Periods can cause pain, but pain that interferes with your entire day, makes you miss school or work, causes pain during intimacy, or can flare up when you use the toilet warrants further investigation. Endometriosis may be a culprit. It can impact a lot more than your period, and the symptoms can vary widely between individuals. Here’s what to know, including how endometriosis is diagnosed and what treatment options can help.
On this page
- What is endometriosis?
- What does endometriosis feel like?
- How is endometriosis different from adenomyosis?
- Why does endometriosis happen?
- Who is more likely to develop endometriosis?
- How is endometriosis diagnosed?
- Can an ultrasound find endometriosis?
- Do you need surgery to diagnose endometriosis?
- How is endometriosis treated?
- Can you treat endometriosis with surgery?
- Can endometriosis make it harder to get pregnant?
- What can help with endometriosis pain day to day?
- When to see a doctor?
Key takeaways
- Endometriosis is a condition that causes tissue similar to the uterine lining to grow outside the uterus, which may cause inflammation, pain, scar tissue, or fertility issues.
- Endometriosis pain that disrupts daily life, such as school, work, sleep, exercise, intimacy, or everyday routines, should be evaluated by a healthcare provider.
- Endometriosis can be diagnosed without surgery, based on symptoms, examination, and imaging.
- A normal ultrasound does not mean endometriosis is absent, as small or superficial areas may be difficult to detect.
- Treatment options are based on your goals and include pain management, hormonal therapy, or surgery, as well as fertility-centered care.
- Endometriosis can make pregnancy more difficult, but that does not mean that pregnancy is impossible.
What is endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue similar to the endometrium (the lining of the uterus) is found elsewhere in the body. It commonly affects organs in the pelvis (the lower part of the abdomen between the hip bones). These abnormal areas of endometriosis, known as lesions, can cause inflammation, pain, scar tissue, and fertility challenges.1
The prevalence of endometriosis is over 11% in American women ages 15-44.2 It can affect the ovaries, fallopian tubes (the tubes that carry a developing egg from the ovaries to the uterus), the outer surface of the uterus, the bowel, the bladder, or other areas in the pelvis.
An endometrioma (an ovarian cyst formed from endometriosis, often called a “chocolate cyst”) can form on the ovary, and adhesions (bands of scar tissue) can develop between tissues and organs.2
It’s important to note that the amount of endometriosis present does not necessarily correlate with pain. Some individuals with minimal disease may experience significant pain, and others with more extensive disease may be less symptomatic.3
What does endometriosis feel like?
Endometriosis can cause pain around the time of menstruation, but symptoms are not related to periods only. You can also experience pain during sex, bowel movements, or urination. Some people also experience bleeding changes, digestive symptoms, fatigue, or difficulty becoming pregnant.23
| What you notice | What it may suggest |
| Very painful periods | Pelvic cramping or pain may begin before bleeding and continue during the period. |
| Pelvic or lower-back pain | Pain may occur between periods or become persistent. |
| Pain during or after sex | Endometriosis can cause deep pelvic pain during intercourse. |
| Pain with bowel movements or urination | These symptoms may become more noticeable around your period. |
| Heavy bleeding or spotting between periods | Bleeding changes can occur, although they can have many other causes. |
| Bloating, constipation, diarrhea, or nausea | Digestive symptoms may become more noticeable around menstruation. |
| Difficulty becoming pregnant | Fertility problems may sometimes be the first clue. |
Severe endometriosis pain may not correlate with the appearance of the disease on examination or imaging. This is especially important to remember because painful periods should not be dismissed or underestimated just because an ultrasound exam looks normal.
Ongoing pain can also affect your mood, sleep, relationships, and daily life. If this is happening, mention it to your healthcare team.
Additionally, endometriosis does not only happen to adults. ACOG (the American College of Obstetricians and Gynecologists) currently includes adolescents (people in the stage between childhood and adulthood) in its guidelines for diagnosing endometriosis, given that they can develop symptoms earlier in life.1
Period pain that repeatedly prevents a teenager from attending school, sleeping, exercising, or taking part in normal activities is a strong reason to seek an evaluation.
