian tubes, making it harder for the egg and sperm to meet.
• Ovarian cysts: Endometriosis can cause endometriomas, which are cysts that form on the ovaries. These can lower ovarian reserve, affect egg quality, and disrupt ovulation.
• Inflammation: The inflammatory chemicals released by lesions can damage sperm, eggs, or embryos, and may also make it harder for a fertilized egg to implant in the uterus.

Some people with endometriosis have completely regular cycles but still find it difficult to conceive.

11. Lower back or leg pain

This is a less obvious but still common symptom of endometriosis. It’s often linked to where the endometrial lesions are growing and which nerves they affect. The pain may feel like a dull ache or sharp stab in the lower back, often worse during your period. Some people also experience pain that radiates down one or both legs, similar to sciatica, or muscle tightness in the lower back, hips, or buttocks. It can be constant or flare up around menstruation.

Lower back or leg pain usually happens because of a mix of nerve irritation, inflammation, and structural changes in the pelvis.

• Nerve irritation: Deep infiltrating endometriosis (DIE) is a more severe form of the condition where endometrial tissue grows deep into surrounding organs and tissues. It can form near the sciatic nerve, sacral plexus, or other pelvic nerves, pressing on or inflaming them and causing pain that radiates down the legs.
• Inflammation: The inflammatory molecules released by lesions can make nearby nerves more sensitive, increasing pain in the lower back or legs.
• Pelvic structural changes: Adhesions and scar tissue can pull on the uterus, ovaries, or intestines, shifting pelvic alignment and creating pain in the lower back, hips, or thighs.

Other digestive and physical symptoms of endo

Endometriosis often affects more than just the reproductive system. When lesions grow on or near the intestines, they can cause a range of digestive and physical symptoms that might be mistaken for something like IBS or food sensitivities. People often report bloating, cramping, nausea, constipation, or diarrhea, especially around their period. Because these symptoms overlap with other conditions, it can take time to realize that endometriosis might be playing a role.

12. Is diarrhea a symptom of endometriosis?

Diarrhea can be a symptom of endometriosis and often follows a cyclical pattern tied to the menstrual cycle. There are a few reasons this can happen, including:

• Endometrial lesions on or near the bowel: These lesions can irritate the bowel wall. During your period, they may swell, bleed, and become inflamed, which can speed up digestion and cause diarrhea.
• Inflammatory chemicals: The inflammatory substances released by endometrial lesions can stimulate the intestines to contract more quickly, leading to loose stools.
• Pelvic muscle contractions: Chronic pelvic pain can cause spasms in the rectum or pelvic floor muscles, which may also trigger diarrhea.

13. Is gas a symptom of endometriosis?

Excess gas can be a symptom of endometriosis, especially when lesions affect the digestive system. Here’s why that can happen:

• Lesions on or near the intestines: Endometrial lesions can grow on the rectum, colon, or small intestine, irritating the bowel. This can slow or disrupt digestion, leading to trapped gas, bloating, or burping.
• Inflammation: The inflammatory chemicals released by endometrial lesions can affect how the gut moves food along, known as motility. When digestion slows down or becomes irregular, gas can build up and cause discomfort.
• Adhesions and scar tissue: These can change how the intestines are positioned, making it harder for gas to move through and increasing bloating.

14. Is heartburn a symptom of endometriosis?

Heartburn can be a symptom of endometriosis, though it’s less common. Dr. Gelman explains that if lesions are located higher up in the digestive tract or cause significant inflammation, they can contribute to heartburn. Lesions on or near the intestines can also slow digestion, allowing stomach acid to move back into the esophagus.

Hormonal changes can play a role too, since estrogen and progesterone can relax the lower esophageal sphincter and make reflux more likely. People who experience “endo belly” may also have trapped gas that increases pressure in the abdomen, pushing stomach contents upward and triggering heartburn.

15. Is hair loss a symptom of endometriosis?

Hair loss can sometimes be linked to endometriosis, though it’s usually an indirect effect rather than a main symptom. Here’s how it can happen:

• Hormonal imbalances: Many people with endometriosis have higher estrogen levels, lower progesterone, or elevated androgens. These hormonal shifts can sometimes lead to thinning hair or increased shedding around the menstrual cycle.
• Iron deficiency: Heavy bleeding caused by endometriosis can lead to low iron levels, and iron deficiency is a well-known cause of hair loss.

