Endometriosis Symptoms: 10 Signs You Shouldn't Ignore | Dr Ria Katwala Solanki

Endometriosis Symptoms: 10 Signs You Shouldn't Ignore

One of the biggest misconceptions about endometriosis is that severe period pain is normal. While mild menstrual discomfort is common, pain that disrupts your daily life, affects your work, school, relationships, or fertility should never be ignored.

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. These deposits can involve the ovaries, fallopian tubes, bladder, bowel, pelvic lining, and, in some women, even areas outside the pelvis. Over time, this can lead to inflammation, scarring, adhesions, ovarian cysts (chocolate cysts), and chronic pelvic pain.

Although endometriosis affects approximately 1 in 10 women of reproductive age, many women wait 7–10 years before receiving the correct diagnosis because their symptoms are often dismissed as "normal period pain."

Recognising the symptoms early can lead to earlier diagnosis, better pain control, improved fertility outcomes, and a better quality of life.

1. Severe Painful Periods (Dysmenorrhoea)

Painful periods are the hallmark symptom of endometriosis.

Unlike routine menstrual cramps, women often experience:

• Pain beginning several days before menstruation

• Severe cramping requiring regular painkillers

• Pain severe enough to miss work or school

• Pain that progressively worsens over the years

• Pain that persists despite medication

A simple question to ask yourself is:

"Can I continue my normal daily routine during my periods?"

If the answer is no, your symptoms deserve further evaluation.

2. Chronic Pelvic Pain

Many women continue to experience pain even after their periods have ended.

This pain may be:

• Constant

• Dull aching

• Sharp stabbing

• One-sided

• Central

• Intermittent throughout the month

Chronic inflammation and adhesions caused by endometriosis can contribute to persistent pelvic pain.

3. Pain During Sexual Intercourse

Pain during deep penetration is another common symptom.

Women may notice:

• Deep pelvic pain

• Pain during specific positions

• Pain lasting several hours afterwards

This often occurs when endometriosis affects the tissues behind the uterus, uterosacral ligaments, or rectovaginal septum.

Pain during intercourse is never something women should feel embarrassed discussing with their doctor.

4. Pain During Bowel Movements

Endometriosis involving the bowel can cause:

• Pain while passing stools

• Constipation during periods

• Diarrhoea during periods

• Pain that worsens during menstruation

• Bloating

• Occasionally blood in the stool during periods

Many women are initially treated for irritable bowel syndrome before bowel endometriosis is recognised.

5. Pain While Passing Urine

Bladder endometriosis is less common but important to recognise.

Symptoms include:

• Pain during urination

• Increased urinary frequency

• Urgency

• Burning sensation without infection

• Blood in urine during periods (rare)

Symptoms often become more noticeable during menstruation.

6. Difficulty Conceiving

Endometriosis is one of the leading causes of infertility.

It may reduce fertility by:

• Distorting pelvic anatomy

• Blocking fallopian tubes

• Damaging ovarian reserve

• Causing inflammation around the ovaries

• Reducing egg quality

The reassuring news is that many women with endometriosis conceive naturally or with appropriate fertility treatment.

7. Chocolate Cysts (Endometriomas)

Some women develop ovarian cysts filled with old blood, commonly called chocolate cysts.

These may cause:

• Pelvic pain

• Painful periods

• Pain during intercourse

• Pelvic heaviness

Not every ovarian cyst is a chocolate cyst, making specialist assessment important.

8. Fatigue

Many women describe:

• Constant tiredness

• Poor concentration

• Brain fog

• Low energy despite adequate sleep

Although fatigue is often overlooked, it can significantly affect quality of life.

9. Lower Back, Buttock or Leg Pain

Endometriosis can sometimes irritate pelvic nerves.

Symptoms may include:

• Lower back pain

• Buttock pain

• Sciatica-like pain

• Pain radiating into the legs

This often worsens around menstruation.

10. Endo Belly (Bloating)

Many women experience sudden abdominal bloating before or during their periods.

Symptoms include:

• Swollen abdomen

• Clothes feeling tighter

• Abdominal discomfort

• Excessive gas

• Fullness after meals

This symptom is commonly referred to as Endo Belly.

When Should You See a Specialist?

You should seek medical advice if you have:

• Severe period pain

• Pelvic pain lasting several months

• Pain during intercourse

• Pain while passing stools or urine during periods

• Difficulty conceiving

• Persistent ovarian cysts

• Symptoms affecting your work, studies, or daily activities

Early diagnosis can improve symptom control and may help preserve fertility.

How Is Endometriosis Diagnosed?

Diagnosis begins with a detailed medical history and pelvic examination.

