Endometriosis symptoms: the signs not to brush aside

You’re in pain during your period, and people tell you it’s normal? This guide helps you recognise the endometriosis symptoms worth mentioning to a doctor, and note them so you’re better heard.

Written by Paul, a nurse, founder of EndoQueen. This guide informs; it doesn’t replace an appointment with a health professional.

Endometriosis, in a nutshell

Endometriosis is the presence, outside the womb (uterus), of tissue similar to the tissue lining the inside of the womb. This tissue responds to the hormones of the cycle. It can cause inflammation, pain and sometimes difficulty getting pregnant.

According to Inserm, the French national institute for health research, it affects about one woman in ten of childbearing age. It can also affect trans and non-binary people who have a womb. Diagnosis often takes years: knowing the signs better already saves time.

One important point: how strong the pain is doesn’t tell you how extensive the disease is. A small lesion can be very painful, and extensive lesions can cause few symptoms.

The most common signs of endometriosis

The European ESHRE guideline (2022) and the UK NICE guideline (NG73) describe several signs that should make doctors think of endometriosis.

Very painful periods (severe dysmenorrhoea)

This is the best-known sign. Pain that makes you miss school or work, that doesn’t ease with your usual painkillers, or that gets worse over the years. Being in a bit of pain happens. Being stuck in bed isn’t “normal”. Our guide to period pain helps you tell the difference.

Deep pain during or after sex (deep dyspareunia)

A pain felt deep in the pelvis during penetration, sometimes lasting afterwards. It isn’t in your head, and it isn’t a lack of desire. It’s a sign to mention to your doctor. Our guide on painful sex and endometriosis helps you talk about it.

Painful bowel movements during your period (dyschezia)

Pain when you open your bowels during your period, sometimes with bloating, diarrhoea or constipation. Many people don’t dare mention it, yet it’s valuable information for your doctor. Read our guide on painful bowel movements during your period.

Pain when urinating during your period

Burning or pain when you pass urine that comes back around your period. Sometimes, blood in the urine at that time.

Other, less well-known signs

• Shoulder pain that comes back during your period, particularly on the right. ESHRE mentions it among the possible signs.
• Pelvic pain outside your period, that lasts or keeps coming back.
• Great tiredness, often underestimated, that weighs on daily life.
• Difficulty getting pregnant. Sometimes it’s the only sign, and the question comes up during fertility tests. See endometriosis and fertility.

Very heavy periods, with clots or nights getting up to change, can also point to adenomyosis, which often goes with endometriosis.

None of these signs, on its own, is enough to draw a conclusion. What counts is how they fit together, their link with your cycle and their impact on your life. Your doctor decides.

When to see a doctor about endometriosis pain

You don’t have to wait until it’s unbearable. It’s worth booking an appointment if:

• your periods stop you living normally (school, work, going out);
• your usual painkillers are no longer enough;
• you have pain during sex, when you open your bowels or when you urinate, especially around your period;
• your pain changes or gets worse;
• you’ve been trying for a baby for a while without success.

You can see your family doctor (GP), a midwife or a gynaecologist. For complex endometriosis, many countries have specialist centres.

Possible tests

It usually starts with a detailed conversation and, if you agree, an examination. The doctor may then suggest a pelvic ultrasound scan, then, if needed, a scan by a specialist or a pelvic MRI.

The ESHRE guideline (2022) points out that a normal examination or normal imaging doesn’t rule out endometriosis. If you’re still in pain, you have the right to raise it again and ask for another opinion. Laparoscopy (keyhole surgery) is no longer the automatic step to confirm the disease: it’s discussed case by case.

How to keep an endometriosis symptom diary

On the day of the appointment, it’s hard to remember everything. A few regular notes make a real difference. Here’s what helps most:

1. The pain, out of 10, each day you’re in pain. Note where it is too (belly, back, legs, shoulder).
2. The point in your cycle: during your period, just before, mid-cycle.
3. Associated signs: bowels, urine, sex, digestion, tiredness.
4. What you took and whether it helped.
5. What the pain stopped you doing: a day of school or work, a cancelled plan.

Two or three cycles are often enough to show a pattern. Next, read our guide to preparing your endometriosis appointment.

Frequently asked questions

Can you have endometriosis without very painful periods?

Yes. For some people, the pain is mainly in the bowels or bladder, or during sex. For others, there’s hardly any pain, and the question comes up during fertility tests.

Does a normal ultrasound scan mean there’s no endometriosis?

No. The European ESHRE guideline (2022) points out that a normal examination or normal imaging doesn’t rule out the condition. If your symptoms continue, talk to your doctor about it again.

Can an app tell me whether I have endometriosis?

No. An app helps you note what you’re going through and show it. Your doctor decides, with an examination and imaging.

Read next

• Period pain
• Preparing your appointment
• Adenomyosis
• All our guides

Sources

• ESHRE, Guideline: endometriosis (2022)
• NICE, Endometriosis: diagnosis and management (NG73)
• Inserm, Endometriosis feature (in French)

Last reviewed: 29 October 2026.