How is endometriosis different from adenomyosis?
Endometriosis grows outside the uterus. Adenomyosis happens when tissue from the uterine lining grows into the muscle wall of the uterus.4
Both conditions can cause painful periods. Adenomyosis can also cause heavy menstrual bleeding.4
Why does endometriosis happen?
The reason why endometriosis occurs is still a mystery. However, a few factors may be involved2:
One suspected cause is retrograde menstruation (when some menstrual blood flows backward through the fallopian tubes into the pelvis). This process can push cells similar to your uterine lining to other parts of your pelvis.2
Genes may also contribute to endometriosis because it is more common in certain families. Hormones and your immune system may also play a role.2
Hormones (chemical messengers that help control different body processes) can cause endometriosis tissue to grow and become active. Estrogen, a specific hormone, appears to be very important in this case.2
The cause of endometriosis is not anything you did. Eating a healthy diet, exercising, managing stress, and other behaviors will not change your risk of endometriosis.
Who is more likely to develop endometriosis?
Some factors are linked with a higher chance of endometriosis. But these factors do not mean that you will definitely develop it.5
Your chance may be higher if a mother, sister, or daughter (first-degree relative) has endometriosis, your periods started before age 11, or your cycles are shorter than 27 days.5
Periods lasting more than 7 days, which studies use as a marker of heavy flow, and difficulty getting pregnant are also linked with a higher risk. Never having had children is another factor linked with a higher chance of endometriosis.5
How is endometriosis diagnosed?
There is no single, quick test that can find every case of endometriosis. The first step usually involves a thorough discussion about your symptoms.
Your OB-GYN may ask when the pain happens and how long it lasts. They may ask if sex, urination, or bowel movements are painful. Your doctor will also want to understand how your symptoms affect your daily routine. Missing school, work, sleep, exercise, or social activities can be important information.
A pelvic exam (an exam of your reproductive organs and nearby pelvic area) might be done. Your doctor may gently press on your lower belly to see if you feel pain or swelling. Some doctors may also do a vaginal exam with gloved fingers. They do this to check for tenderness, cysts, or other changes.
Can an ultrasound find endometriosis?
An ultrasound can show some signs of endometriosis, but it can miss others. If your ultrasound shows signs, you’re more likely to have endometriosis, but a normal test does not completely rule it out.13
A transvaginal ultrasound is a test done with a thin device the size of a finger placed inside your vagina. It provides a detailed image of your uterus and ovaries. It can help find cysts (fluid-filled sacs) inside your ovaries and some areas of endometriosis deep in your pelvis.1
Small patches of endometriosis may not show up on the ultrasound picture. So, you should still consider your symptoms when the test is normal.1
In some cases, your doctor may do an MRI, or magnetic resonance imaging (a detailed picture of the inside of your body), for more detailed images.1
Do you need surgery to diagnose endometriosis?
Not always. Current ACOG guidance allows a presumptive diagnosis (a likely diagnosis based on symptoms, examination, and test results) in appropriate patients.16
This allows treatment to begin without surgery in some cases. Surgery remains an important tool when further diagnosis or surgical treatment is needed.
A laparoscopy (a surgical procedure where a thin camera is inserted through small cuts in your belly to look inside your pelvis) allows your surgeon to see inside and remove visible endometriosis. Sometimes, a small tissue sample (called a biopsy) is taken for testing under a microscope.
How is endometriosis treated?
