What are the Symptoms of Endometriosis?

Endometriosis is a complex disease of the female reproductive system in which tissue similar to the lining of the uterus grows outside the womb. This disease can cause pain, fertility problems, severe menstrual cramps, menstrual delay, severe pain during and after sexual intercourse, and bowel problems.

What Is Endometriosis?

One of the most common diseases in women is endometriosis, abnormal growth of uterine tissue outside the uterus. Mainly, this tissue is formed in the pelvis, ovaries, fallopian tubes, peritoneum, and the wall separating the anus and pelvis. We should note that endometriosis can also grow on cesarean wounds, laparoscopy wounds, bladder, intestine, appendix, and anus. The most crucial symptom of endometriosis is severe pain in the pelvic area. This pain often occurs during the menstrual cycle and sometimes before or after. 

It should be noted that the upper transient tissue of the uterus sheds during menstruation, but this does not happen if the tissue is formed outside the uterus. As a result, endometriosis can have a wide range of side effects on the body. Complications of endometriosis include the obstruction of the fallopian tubes, difficulty in having sexual intercourse, difficulty in doing daily activities and working, and infertility. 

Endometriosis is an abnormal growth of uterine tissue outside the uterus.

Stages of Endometriosis

Endometriosis occurs in four different stages; therefore, it has four types of symptoms and complications. The stages of endometriosis are determined according to the tissue's location, size, number, and depth. In the following, the four stages of endometriosis are introduced. 

Stage 1 or Minimal Endometriosis

At this stage of endometriosis, the endometrial tissue is shallow, and the severity of the disease is very low. In minimal endometriosis, these problems may occur:

  • Inflammation in and around the pelvic cavity;
  • The emergence of minor wounds inside the ovaries;
  • Irritation in the intestines and bladder;
  • Pain during the sex;
  • Painful periods; and
  • Excessive menstrual bleeding.

Stage 2 or Mild Endometriosis

The symptoms of mild endometriosis are the same as minimal endometriosis but with deeper endometrial layers. Since during mild endometriosis, light lesions are formed in the ovaries and pelvic, the last two weeks of the menstrual cycle are more painful. Also, you may experience pain during or after sex and while urinating, nausea, constipation, or diarrhea when you have stage 2 endometriosis. 

Stage 3 or Moderate Endometriosis

In moderate endometriosis, more lesions are formed, and the depth of endometrial tissue in the ovaries and pelvic lining also increases. At this stage, some cysts and adhesions are formed in one or both ovaries that cause severe pain in the pelvis and abdomen.

Endometriosis may cause ovulation disorders and infertility.

Stage 4 or Severe Endometriosis

In stage 4 endometriosis, the lesions are deeply implanted in the pelvic and ovaries or the intestines and fallopian tubes. The more endometriosis layers increase, the more pain and digestive problems increase; therefore, removing cysts is necessary.

It should be noted that severe cases of endometriosis can lead to infertility as it causes problems such as low egg quality, inflammation of the fallopian tubes, and adenomyosis or heterogeneous myometrial. However, mild to moderate endometriosis does not usually cause infertility.

15 Symptoms of Endometriosis

The first and most common sign of endometriosis is pain in the pelvis, especially during menstruation. This pain may occur in different areas and at different times. Some other symptoms of endometriosis include:

  • Pain in the abdomen during menstruation which cannot be controlled by common painkillers such as ibuprofen;
  • A menstrual period that lasts more than seven days;
  • Severe bleeding accompanied by blood clot discharges during menstrual period;
  • Menstrual cycle less than 27 days;
  • Pain in the lower abdomen during urinating or bowel movement;
  • Intestinal disorders and irritable bowel syndrome (IBS) with symptoms such as diarrhea, constipation, stomachache, and bloating;
  • Pain during or after sex;
  • Chronic pain in the lower back;
  • Nausea and vomiting;
  • Constant fatigue;
  • Pain during examination by a doctor;
  • Depression;
  • Bleeding and spotting between menstrual periods;
  • Painful intestine movements and bleeding when defecting; and
  • Feeling pain in legs.

