Updated March 2026
Symptoms of Endometriosis:
More Than Just Period Pain
Contrary to what some people may believe, endometriosis is not simply characterised by heavier-than-usual periods. This condition, which affects 1 in 10 women globally, is often misunderstood and discussed far less often than it should be as a highly prevalent women’s health issue.
As a result, many women face a long and difficult journey to diagnosis. On average, this can take 7.5 years from the onset of symptoms. However, awareness of the symptoms of endometriosis is improving, and there is support available for those affected.
20-25% of women with endometriosis are asymptomatic, but for many, symptoms extend far beyond heavy bleeding (menorrhagia) and can include:
- Painful cramps which may get worse over time
- Pain during or after sex
- Bleeding between periods (spotting)
- Painful bowel movements and urination
For others, more unusual symptoms of endometriosis can make diagnosis even more challenging. The symptoms of this condition can regularly affect daily life, impacting work, leisure time, and even relationships.
Dr Ghazala Aziz-Scott at the Marion Gluck Clinic explains: “There is a preconception that heavy and painful periods are normal, and as a result many women will put up with severe symptoms. We now know that, for women, the health of the menstrual cycle is almost a fourth vital sign. Cycles that are irregular, heavy and cause severe pain can tell us that something is wrong with a patient’s health. But unfortunately, these symptoms are often dismissed, or the patient is prescribed the pill, which masks symptoms rather than establishing the underlying cause.”
Below, we explore some of the less commonly discussed symptoms of endometriosis and how they may affect daily life.
1. Fatigue
Fatigue is a feeling of exhaustion and tiredness that goes far beyond a typical mid-afternoon slump. It may be impossible for you to carry on as normal with your day, and you may have the constant urge to sleep. This type of fatigue is often linked to chronic inflammation and ongoing endometriosis pain, yet it is frequently dismissed. Persistent fatigue should always be taken seriously and investigated.
2. Acne
Similarly to other hormonal conditions such as Polycystic Ovary Syndrome (PCOS), women with endometriosis may also find that their skin is more susceptible to acne breakouts, even into adulthood. Research suggests that women who experienced severe teenage acne were 20% more likely to develop endometriosis. Acne can be difficult to treat with over-the-counter face washes and creams. However, hormone balancing and addressing gut health can support treatment for this endometriosis symptom.
3. Infertility
Although endometriosis does not cause infertility in all cases, endometrial tissue can cause scarring around the ovaries and fallopian tubes, causing damage which can lead to infertility. There is also a small risk associated with surgery to remove this tissue. However, it’s important to note that many women with endometriosis can still conceive naturally.
4. Depression
Like many chronic conditions, endometriosis can have a significant impact on mental health. Ongoing endometriosis pain, delayed diagnosis, and limited awareness can contribute to feelings of frustration, isolation, and depression. The emotional burden of living with persistent symptoms should not be overlooked.
5. Urgency To Urinate
Endometriosis can sometimes mimic a urinary tract infection (UTI) If endometrial tissue is present near the bladder, it may cause:
- A frequent or urgent need to urinate
- Pain in the bladder area, particularly during menstruation
- Discomfort when urinating
6. Bloating (“Endo Belly”)
Bloating is actually so common in endometriosis sufferers that it has its own name: ‘endo belly’. Inflammation in the digestive system can lead to persistent bloating, nausea, and excess gas, particularly after eating. This is one of the most noticeable gastrointestinal symptoms of endometriosis..
7. Acid Reflux
Endometriosis, as well as the regular use of pain medication to manage endometriosis pain, can contribute to acid reflux. Endometrial tissue in the gastrointestinal tract may cause inflammation and gut imbalances (dysbiosis), disrupting digestion before and during menstruation.
8. Pain During or After Sex
Pain during or after sex (dyspareunia) is a common, but often under-discussed, symptom of endometriosis. This type of pain can occur when endometrial tissue grows behind the uterus or around pelvic nerves, causing deep discomfort during intimacy and affecting quality of life and relationships
9. Lower Leg and Back Pain
Endometriosis can also cause lower back pain and radiating leg pain. This happens when endometrial tissue affects nerves in the pelvic region, leading to symptoms similar to sciatica. Leg pain and endometriosis are closely linked in some cases, particularly when symptoms worsen during menstruation.
What To Do If You Have Symptoms Of Endometriosis
Endometriosis is not just a hormonal condition, it is a whole-body inflammatory disease with immune dysfunction at its core. The immune system is unable to effectively clear abnormal endometrial tissue from the body.
Potential contribution factors include:
- Genetics – having a genetic predisposition to the condition
- Epigenetics – how the gene expression is affected by the environment
- Gut dysbiosis – overgrowth of bad bacteria in the gut (women with endometriosis have high levels of gram-negative bacteria, which comes from the gut, in their pelvis)
In conventional medicine, the standard treatment for endometriosis is surgical or medications to block ovulation. However, if it is possible to determine the root cause of the condition, complications of endometriosis requiring surgery may be prevented.
A more integrative approach typically includes:
- Supporting the immune system
- Reducing inflammation through diet
- Addressing gut health
- Hormone balancing
Hormone treatment is beneficial, particularly for women with oestrogen dominance. In some cases, bioidentical progesterone may help prevent symptoms from worsening.
Before starting treatment, it is essential to rule out other conditions with similar symptoms, such as:
Testing, including blood tests and more advanced hormone assessments, can provide valuable insight into your hormone profile and help guide treatment decisions.
What Next?
If you recognise any of these symptoms of endometriosis, it’s important to seek support. Early intervention can reduce symptoms, improve quality of life, and prevent progression of the condition.
To learn more about treatment options, book a consultation with one of our experienced hormone specialists at the Marion Gluck Clinic.
To find out more about the treatment of endometriosis, read our blog post here.