16. Pain with bowel movements

This is one of the hallmark symptoms when endometriosis affects the bowel. It can feel like sharp or cramping pain during bowel movements, especially around your period, or a sense of pressure or pulling in the rectal area before or after going to the bathroom. Some of the possible endometriosis-related causes of this pain include:

• Endometrial lesions on the rectum or sigmoid colon: These can cause inflammation, swelling, and irritation. During menstruation, they may bleed or swell even more, which increases pain with bowel movements.
• Deep infiltrating endometriosis (DIE): When endometrial tissue grows deeply into the bowel wall, it can cause intense pain or cramping when passing stool.
• Adhesions and scar tissue: These can limit how the bowel moves and stretch uncomfortably during bowel movements, leading to pain.

17. Constipation

Constipation is one of the most common and frustrating symptoms of endometriosis, and it often changes throughout the menstrual cycle. It usually happens because of a mix of mechanical, hormonal, and inflammatory factors.

• Mechanical: Lesions and adhesions on or around the bowel, rectum, or sigmoid colon can narrow parts of the intestines and make it harder for stool to pass, leading to constipation or obstruction-like symptoms.
• Hormonal: Progesterone peaks during the luteal phase of the menstrual cycle and naturally slows digestion. In people with endometriosis, this effect can be stronger, causing constipation before and during their period.
• Inflammatory: The inflammatory chemicals released by endometrial lesions can affect how the intestines contract and move. Chronic inflammation may either dull or overstimulate nerve activity, causing alternating constipation and diarrhea, which is often mistaken for IBS.

18. Rectal bleeding

Rectal bleeding is a rare but possible symptom of endometriosis. It’s usually linked to deep-infiltrating or bowel-involving endometriosis rather than mild or superficial forms. Rectal bleeding means seeing blood in or around your stool, on toilet paper, or in the toilet bowl. In people with endometriosis, this can happen when lesions grow into the bowel wall and bleed in response to hormonal changes during the menstrual cycle. If the lesions reach the inner lining of the bowel, the blood can mix with stool and become visible. This type of bleeding usually follows a cyclical pattern, appearing during menstruation.

19. Headaches or migraines

Headaches and migraine are fairly common but often overlooked symptoms in people with endometriosis. Research suggests that around 30% of people with endo experience frequent headaches or migraines. These are usually not caused by the lesions themselves, unless they occur in the brain, but are more often linked to the hormonal, inflammatory, and pain-related changes endometriosis can trigger throughout the body. Here’s how that can happen:

• Hormonal fluctuations: Endometriosis symptoms often flare with hormonal changes, especially around ovulation and menstruation. People with endo are often more sensitive to these shifts, and the drop in estrogen before a period is a well-known migraine trigger.
• Inflammation: The inflammatory chemicals released by endometrial lesions can increase inflammation in the nervous system, which plays a major role in migraines.
• Prostaglandin overproduction: Endometrial lesions produce too many prostaglandins, chemicals that make blood vessels constrict and then widen, which is a hallmark of migraine pain.

20. Bladder pressure, urgency, or frequency

Bladder symptoms are common in people with endometriosis, especially when lesions are on or near the bladder. When this happens, the inflammation can make nearby areas extra sensitive, causing feelings of pressure or bladder fullness. It can also irritate the nerves that control the bladder, sending false signals that make you feel like you constantly need to pee. Over time, chronic inflammation or lesions on the bladder wall can reduce bladder capacity, which means needing to urinate more often — sometimes as frequently as every 30 to 60 minutes in more severe cases.

21. Spotting or breakthrough bleeding

Spotting between periods is a common menstrual-related symptom of endometriosis and reflects the hormonal and structural changes the condition can cause in the body. It can happen for a few reasons:

• Hormonal imbalances: Fluctuations in estrogen and progesterone are common in people with endometriosis. These shifts can make the uterine lining less stable, causing it to shed slightly outside of your period.
• Inflammation: Ongoing inflammation in the pelvis can affect the stability of blood vessels in the uterus, making them more likely to leak.
• Endometrial lesions: Lesions on or near the uterus can distort uterine tissue, leading to uneven shedding of the lining. Adhesions or endometriomas can also interfere with normal menstrual flow, sometimes causing light bleeding between periods.