Pain in the abdomen during menstruation is one of endometriosis Symptoms

In some cases, the above symptoms are caused by other diseases such as ovarian cysts, pelvic inflammatory disease (PID), or irritable bowel syndrome (IBS). Therefore, doctors must carefully determine the leading causes of such symptoms before doing any treatment.

What Causes Endometriosis?

The leading causes of endometriosis are still unknown. But scientists believe that estrogen will worsen endometriosis. That’s why estrogen-regulating drugs are used to treat endometriosis. In addition to estrogen production, other factors cause endometriosis, such as:

  • Genetic or inherited problems;
  • Growth of stem cells in the pelvic and gastric mucosa;
  • Transfer of endometrial cells by the lymphatic system to different parts of the body;
  • Immune system disorders;
  • Deformation of embryonic stem cells into endometrial-like cells due to stimulation of some hormones such as estrogen;
  • The problem in menstrual blood flow that causes its entry into the pelvis or fallopian tubes instead of leaving the body;
  • Being over the age of 35 years;
  • Not exercising;
  • Drinking too many caffeinated and alcoholic beverages;
  • Low body mass index (BMI);
  • Early menstruation;
  • Late menopause; 
  • Genital disorders; etc.

Estrogen is one of the main causes of endometriosis

Complications of Endometriosis

Endometriosis, as one of the most common and complicated diseases in women, has multiple complications such as:

  • Diarrhea and constipation;
  • Bloating and nausea;
  • Severe or irregular bleeding during menstruation;
  • Infertility;
  • Cramping;
  • Ovarian cysts;
  • Intestinal and bladder problems such as ileus;
  • Increased risk of ovarian and breast cancer;
  • Rupture of cysts and lesions;
  • Adhesion and scarring of internal tissues; and
  • Inflammation of the surrounding areas of endometriosis.

Who Is More Likely to Get Endometriosis?

People with a family history of endometriosis are more likely to get this disease. Also, women who:

  • Are between the ages of 25 and 35,
  • Have no account of childbearing,
  • Had endometriosis in the past,
  • Have irregular periods longer than seven days with the interval of fewer than 27 days, and
  • Undergone menstruation before the age of 12.

In general, endometriosis is highly dependent on sex hormones such as estrogen; therefore, being at the reproductive age increases the risk of developing this disease in women.

How Is Endometriosis Diagnosed?

There are several ways to diagnose endometriosis and its severity. Some lead to a definitive diagnosis of the disease, and some rule out the possibility of other conditions.

Some ways of diagnosing endometriosis include:

  • Endometriosis ultrasound
  • Having a detailed medical history
  • Pelvic examination
  • Differential diagnoses
  • Laparoscopy and biopsy
  • MRI
  • Blood test

Endometriosis ultrasound

The doctor can perform a transvaginal or transabdominal ultrasound to diagnose the endometriosis in the uterus, ovaries, bladder, and intestines.

Using ultrasound is a way to diagnose endometriosis.

Having a detailed medical history

Doctors recommend patients to report their problems such as painful menstruation, pain during intercourse, and spotting before menstruation to the doctor.

Pelvic examination

Clinical examinations of the pelvis and the surrounding organs are essential in identifying the early signs of Endometriosis.

Differential diagnoses

Doctors can diagnose Endometriosis by comparing its symptoms with other diseases with similar signs such as ovarian cysts, pelvic inflammatory disease (PID), and irritable bowel syndrome with common symptoms such as abdominal pain, diarrhea, constipation, etc.

Laparoscopy and biopsy

Laparoscopic surgery and biopsy of the internal organs is the only definitive way to diagnose Endometriosis. Laparoscopy can determine the size, location, and depth of endometriosis.

laparoscopic surgery


By imaging the internal organs of the pelvic cavity and observing their condition, the doctor can detect the development of endometriosis.