There is no one-size-fits-all approach to dealing with endometriosis. Treatment depends on your symptoms, how they affect your life, and whether pregnancy is currently a goal. There is no cure, and treated endometriosis can come back. However, several treatments can reduce pain and other symptoms.7
| Treatment | What it may help with |
| Pain medicines | Medicines such as ibuprofen or naproxen may reduce period and pelvic pain. |
| Hormonal treatment | Hormonal medicines may reduce periods and endometriosis-related pain. |
| GnRH medicines | These medicines lower certain reproductive hormones and may reduce symptoms. |
| Surgery | Surgery may remove areas of endometriosis or scar tissue. |
| Fertility treatment | Fertility care may help when endometriosis makes pregnancy difficult. |
Non-steroidal anti-inflammatory drugs, or NSAIDs (a class of medicines that can help with pain and can lower inflammation), including ibuprofen and naproxen, may help with period and pelvic pain.7
Hormonal treatment may include birth control pills or other forms of progestin (a medicine that acts like the hormones we produce). This can help to lessen or stop bleeding during a period and help with pain.7
A hormonal IUD, or intrauterine device (a small device placed inside the uterus), may also help with pain and bleeding. This is different from a copper IUD, which does not contain hormones.7
Another option is GnRH (gonadotropin-releasing hormone) medicine, which lowers hormone signals involved in the menstrual cycle. These medicines can reduce or temporarily stop menstruation and ovulation.7 These medicines can also cause menopause-like side effects, such as hot flashes, mood changes, and bone density loss with longer use.7 Doctors often pair them with a low-dose “add-back” hormone therapy to help offset these effects.
Ovulation (the release of an egg from an ovary) is needed for pregnancy. For this reason, treatment is different when someone is actively trying to become pregnant.
Can you treat endometriosis with surgery?
Yes. Surgery may be used if your symptoms are severe or when other forms of treatment did not work well enough. Your doctor can remove or destroy endometriosis tissue using laparoscopy. They might also remove scar tissue if needed.7
Surgery can improve symptoms for some women, but the tissue can grow back. Additionally, having a hysterectomy (surgery that removes your uterus) is also not a guaranteed cure because endometriosis can exist outside your uterus.7
Can endometriosis make it harder to get pregnant?
Yes. Having endometriosis can make getting pregnant a little harder, but it does not mean that it is not possible.28
Endometriosis can cause inflammation, scar tissue, cysts on the ovaries, or changes in the area around the fallopian tubes. These changes can sometimes make it harder for an egg to meet a sperm. Even then, some people with endometriosis get pregnant without help, while others need help to get pregnant.28
If pregnancy is a goal, mention this when discussing treatment. Some treatments used mainly for pain are not suitable while you are trying to become pregnant.
Fertility testing usually begins after 12 months of trying if you are younger than 35. It usually begins after 6 months if you are 35 or older.8
Testing may begin sooner when a condition such as endometriosis may affect fertility. More immediate evaluation may also be considered for women older than 40.8
Some people may need IVF, or in vitro fertilization (a fertility treatment in which eggs and sperm are combined in a laboratory). The resulting embryo can then be placed inside the uterus.
What can help with endometriosis pain day to day?
A heating pad or warm bath can help with period cramps. Regular physical activity, pelvic floor physical therapy, and enough sleep also help some people manage menstrual pain.9 It can also be useful to keep a simple record of your symptoms. You do not need an app or a complicated diary. Write down:
- When the pain starts.
- Where you feel the pain.
- Whether it gets worse around your period.
- Whether sex, urination, or bowel movements make it worse.
- How heavy your bleeding is.
- What the symptoms stop you from doing.
The effect on your daily life is especially useful to record. “I missed two days of work because of the pain” can tell your doctor more than a pain score.
When to see a doctor?
Period pain does not always mean endometriosis. However, pain that keeps returning, becomes worse, or affects your daily life deserves medical attention. See an OB-GYN or primary care doctor if:
- Period pain regularly stops you from going to school or work.
- Pain keeps you awake or stops you from doing normal activities.
- Your period pain is becoming worse.
- You have pelvic pain between periods.
- Sex repeatedly causes deep pelvic pain.
- Bowel movements or urination are painful around your period.
- You often have spotting between periods.
- Your periods are unusually heavy.