22. Weight fluctuations

Weight fluctuations aren’t talked about as often, but they’re a very real symptom for some people with endometriosis. These changes are usually mild and often linked to hormonal shifts, inflammation, and water retention rather than actual fat gain or loss. Estrogen can cause the body to hold onto water, so those with higher estrogen levels may notice more bloating or puffiness. Chronic pelvic inflammation can also make tissues retain fluid, which can lead to small, temporary weight changes of around 2 to 5 pounds as the body holds and releases extra water.

Age-specific symptoms of endo

Endometriosis can look and feel different at every age. Hormonal changes, life stages, and even treatments can all influence how symptoms show up over time. Understanding what endo might look like in your teens, 20s, 30s, and beyond can help you recognize patterns, advocate for yourself, and get the care you need sooner.

Symptoms of endometriosis in older age groups

Dr. Gelman explains that people with endometriosis may notice their symptoms change as they get older. Hormonal shifts during perimenopause and menopause can affect how severe those symptoms feel. For some, endometriosis becomes less active after menopause, leading to a noticeable decrease in discomfort.

Symptoms of endometriosis after a hysterectomy

A hysterectomy involves removing the uterus and sometimes the cervix. However, endometriosis can still cause symptoms afterward, depending on where the endometrial lesions are located. Because endometriosis is sensitive to estrogen, which is produced by the ovaries, keeping one or both ovaries can allow residual lesions to stay active. Lesions that grow outside the uterus or cervix can also continue to cause pain and other symptoms even after surgery.

Other endo symptoms: Special circumstances

Endometriosis can show up in some unexpected ways, depending on where the lesions grow or how your body responds. In certain situations, symptoms may look a little different or become more noticeable. Understanding these less common scenarios can help you piece together what’s really going on with your body and get the right kind of care.

Signs of endometriosis after a C-section

Endometriosis can sometimes develop or flare up after a C-section. This may happen because it was already present and worsened due to hormonal changes, or because endometrial cells were accidentally implanted in the surgical scar during delivery. This rare condition is called Cesarean scar endometriosis and occurs in about 0.03 to 0.4% of C-sections, but it’s well-documented. Symptoms may include:

• Pain near the C-section scar that gets worse during your period
• A small, firm, or tender lump under or near the incision line
• In some cases, discoloration, swelling, or bleeding from the scar

Can birth control mask symptoms of endometriosis?

Birth control is one of the most common treatments for endometriosis. It works by balancing or lowering hormone levels, which can help slow the growth and activity of endometrial lesions. For many people, this leads to a noticeable reduction in pain and makes day-to-day life much more manageable. While it doesn’t stop the disease itself, it can go a long way in easing symptoms and improving quality of life.

How to relieve symptoms of endometriosis

Managing endometriosis symptoms often requires a mix of medical, surgical, and lifestyle approaches that work together to bring relief.

• Medical: Hormonal therapies are designed to slow the growth of endometrial tissue and reduce inflammation. Common options include combined oral contraceptives to ease menstrual pain, progestins to shrink lesions and stop periods, and NSAIDs to help manage pain.
• Surgical: Dr. Gelman explains that excision surgery is considered the gold standard for treating endometriosis because it removes lesions directly. Laparoscopy can also be used to both diagnose and remove endometrial tissue.
• Lifestyle: Eating an anti-inflammatory diet rich in omega-3s, fruits, vegetables, and whole grains while reducing dietary fat and increasing fiber may help lower estrogen levels. Vitamins C, D, and E have also been shown to reduce endometriosis symptoms. For those with digestive issues, following a low-FODMAP diet may provide additional relief.

Endometriosis symptoms can be complex, but you’re not alone

Endometriosis is so much more than “bad periods.” It’s a complex condition that can affect nearly every part of your life, from your physical health to your energy levels and emotional well-being. And while symptoms can vary from person to person, one thing stays the same — you deserve to be heard, believed, and supported.

If you suspect you have endometriosis or your symptoms just don’t feel “normal,” trust your instincts and talk to a healthcare provider who takes your concerns seriously. Getting answers can take time, but understanding your body is the first step toward relief and better care.

You’re not alone in this. Millions of people are navigating endo right alongside you, finding hope, managing symptoms, and building lives that feel good again.

---

Nora Rosenfeld is an editorial intern at Rescripted, studying Journalism and Global Health at Northwestern University. She is passionate about women’s and mental health and plans to pursue health and science writing.