Many women are told that painful periods are “normal”. But for those with endometriosis, symptoms can go far beyond this. Understanding the signs and symptoms are the first step towards getting the right support and improving your quality of life.

Endometriosis is a chronic, multisystem inflammatory condition where tissue similar to the lining of the uterus (the endometrium) grows outside it, often causing pain and other symptoms. Recognising the symptoms early can help support more effective management, contribute to earlier diagnosis, and ultimately improve quality of life.

Endometriosis commonly grows within the abdominal cavity on the ovaries, fallopian tubes, uterosacral ligaments, and the gastrointestinal tract. It can also, although less commonly, be found on the lungs, heart, or the central nervous system. Specific symptoms depend on the location of the lesions; however, non-specific symptoms such as fatigue and chronic pelvic pain can occur regardless of location.

You may also be wondering, can endometriosis cause fatigue, digestive issues, or even anxiety? The answer is yes - endometriosis is a whole-body condition that can affect far more than the reproductive system.

The severity of the disease or the size of the lesions does not necessarily correlate with the severity of symptoms experienced. You might be surprised to learn how many of your symptoms are actually related to endometriosis.

The 3 Ds of Endometriosis- And The 4th D!

The 3 Ds of Endometriosis are the most common symptoms of Endometriosis. They are are:

1. Dysmenorrhea
2. Dyspareunia
3. Dyschezia

In normal terms, this is period pain, painful sexual intercourse and pain whilst using your bowels. Sometimes a fourth D is added- dysuria (painful urination).

However in addition to these most commonly complained of symptoms, women can experience a wide range of symptoms diminishing their quality of life such as increased incidence of depression, reduced capacity to participate in daily activity, reduced social activity, loss of productivity and income, adverse affects on intimate relationships, and also increased risks of other chronic disease manifestations, including obstetric and neonatal complications, cancer and Chronic Fatigue Syndrome (Harada et al 2016; Chen et al 2018).

1. Key Symptoms of Endometriosis

Pain

One of the most common endo symptoms is pelvic pain. Pelvic pain is experienced by approximately 80–90% of people with endometriosis, particularly before and during menstruation (dysmenorrhea), but can occur at any time. You may notice that it is often not relieved by painkillers (severe), may worsen over time, and can become present throughout the month, not just before and during menstruation. Due to the systemic nature of endometriosis, pain is not limited to where the lesions are located. The following pain symptoms can occur:

• Severe pelvic pain, associated with periods (dysmenorrhea), but also at ovulation and other times
• Pain during sexual intercourse (dyspareunia)
• Pain with bowel movements or urination (dyschezia or dysuria)
• Chronic and can be severe lower back or abdominal pain
• Headaches or migraines
• Stiff or painful joints
• Pain in ovaries

Read about the Natural Medicine approach to pain relief here. 

Menstrual Changes

Other common symptoms of endo are menstrual changes. As a woman’s menstrual experience is highly personal and subjective, it can sometimes be difficult to know if what you are experiencing is normal or not.

A normal period typically lasts between 3–7 days, with the cycle lasting between 21–35 days. An average amount of blood lost is around 60 ml per cycle. If you are losing more than 80 ml, it is considered heavy. In practical terms, if you need to change your sanitary products more than every couple of hours, and your period lasts many days, your bleeding is likely heavy.

• Heavy bleeding (menorrhagia), prolonged periods, and blood clots
• Irregular periods
• Spotting between periods
• Iron deficiency

Bowel and Bladder Symptoms of Endometriosis

Many of the following symptoms can make endometriosis difficult to diagnose, as it can mimic other conditions due to its systemic, whole-body nature. Women may not recognise that these symptoms are part of the illness, even though they are very common in people with endometriosis.

• Bloating (“endo belly”)
• Nausea- can be before, during or after periods
• Diarrhea or constipation (especially with periods)
• Haemorrhoids
• Reflux, indigestion, or heartburn
• Burning or stinging urination
• Frequency and/or urgency of urination
• Blood in the urine
• Vaginal discharge or irritation

Fatigue and General Wellbeing

Despite being a major symptom of endometriosis, fatigue associated with the condition is not acknowledged nearly enough. It affects anywhere between 71% and 95% of people with endometriosis. This level of exhaustion can significantly impact quality of life, including work, relationships, social life, sport, and education. Interestingly, people diagnosed with Chronic Fatigue Syndrome (CFS) often have endometriosis as part of their gynaecological history.

• Chronic and severe tiredness or low energy
• Brain fog
• Mood changes (linked to pain and hormonal fluctuations), including PMS
• Dizziness
• Sleep difficulties

Mental Health Symptoms

Depression and anxiety are commonly experienced by people living with chronic conditions. Whilst pain and fatigue affect the majority of people with endometriosis, depression may occur in about a third of these women.

• Depression
• Anxiety

2. Uncommon Symptoms of Endometriosis

Other symptoms have also been associated with endometriosis and are indicative of the systemic, widespread inflammation and immune system involvement that occurs with this condition. Less common, or symptoms that may not typically be recognised as part of endometriosis, include:

• Allergies, hay-fever, sinusitis
• Sciatic and leg pain
• Insomnia
• Palpitations
• Allodynia (intolerable pain in response to normally non-painful pressure) / neuropathic pain

2. Symptom Variability and Misdiagnosis of Endometriosis

Symptoms of endometriosis can vary widely. Some people experience severe pain, while others have milder symptoms. Some present with a wide range of symptoms, while others may only discover the condition through infertility.

Because of this variability, diagnosis can often be delayed. On average, it takes between 4 and 7 years to receive a diagnosis, with many people seeing multiple healthcare practitioners (often around seven) before reaching an accurate diagnosis. This is partly because endometriosis is frequently mistaken for other conditions such as IBS, pelvic inflammatory disease, or even “normal” period pain.

If this has happened to you, know that there are several reasons why diagnosis may be delayed, and that misdiagnosis is common. Receiving a diagnosis is an important step, and from here you can begin to feel more informed and empowered in managing your health.

3. Possible Contributing Factors

While the exact cause of endometriosis is not fully understood, several contributing factors may play a role, including:

• Toxin accumulation
• Hormonal imbalance
• Immune dysregulation
• Inflammation
• Nutrient deficiencies
• Nervous system stress
• Genetics

When these underlying factors are addressed, many women may experience improvements in their symptoms and overall quality of life. Identifying and addressing these imbalances can be an important part of a comprehensive approach to managing endometriosis.

4. When to Seek Help

It is important to seek professional health support if you are experiencing any of the following symptoms:

• Persistent pelvic pain
• Heavy bleeding during periods or between periods
• Difficulty managing daily activities due to any symptoms
• Problems conceiving

5. Naturopathic Support for Endometriosis Symptoms

While endometriosis can be challenging, there are ways to support your body and reduce symptoms, especially when underlying imbalances are addressed.

There are many approaches that can support your health, including lifestyle and dietary modifications, along with clinical care from an experienced naturopath specialising in endometriosis. Utilising powerful herbal medicine and nutrient and mineral therapy can help reduce symptoms and support your overall wellbeing.

Read how to treat endometriosis naturally here.

Conclusion

You may have been told your symptoms are “just part of being a woman”- but ongoing pain, heavy bleeding, and fatigue are not something you have to live with.

If you are struggling with any endometriosis symptoms, please seek the help you need. It is not normal to live with these issues.

You may need to advocate for yourself due to the complex and often misunderstood nature of this condition, but please don’t give up. Your experience deserves to be acknowledged and supported, not dismissed or ignored.

With the right support, many women experience significant improvements in their symptoms and quality of life. There is real help available, and there is hope.

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