Blood test

A blood test is ineffective for diagnosing endometriosis, but doctors may use it to check hormones.

Endometriosis Treatment

Since the causes of endometriosis are not yet known, there is no definitive treatment for it. However, most physicians suggest one of the following treatments to the patients based on the severity of their disease, their symptoms, age, and their desire to have children in the future.

In the following, we introduce the most common methods of treating endometriosis:

  • Dietary modification
  • Taking analgesics
  • Laparoscopy
  • Hormone therapy
  • Removing the ovaries and uterus
  • Progestin therapy
  • Taking gonadotropin-releasing hormone (Gn-RH) agonists
  • Using ARTs

Dietary modification

People with endometriosis should avoid having fatty foods, red meat, and by-products from animals because these foods can increase estrogen production in the body.

Eating high-fat foods is harmful for endometriosis.

Taking analgesics

The doctors usually ask the patients to take nonsteroidal anti-inflammatory drugs such as naproxen, ibuprofen, and mefenamic acid to reduce their pain during menstruation.


The best way to treat and diagnose endometriosis is laparoscopy or, in severe cases, laparotomy.

Hormone therapy

By taking hormonal medications, the amount of estrogen in the body gets balanced, and therefore, the pain of endometriosis is reduced to a great extent.

Hormonal therapy, one of the ways to treat endometriosis by regulating estrogen

Removing the ovaries and uterus

Removing the ovaries (oophorectomy) and uterus (hysterectomy) are the last options in treating endometriosis because the patient cannot get pregnant after these surgeries.

Progestin therapy

Subdermal progestin implant, levonorgestrel intrauterine device (IUD), injectable contraceptives, and progestin pills stop the growth of endometrial tissue.

Taking gonadotropin-releasing hormone (Gn-RH) agonists

Taking these medications lowers estrogen levels, stops the production of ovarian-stimulating hormones, and prevents menstruation; as a result, the endometrial tissue will shrink.

Using ARTs

In some cases, assisted reproductive techniques such as IVF treatment or IUI are used to treat endometriosis-related infertility.

Estrogen is one of the main causes of endometriosis
Read more: What Should We do to Treat Endometriosis Pain?

Use assisted reproductive methods, is a means of pregnancy with endometriosis

Endometriosis and Infertility

About 30 to 50% of women with endometriosis have fertility problems because this disease causes:

  • Adhesion and scarring in the uterus;
  • Blockage of fallopian tubes that prevents the movement of sperm and eggs;
  • Limitation in egg growth;
  • Reduction in egg production and quality;
  • Disorders in the ovulation process;
  • Changes in the pelvic anatomy;
  • Pelvic inflammation; and
  • Hormonal imbalance.

As it was mentioned above, most women with endometriosis have ovulation problems. For this reason, the doctor may prescribe fertility and ovulation induction drugs. As soon as ovulation begins, the doctor uses IVF or IUI procedure to increase the chance of pregnancy. 

We should note that some treatments for endometriosis can prevent pregnancy or cause congenital disabilities; therefore, the whole treatment process should be done under the supervision of a skilled and experienced physician. Treatment for endometriosis to treat infertility is also time-consuming, so it should begin without delay.

Endometriosis and Uterine Cancer

The relationship between endometriosis and uterine cancer has not yet been found. In fact, endometriosis does not cause uterine cancer in all patients; but it seems that some cancers such as breast cancer and hematologic malignancies are more common in women with this disease.

Uterine cancer or endometrial cancer, which starts from the endometrial tissue, shows symptoms such as bleeding and spotting after menopause, spotting between menstrual periods, and pelvic pain. Cases such as chronic inflammation and estrogen stimulation in patients with endometriosis increase the risk of endometrial cancer. So, if you noticed any of the mentioned symptoms, visit your doctor and get a full checkup before it’s too late.

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