- You are having difficulty getting pregnant.
- Measures that once helped no longer work.
Seek emergency care if:
- You have sudden, severe abdominal or pelvic pain with shoulder pain, dizziness, weakness, or fainting, especially if pregnancy is possible. These can be signs of an ectopic pregnancy (a pregnancy growing outside the uterus, usually in a fallopian tube), which can cause dangerous internal bleeding.10
- You are soaking through one or more pads or tampons every hour for more than two hours in a row.11
- You have chest pain, shortness of breath, dizziness, or lightheadedness with heavy bleeding.11
Yes. Some people have mild pain or no obvious pain at all. Endometriosis may first be found during an evaluation for fertility problems. It can also be found during an operation for other issues.
Yes. Endometriosis can happen as early as the teenage years. Severe period pain that consistently affects school, sleep, sport, or everyday life is worthy of a proper consultation with a healthcare provider. It shouldn’t be accepted as normal for periods.
Yes. Bloating, constipation, diarrhea, nausea, and other gut symptoms are common with endometriosis.
No. Some forms of endometriosis are visible on ultrasound, but small areas may be missed. A normal ultrasound scan does not mean that ongoing pelvic pain should be ignored, and your history is also important.
Endometriosis grows outside the uterus, while adenomyosis grows into the muscle wall of the uterus. Both can cause painful periods, but they are different conditions.
No. There is no blood test that can reliably diagnose endometriosis. ACOG recommends against using blood biomarkers (substances measured in the body), including CA-125, to diagnose it.
Not necessarily. Going through menopause (the stage when 12 months in a row pass without a period) reduces the level of estrogen produced by the ovaries. Endometriosis symptoms may become less noticeable after menopause, but they can also persist.
Not always. A hysterectomy (the removal of the uterus) does not treat endometriosis, which can be present outside the uterus.
Last medically reviewed on
References
Our commitment to accuracy is paramount; we use high-quality sources, including peer-reviewed studies, to support the facts in our articles. Learn more about our Editorial Process.
- American College of Obstetricians and Gynecologists. (ACOG).(2026). Diagnosis of endometriosis: ACOG Clinical Practice Guideline No. 11. Obstetrics & Gynecology, 147(3), 432–448. doi.org
- Office on Women’s Health (OWH). (2025). Endometriosis. U.S. Department of Health and Human Services. Page last updated October 24, 2025. womenshealth.gov
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). (2020). What are the symptoms of endometriosis? National Institutes of Health. Last reviewed February 21, 2020. nichd.nih.gov
- American College of Obstetricians and Gynecologists. (ACOG).(2025). Chronic pelvic pain. Last reviewed July 2025. acog.org
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). (2022). What are the risk factors for endometriosis? National Institutes of Health. Last reviewed January 28, 2022. nichd.nih.gov
- American College of Obstetricians and Gynecologists. (ACOG).(2026). ACOG publishes new endometriosis clinical guidance, aiming to shorten time to diagnosis and improve access to care. acog.org
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). (2025). What are the treatments for endometriosis? National Institutes of Health. Last reviewed December 11, 2025. nichd.nih.gov
- Practice Committee of the American Society for Reproductive Medicine. (2021). Fertility evaluation of infertile women: A committee opinion. Fertility and Sterility, 116(5), 1255–1265. doi.org
- American College of Obstetricians and Gynecologists. (ACOG).(2020). Painful periods. Last reviewed May 2026. acog.org
- American College of Obstetricians and Gynecologists. (ACOG).(2020). Ectopic pregnancy. Last reviewed April 2026. acog.org
- American College of Obstetricians and Gynecologists. (ACOG).(2021). Abnormal uterine bleeding. Last reviewed August 2025. acog.org
Update history
Our team monitors the health and wellness space to keep articles current.
Current version (September 30, 2026) — Medically reviewed by Dr. Sara Ahmad Qureshi, MBBS, MS. Written by Dr. Aqsa Munir, MBBS.
