If your periods have always been painful, you might have learned to push through them. And if the same symptoms show up at other times of the month, there’s a good chance you didn’t connect them with your period at all.
That’s part of what makes endometriosis so hard to recognize.
“Many people think endometriosis always means unbearable period cramps,” says Jessica Mullins, MD, director of gynecology at Hartford Hospital. “But the symptoms can look very different from person to person. It happens when tissue similar to the lining of the uterus grows outside the uterus, and it affects about 1 in 10 women of reproductive age worldwide.”
So what else should you be looking for? Here are six symptoms of endometriosis to bring up with your doctor.
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1. Pelvic pain
Endometriosis pain is often worst before or during your period, but it doesn’t always follow that pattern.
You might notice:
- A deep ache or pressure in your pelvis.
- Lower abdominal or back pain.
- Pain that comes and goes.
- Pain that has gradually gotten worse.
“Your period can give us an important clue, but we also want to know what happens during the rest of the month,” says Dr. Mullins. “Pain that keeps returning or interferes with school, work or everyday activities deserves a closer look. And although it’s rare, endometriosis can sometimes affect the diaphragm or chest, causing shoulder or chest pain.”
> Related: 5 Pelvic Floor Exercises That Are Actually Worth Trying
2. Pain during or after sex
If you’re experiencing pain during or after sex, it can be hard to bring up with your doctor, but it’s important to mention.
“With endometriosis, pain may feel deep in the pelvis or continue after sex,” explains Dr. Mullins. “You may even start avoiding certain positions or sex altogether because you expect it to hurt.”
And you don’t have to feel embarrassed about bringing it up.
“Your doctor has heard this before,” she adds. “That detail can help us better understand what may be happening.”
> Related: Does Sex Cause UTIs in Women?
3. Bowel or bladder symptoms during your period
Stomach or bathroom problems might not seem related to your period, but sometimes the timing is a hint.
Endometriosis can affect areas near the bowel or bladder and can cause:
- Pain with a bowel movement or urination.
- Diarrhea or constipation.
- Bloating or nausea.
- Lower abdominal pain.
- A strong urge to urinate.
“The timing matters,” explains Dr. Mullins. “If your stomach or bathroom symptoms seem to flare before or during every period, tell your doctor. That pattern may be an important part of the story.”
> Related: 9 Common Causes of Constipation
4. Heavy or unexpected bleeding
Cramps aren’t the only period symptom you should pay attention to.
“Endometriosis can also be associated with heavy or longer periods or bleeding between periods,” says Dr. Mullins. “Heavy bleeding can leave you feeling drained and may contribute to low iron levels over time.”
It helps to be specific about what “heavy” means for you.
“Tell us how often you change period products, whether you bleed through clothes or bedding and whether bleeding keeps you from leaving home,” she says.
> Related: Heavy Periods? Signs It Could Be Uterine Fibroids
5. Fatigue
Endometriosis can leave you feeling exhausted, especially around your period.
“You may feel especially tired around your period or like you never quite catch up, even after a full night of sleep,” says Dr. Mullins. “Pain, poor sleep and heavy bleeding may all play a role.”
Of course, fatigue by itself doesn’t point directly to endometriosis.
“But when it shows up along with pelvic pain, heavy periods or other symptoms, we want to hear about the whole picture,” she adds.
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6. Trouble getting pregnant
For some people, trouble getting pregnant is the first sign of endometriosis.
Endometriosis can cause inflammation or scar tissue around the ovaries or fallopian tubes, which can interfere with fertility.
“Endometriosis can affect fertility, but every person’s situation is different,” says Dr. Mullins. “The important thing is to ask for an evaluation so we can talk about your options instead of assuming the worst.”
> Related: 5 Uterine Fibroid Treatments That Can Help Relieve Symptoms
When to see a doctor
Endometriosis can look like digestive, bladder or other health problems, which is one reason diagnosis can take time.
“Many patients have spent years assuming that painful periods are just something they have to push through,” says Dr. Mullins. “But if pain is changing how you live your life, we need to talk about it.”
Your doctor may use your symptoms, exam and imaging to help guide next steps. Treatment can include pain medicine, hormonal treatment or surgery.
“You don’t need to know exactly what’s wrong before you come in,” she adds. “Tell us what you’re experiencing, and we can figure out the next steps together.”
