What are the symptoms of endometriosis?

Endometriosis is a condition in which the inner layer of the uterus, called the endometrium, grows outside of the uterus throughout the pelvis. It mainly affects the ovaries, fallopian tubes and the inner lining of the pelvis, less commonly it may spread to other organs beyond the pelvic area.

It is estimated endometriosis affects one in 10 Australian women.

female reproductive system diagram

Symptoms of endometriosis can be debilitating and include:

  • Chronic and severe pain in the pelvic area, lower back or legs that affects normal activities. This is the most common symptom.
  • Pain during your periods
  • Pain before and during periods
  • Heavy, irregular or long periods
  • Pain with or after intercourse
  • Pain with bowel movements or urination
  • Diarrhoea and constipation
  • Infertility, or difficulty becoming pregnant
  • Nausea or tiredness

Symptoms can vary from person to person depending on where the endometriosis is located. Pain levels are not associated with the extent of the disease i.e. severe pain does not necessarily mean severe disease and vice versa. Women may have severe pain with mild endometriosis, or advanced endometriosis with little or no pain.

If left untreated, endometriosis can become worse over time. Many women may think painful periods are normal, which is not the case. Some women suffer so much pain that they cannot function normally for a few days every month. If the pain is affecting your daily activities then you should visit your GP in the first instance.

Why does endometriosis cause pain?

In healthy women, the endometrium is under hormonal regulation. When the tissue from inside the uterus lining (endometrium) grows outside the uterus it behaves in the same way as it would inside the uterus. It thickens, break down and bleeds. Because the tissue outside the uterus cannot leave the body like the normal menstrual blood does, it stays inside the pelvis and causes inflammation and pain.  This can also cause formation of scar tissue and adhesions which can result in pelvic organs sticking together.

Endometriosis risk factors

While the exact causes of endometriosis are not known, there are certain risk factors that may increase your likelihood of developing this condition. Some risk factors can be changed through lifestyle, such as body weight. Others such as your family history cannot be changed.

While these risk factors can increase risk, they do not cause the disease. You may still have one or more of these risk factors and never develop endometriosis. Risk factors of endometriosis may include:

  • Never given birth
  • Heavy or prolonged periods
  • Low body weight
  • Had their first period at an early age (before 11 years)
  • Frequent periods or short cycles (less than 27 days)
  • A first-degree family member (mother, sister) with endometriosis.
  • High estrogen levels. The hormone estrogen promotes endometriosis.
  • Medical conditions that increases, blocks or redirects your menstrual flow.


A definitive diagnosis can only be made by laparoscopy, where under general anaesthesia a thin telescope is placed through a small incision through the belly button to see inside. More information about diagnosis, the types of endometriosis and treatment plans can be read on the Endometriosis page.

Early detection and treatment can help manage endometriosis, and there are a range of treatments available that aim to target symptoms or remove the disease.  

I specialise in managing complex and severe endometriosis cases in collaboration with general gynaecologists, bowel and urological surgeons. If you would like to make an appointment, please contact me.

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