Depending on your symptoms, your doctor may recommend:

• Pelvic ultrasound

• MRI for deep infiltrating endometriosis

• Additional investigations where indicated

Current international guidelines recognise that many women can be diagnosed based on symptoms and imaging, and laparoscopy is not required in every case.

How Is Endometriosis Treated?

Treatment depends on your symptoms, age, fertility goals, and the extent of disease.

Options include:

• Pain relief

• Hormonal medications

• Lifestyle modifications

• Fertility-focused treatment

• Minimally invasive laparoscopic surgery

• Robotic surgery in selected cases

The treatment plan should always be individualised.

Frequently Asked Questions

Can endometriosis symptoms get worse with age?

They can. In many women, endometriosis progresses over time if left untreated. Symptoms such as pelvic pain, painful periods, and pain during intercourse may gradually become more severe. However, the severity of symptoms does not always reflect the extent of the disease.

At what age do endometriosis symptoms usually begin?

Symptoms often begin during the teenage years or early twenties, shortly after menstruation starts. Unfortunately, many women experience symptoms for several years before receiving the correct diagnosis.

Can endometriosis cause pain even when I'm not on my period?

Yes. While pain is commonly associated with menstruation, many women experience chronic pelvic pain throughout the month. This may be due to inflammation, adhesions, or deep endometriosis affecting nearby organs.

Can endometriosis affect the bowel?

Yes. Endometriosis can involve the bowel, particularly the rectum and sigmoid colon. Symptoms may include painful bowel movements, constipation, diarrhoea, bloating, or pain that worsens during periods. In some cases, blood in the stool during menstruation may occur.

Can endometriosis affect the bladder?

Yes. Bladder endometriosis may cause pain while passing urine, increased urinary frequency, urgency, or blood in the urine during menstruation. These symptoms should be evaluated by a specialist.

Can I have endometriosis without severe pain?

Yes. Some women have extensive endometriosis with very few symptoms, while others experience severe pain despite having relatively limited disease. Every woman's experience is different.

Does every ovarian cyst mean I have endometriosis?

No. Most ovarian cysts are not caused by endometriosis. However, ovarian endometriomas (commonly called chocolate cysts) are a specific type of cyst associated with the condition and require specialist evaluation.

Can endometriosis cause infertility?

Yes. Endometriosis is one of the common causes of infertility. It may affect fertility by causing inflammation, scarring, adhesions, or ovarian cysts. However, many women with endometriosis conceive naturally, while others may benefit from medical or surgical treatment.

Can pregnancy cure endometriosis?

No. Pregnancy does not cure endometriosis. Although symptoms may temporarily improve during pregnancy due to hormonal changes, they can return after childbirth or when menstrual cycles resume.

Does endometriosis increase the risk of cancer?

The overall risk remains low. Certain types of ovarian cancer are slightly more common in women with endometriosis, but the vast majority of women with endometriosis will never develop cancer.

Is endometriosis hereditary?

There appears to be a genetic component. Women with a mother, sister, or close relative who has endometriosis have a higher risk of developing the condition.

Can diet help improve endometriosis symptoms?

A balanced diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids may help reduce inflammation in some women. However, diet alone cannot treat endometriosis and should complement, not replace, medical care.

Can exercise help with endometriosis?

Regular physical activity may improve overall wellbeing and help reduce pain for some women by improving circulation, reducing stress, and releasing endorphins. Exercise should be tailored to individual comfort levels.

How is endometriosis different from adenomyosis?

Although the conditions can occur together, they are different. Endometriosis involves tissue similar to the uterine lining growing outside the uterus, whereas adenomyosis occurs when this tissue grows into the muscle wall of the uterus.

Should I see a specialist if I think I have endometriosis?

Yes. If you have persistent pelvic pain, painful periods, pain during intercourse, bowel or bladder symptoms during menstruation, or difficulty conceiving, an evaluation by a gynaecologist with experience in endometriosis can help establish the diagnosis and discuss the most appropriate treatment options.

Consult Dr. Ria Katwala Solanki

If you experience severe period pain, chronic pelvic pain, pain during intercourse, infertility, or suspect endometriosis, early evaluation can help prevent years of unnecessary suffering.

Dr. Ria Katwala Solanki is a Minimally Invasive Gynaecologist and Gynaecologic Oncosurgeon with expertise in the advanced diagnosis and treatment of endometriosis, adenomyosis, fibroids, ovarian cysts, fertility-enhancing surgery, and gynaecological cancers.

She consults patients across Mumbai, including Andheri, Vile Parle, Juhu, Bandra, and Santacruz, and offers personalised treatment plans using evidence-based, minimally invasive techniques.

Book a consultation today to discuss your symptoms and receive expert guidance tailored to your needs.