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The symptoms of endometriosis

Last Update: October 19, 2017; Next update: 2020.

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 (endometrial tissue) 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 things like how many endometrial implants a woman has, and where they are in her body. 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 cramp-like 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 is not necessarily associated with women’s menstrual 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.

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...”

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. This doesn't always make sense to the woman, or to her doctors.


  • Denny E. Women's experience of endometriosis. J Adv Nurs 2004; 46(6): 641-648. [PubMed: 15154905]
  • Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ 2014; 348: g1752. [PubMed: 24647161]
  • 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. [PubMed: 15715035]
  • 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. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279502


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