7 Symptoms of Endometriosis

The diagnosis of endometriosis is often a slow, drawn-out process. Evidence shows that the average time to diagnosis in Australian women aged 18–45 is 6.5 years.¹

There are many reasons for the delay, one of which is that the symptoms of endometriosis vary greatly between individuals. Many of the symptoms can also overlap with other conditions such as pelvic inflammatory disease, ovarian cysts, Crohn’s disease, irritable bowel syndrome, or even appendicitis.

Below we explore seven common symptoms of endometriosis. If you experience any of these and your menstrual period is impacting your quality of life, speak to your GP or gynaecologist about further investigation—or seek support from a qualified natural medicine practitioner.

Traditional Chinese Medicine (TCM), including acupuncture and herbal medicine, can help address endometriosis symptoms naturally.

1. Severe Period Pain (Dysmenorrhea)

Dysmenorrhea is the number one symptom of endometriosis. This includes:

• Pelvic pain

• Abdominal cramping

• Lower back pain

• Upper leg pain

Pain may occur before, during, and after menstruation, often severely enough to interfere with daily activities and reduce productivity.

This pain is caused by endometrial tissue growing outside the uterus, which sheds each month but has nowhere to exit the body. The result: inflammation, scar tissue, adhesions, and blockages.²

2. Heavy Menstruation (Menorrhagia)

Many women with endometriosis experience very heavy periods, often soaking through a pad or tampon every hour or two for consecutive hours. Other signs include:

• Large blood clots

• Bleeding lasting longer than 7 days

• Spotting before the period

• Bleeding between periods

These symptoms are all common indicators of endometriosis.

3. Painful Sex (Dyspareunia)

Women with endometriosis may experience pain during or after intercourse, depending on the timing in their cycle or sexual position. This pain may feel:

• Sharp or stabbing

• Achy or radiating

• Deep within the pelvis or vagina

This is often due to endometrial lesions in the pelvic walls and vaginal tissue. Research shows that around 80% of women with endometriosis experience significant sexual dysfunction, which may also lead to relationship difficulties and anxiety around sex.¹ ²

4. Infertility

A University of Queensland study found that 40% of Australian women with endometriosis experience infertility.³

In many cases, women are only diagnosed after seeking help for fertility issues. Endometriosis can affect fertility due to:

• Scar tissue

• Adhesions

• Inflammation

• Distorted pelvic or fallopian tube anatomy

Natural medicine can help to reduce inflammation, which in turn supports implantation and improves reproductive health.⁴

5. Bowel and Urinary Disorders

Many women with endometriosis experience:

• Constipation or diarrhoea

• Painful urination or bowel movements

These symptoms typically appear around the time of menstruation. While the exact cause is unclear, it may indicate endometrial tissue on the bowel, bladder, or peritoneum.

6. Neuropathy

It’s not uncommon for women with endometriosis to feel a warm, radiating, nerve-like pain in the upper legs, especially around menstruation or ovulation.

This may be due to:

• Inflammation near the sciatic nerve

• The nerve becoming trapped in endometrial tissue²

Research into this symptom is still ongoing.

7. Fatigue

A 2020 study that interviewed 22 women with endometriosis found that all participants experienced fatigue, especially before or during their periods.⁵

Women described this fatigue as:

• Lethargy

• Exhaustion

• Weakness that affects daily function

This may be due to the physical toll of pain and bleeding, or because of low iron resulting from prolonged heavy periods. Left untreated, this can lead to anaemia, worsening the cycle of fatigue.

Additional Notes

Not every woman with endometriosis will experience all seven symptoms. Some may only experience one or two. Conversely, a woman may be found to have stage 4 endometriosis despite having no pain or symptoms, while another with severe symptoms may have only minor lesions.

Women with endometriosis may also have:

• Diagnosed immune or autoimmune conditions

• Allergies or chemical sensitivities

• Recurrent yeast infections

At Sydney Natural Fertility, our goal is to support your body naturally to reduce the symptoms of endometriosis and enhance your overall reproductive health.

We hope this list of 7 symptoms helps you feel more informed and empowered on your journey toward better health.

References

1. Endometriosis Australia (2022). Endometriosis Fact Sheet. https://www.endometriosisaustralia.org/downloads

2. Endometriosis Foundation of America (2023). Endometriosis Symptoms. https://www.endofound.org/endometriosis-symptoms

3. Moss, K.M. et al. (2021). Delayed diagnosis of endometriosis disadvantages women in ART: a retrospective population linked data study. Human Reproduction, 36(12): 3074–3082. https://academic.oup.com/humrep/article/36/12/3074/6381310?login=false

4. Zhong, Y. et al. (2019). Acupuncture in improving endometrial receptivity: a systematic review and meta-analysis. BMC Complement Altern Med, 19(61).

5. DiBenedetti, D. et al. (2020). Patients’ perspectives of endometriosis-related fatigue: qualitative interviews. Journal Patient Rep Outcomes, 4(33). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203274/