7 Symptoms of Endometriosis
The diagnosis of endometriosis is often a slow drawn out process, with evidence showing that the average length of time for diagnosis in Australian women aged between 18-45 is 6.5 years.(1) There are many reasons for the delay in diagnosis, one of which is because the symptoms of endometriosis vary from case to case and also because these symptoms can be associated with other conditions including but not limited to; pelvic inflammatory disease, ovarian cysts, Crohn’s disease, irritable bowel syndrome or even appendicitis.
Below we will explore 7 symptoms of endometriosis. If you feel like you experience any of these symptoms and that your menstrual period is impacting upon your quality of life, speak to your GP or gynaecologist for information on diagnosis, or seek support from your natural medicine practitioner. Traditional Chinese medicine in the form of acupuncture and herbal medicine can help to address the symptoms of endometriosis.
Severe period pain (dysmenorrhea)- Dysmenorrhea is the number one symptom of endometriosis. It includes pain in the pelvis, stomach and leg cramps, lower back pain, abdominal pain and upper leg pain which often presents for days prior to the onset of the menstrual period, during the period and even after it has finished. The pain is often so severe in nature that it impacts upon activities of daily living resulting in reduced productivity at work and home. The pain occurs as the endometrial tissue growing outside of the uterus sheds monthly but has nowhere to exit the body, resulting in inflammation, irritation, scar tissue, adhesions and blockages.(2)
Heavy menstruation (menorrhagia)- Women with endometriosis may find their menstrual period to be heavy, soaking through a pad or tampon every hour or two for consecutive hours. There may be clots present, and the bleeding may be irregular and continue for longer than 7 days. There may be bleeding between periods and spotting prior to the period, which is a common indicator of endometriosis.
Painful sex (Dyspareunia)- Women with endometriosis may experience pain during and/or after intercourse or in certain sexual positions. The timing and intensity of the pain can vary. Some women experience pain at only certain times of their cycle, some describe a stabbing pain whilst others an ache. This pain is likely the result of endometriosis being present in the pelvic walls and vagina. Research indicates that approximately 80% of women with endometriosis experience a high level of sexual dysfunction, which may include increased anxiety around the act of sex leading to relationship issues and poor sexual quality of life.(1,2)
Infertility-. A study by the University of Queensland found that 40% of Australian women with endometriosis experience infertility. The same study noted that a third of women are not diagnosed with endometriosis until they start investigating infertility issues.(3) Endometriosis can impact fertility due to scarring, adhesions, inflammation and distorted anatomy of the pelvis and/ or fallopian tubes. Natural medicine is known to be very effective at reducing inflammation, which can help to promote endometrial receptivity for implantation.(4)
Bowel and urinary disorders– Leading up to the menstrual period and during the period a woman with endometriosis may experience constipation or diarrhoea, and pain when defecating or urinating. The cause of these bowel and bladder issues is unclear, however it may be a sign of endometriosis in the bowel, peritoneum or bladder.
Neuropathy– It is common in endometriosis to feel a warm, radiating nerve type pain in the upper legs prior to menstruation or during ovulation. Research is continuing into the reasoning for this pain, it may be caused by inflammation from endometrial tissue close to the sciatic nerve or due to the sciatic nerve becoming trapped in endometrial tissue.(2)
Fatigue- A 2020 study interviewed 22 women with endometriosis, 100% of women interviewed noted that they experienced fatigue which was worse before their period or in the first few days of their period. They described the fatigue as lethargy, exhaustion and weakness impacting on their participation in activities of daily living. More research is required into fatigue in endometriosis to understand if it is a result of dealing with the physical symptoms of pain and heavy bleeding impacting the body or something else.
Prolonged heavy periods can lead to lower iron stores, also leading to anaemia and fatigue.(5) Low iron and heavy bleeding can become a cyclical issue, which is why addressing the anaemia is an important factor in resolving heavy menstrual bleeding.
In addition to these 7 symptoms of endometriosis, women with the condition often have diagnosed immune or autoimmune disorders, may suffer with allergies and/or chemical sensitivities, and may frequently suffer from yeast infections.
It is important to remember that not all women will experience all of the above symptoms, and may only experience one or two. In fact, sometimes a woman may be discovered to have stage 4 (the most severe) endometriosis on explorative laparoscopy, despite having no pain or symptoms to suggest endometriosis. Meanwhile, a woman with severe dysmenorrhoea may have only minimal endometrial lesions. Our goal at Sydney Natural Fertility, is to support your body to reduce symptoms of endometriosis, naturally enhancing your reproductive capacity. We hope this list of 7 symptoms of endometriosis can help you on your journey to discovering more about your body, on your path to better health.
1) Endometriosis Australia (2022). Endometriosis Fact sheet.
2) Endometriosis Foundation of America (2023). Endometriosis Symptoms.
3) Moss, K.M., Homer, J.D., Rowlands, I.J, Hockey, R., & Mishra, G.D. (2021). Delayed diagnosis of endometriosis disadvantages women in ART: a retrospective population linked data study. Human Reproduction. 36(12): 3074-3082
4) Zhong, Y., Zeng, F., Liu, W., Guan, Y., and Song, Y. (2019). Acupuncture in improving endometrial receptivity: a systematic review and meta analysis. BMC Complement Altern Med. 19(61).
5) DiBenedetti, D., Soliman, A.M., Gupta, C., & Surrey, E.S (2020). Patients’ perspectives of endometriosis-related fatigue: qualitative interviews. Journal Patient Rep Outcomes. 4(33).
Written by Lisa Burnley.