What Are the Three Signs of Endometriosis?

Reviewed on 6/22/2022

Woman experiencing endometriosis pain and lying on the couch holding her stomach
Three common signs of endometriosis may include pain (pelvic pain, pain with menstruation, pain during sexual intercourse, lower abdominal pain, pain during bowel movements), infertility, bladder and bowel symptoms, constipation, bloating, pain with urination, and blood in urine.

Endometriosis is a common condition in which tissue similar to the lining of the uterus grows outside the womb, resulting in pelvic pain and fertility problems.

Endometriosis may not always cause signs or symptoms. Three common signs of endometriosis may include: 

Other signs of endometriosis may include: 

  • Heavy menstrual bleeding
  • Irregular bleeding
  • Spotting between periods
  • Ovarian cysts called endometriomas (cysts containing endometriosis tissue)
    • Usually filled with old blood resembling chocolate syrup and are sometimes referred to as “chocolate cysts”
    • They are benign (not cancerous) but may also cause pelvic pain

What Causes Endometriosis?

It is unknown what causes endometriosis, but there are theories as to why the condition occurs such as:

  • Metaplasia is when one type of tissue changes to another normal type of tissue
    • One theory is that endometrial tissue may change and replace other types of tissues outside the uterus
  • There may be a genetic predisposition to developing endometriosis
    • First-degree relatives of women who have endometriosis are more likely to develop the condition
  • Immune system dysfunction it thought to possibly play a role
  • Lymphatic or vascular distribution of endometrial cells in which endometrial fragments travel through blood vessels or the lymphatic system to other parts of the body may explain how endometriosis cells end up in distant sites, such as the brain, lung, skin, or eye
  • Retrograde menstruation is an older theory that suggests menstrual tissue flows backwards through the fallopian tubes (“retrograde flow”) and deposits on the pelvic organs where it grows
    • However, researchers have found 90% of women have retrograde flow and do not have endometriosis, so not believed to be a trigger for endometriosis
  • A controversial theory is that environmental factors may contribute to the development of endometriosis, such as the effects of toxins in the environment on reproductive hormones and immune system function. 


Endometriosis occurs deep inside the uterus. See Answer

How Is Endometriosis Diagnosed?

  • There is no single test to diagnose endometriosis, and it can be difficult to diagnose. Many women are conditioned to believe their pain symptoms are normal, and birth control hormones or pregnancy can temporarily relieve symptoms even without a diagnosis, so a diagnosis is often difficult.  
  • A common problem among patients with endometriosis is having a healthcare provider take the pain seriously so it is important for women to find a doctor experienced in treating endometriosis.
  • The only way to definitively diagnose endometriosis is with an invasive laparoscopic procedure and a tissue biopsy. This procedure may also be used to remove endometriosis at the same time. 
  • Endometriomas (ovarian cysts containing endometriosis tissue) may be seen with ultrasound

What Is the Treatment for Endometriosis?

Endometriosis symptoms usually go away when a woman goes through menopause.

Medications used to treat endometriosis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Hormonal birth control
  • Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists 
  • Aromatase inhibitors 

Surgery for endometriosis is used both to diagnose endometriosis and also to remove it. It may be performed before medications are tried since it’s used diagnostically. It may also be considered if medications do not work to relieve pain. 

Endometriosis can also cause infertility. Treatments for infertility related to endometriosis include:

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Reviewed on 6/22/2022

Image Source: iStock Images