Symptoms and causes of endometriosis

Symptoms of endometriosis

Common symptoms of endometriosis include:

• severe period pain
• deep pain during or after sex
• infertility
• persistent pelvic pain
• heavy periods.

Less common symptoms include:

• bowel symptoms (e.g. bloating, constipation, diarrhoea or pain when doing a poo)
• feeling very tired
• back pain
• sleep problems
• headache
• urinary symptoms (e.g. pain when weeing or blood in your wee)
• allergies.

Endometriosis and menopause

Endometriosis symptoms often improve after menopause due to the drop in oestrogen hormone levels.

But menopause is not a ‘cure’ for endometriosis. Some women continue to have symptoms after natural or medically induced menopause.

If you have endometriosis and are using menopausal hormone therapy (MHT) to manage menopausal symptoms, it’s recommended you use combined MHT rather than oestrogen-only MHT.

Endometriosis and persistent pelvic pain

Some women who have endometriosis also have persistent pelvic pain (PPP). PPP is pain in your pelvic area that’s felt most days and lasts for more than 6 months.

If your endometriosis symptoms stop you from doing day-to-day activities, for example, work, study or exercise, see your doctor. It’s also a good idea to see your doctor if your symptoms are getting worse or making you feel anxious or depressed.

Read Zoe’s story about living with chronic pain.

Causes of endometriosis

It’s not yet known exactly how and why some women develop endometriosis. It’s a complex condition that depends on the oestrogen hormone. But it may also be influenced by other factors.

Backwards (retrograde) menstruation

When you have a period, blood flows out of your vagina. But it can also flow backwards along your fallopian tubes into your pelvic area. Nearly all women experience this, but the blood (which contains endometrial cells) is usually absorbed or broken down in the body. In some women, the endometrial tissue starts to grow and form lesions.

Genetics

Genetics play an important role, but genetics don’t fully explain why some women develop endometriosis and others don’t.

How body systems work

Researchers are looking at different factors that might cause endometriosis. For example, how the immune and hormone systems interact.

Risk factors for endometriosis

We need more research to show how genetics can increase the risk for endometriosis, and to identify the genes involved. Other factors that might increase your risk for endometriosis include:

• having a low birth weight
• getting your first period at an early age
• having a low body weight
• having short menstrual cycles.

The risk of endometriosis developing may also decrease with each pregnancy. This might be due to an increase in the progesterone hormone in the body during pregnancy.

Can you prevent endometriosis?

There is no known way to prevent endometriosis. We need more research to understand what actions might help to reduce the risk of developing the condition.

Endometriosis and other health conditions

Some other health conditions are more likely in women with endometriosis, but we need more research to better understand this. It’s helpful to be aware of the links, but it doesn’t mean you will develop these conditions:

• depression and anxiety
• other chronic pain conditions, such as migraine
• uterine fibroids (non-cancerous tumours that grow into the wall of the uterus).
• adenomyosis (where tissue that normally lines the uterus grows into the muscle wall)
• ovarian, breast, endometrial and thyroid cancer (although the risk is small)
• autoimmune diseases, such as lupus, rheumatoid arthritis or inflammatory bowel disease
• early menopause
• cardiovascular disease.

When to see your doctor about endometriosis symptoms

Pain is a common symptom of endometriosis. But it’s not normal to have severe period pain.

If you think you have endometriosis, see your doctor as soon as possible.

Your doctor may ask questions about:

• your periods, for example, if your periods are regular and if you have heavy bleeding
• period pain, for example, where you have pain, how long the pain lasts, if the pain stops you from doing normal activities and what medicines help to reduce the pain
• different types of pain, for example, if you have pain during or after sex or when you go to the toilet
• different types of symptoms, for example, if you have constipation, diarrhoea or bloating; lower back or leg pain; or fatigue
• your family history, for example, if family members have had endometriosis
• your fertility, for example, if you have tried to get pregnant.

You might also like to read our Seeing your doctor about persistent pelvic pain fact sheet.