5 Signs Your Period Pain May Actually Be Endometriosis, According to Doctors

For many who menstruate, the discomfort of period cramps is a predictable—albeit unpleasant—monthly occurrence. But for those battling endometriosis, the pain is not just an inconvenience; it’s an unrelenting force that can derail daily life entirely.

Endometriosis afflicts an estimated 190 million women across the globe. This enigmatic condition arises when tissue strikingly similar to the uterine lining—medically termed the endometrium—migrates beyond its rightful domain. Instead of remaining confined to the womb, it establishes itself in the ovaries, fallopian tubes, or even the external walls of the uterus, setting off a cascade of complications.

Pain That Disrupts Daily Function

Mild cramping during menstruation? Expected. Crippling agony that leaves you doubled over in distress? That’s another story entirely.

“This pain stems from the uterine muscles contracting to expel menstrual blood,” explains Asima Ahmad, MD, Chief Medical Officer and co-founder of Carrot Fertility. “But when the pain reaches an incapacitating level, it signals something deeper.”

Society often conditions women to believe that excruciating period pain is simply part of the package. Albert Hsu, MD, fertility specialist and IVF Medical Director at UC Health, refutes this notion: “Menstruation should not induce such severe cramping that it prevents someone from attending work or school.”

If your period pain commands your schedule rather than the other way around, it’s time to seek medical insight.

Pelvic Pain Beyond Menstruation

While the torment of endometriosis frequently intensifies around menstruation, it’s hardly confined to those days alone.

Individuals with the condition often experience discomfort at unexpected moments—while ovulating, using the restroom, or even during urination. Unlike the dull ache of typical period cramps, endometriosis pain can manifest as a searing, stinging, or throbbing sensation that may radiate into the abdomen, lower back, or even down the legs.

Painful Intercourse

Intimacy should be pleasurable, not punctuated by pain. Yet for many with endometriosis, intercourse becomes a source of distress rather than connection.

Dyspareunia—the clinical term for painful sex—can arise from multiple factors, including vaginal dryness, fibroids, and pelvic floor dysfunction. However, persistent, stabbing, or deep internal pain during penetration, particularly around menstruation, might be a red flag for endometriosis.

“A lot of people chalk it up to a positional issue or lack of lubrication,” says Hsu. “But if intercourse consistently causes pain, it’s a warning sign that shouldn’t be dismissed.”

Taking note of the pain’s nature and timing can provide invaluable clues for diagnosis. A sharp, deep ache that flares up cyclically may warrant further investigation.

Struggles With Fertility

For those trying to conceive, endometriosis can present a formidable barrier. Infertility is typically diagnosed after a year of unsuccessful attempts at pregnancy, but the underlying cause often remains elusive—until endometriosis comes into the picture.

“This condition can interfere with fertility in myriad ways,” explains Ahmad. “It can affect egg and embryo quality, create scarring, disrupt fallopian tube function, or alter the pelvic anatomy altogether.”

Not every individual with endometriosis will face infertility, but those grappling with unexplained reproductive struggles may unknowingly have the condition. In some cases, only a surgical procedure like a laparoscopy reveals the hidden culprit.

Interestingly, pregnancy itself can temporarily quell endometriosis symptoms due to heightened progesterone levels. However, this relief is fleeting—symptoms often resurface postpartum as hormone levels normalize.

Extreme Fatigue

Endometriosis doesn’t just ravage the reproductive system—it takes a profound toll on energy levels as well. While not traditionally classified as a primary symptom, fatigue is a common yet underrecognized consequence of the condition.

“Endometriosis patients frequently experience exhaustion due to relentless pain and the emotional burden of infertility,” notes Hsu. “The stress of missed work, sleep disturbances, and chronic discomfort all contribute to this overwhelming fatigue.”

A 2022 study published in In Vivo reinforced this link, suggesting that chronic fatigue syndrome may be intrinsically tied to endometriosis. More research is needed, but the connection is becoming increasingly difficult to ignore.

How Is Endometriosis Diagnosed and Treated?

Pinning down an endometriosis diagnosis isn’t straightforward. Often, the most definitive method involves surgery, typically performed via laparoscopy—a minimally invasive technique that allows for internal examination and tissue sampling.

While imaging and symptom assessment can hint at the presence of endometriosis, Ahmad emphasizes that “the gold standard remains surgical visualization and histological confirmation.” The journey to a formal diagnosis is often frustratingly protracted, with the average delay stretching to 7.5 years—a timeframe that allows the condition to progress unchecked, leading to worsening scarring and inflammation.

Fortunately, treatment doesn’t have to wait for a confirmed diagnosis. Hormonal contraceptives, including birth control pills and IUDs, are commonly used to temper symptoms. Pain management strategies, such as anti-inflammatory medications, offer additional relief. For those facing fertility challenges, assisted reproductive technologies like IVF may present a viable path forward.

Surgical interventions, ranging from lesion removal to hysterectomy in severe cases, provide further options for symptom control.

Ultimately, no two endometriosis journeys are alike. “The right management plan should be individualized,” stresses Ahmad. “Engaging in an open and detailed conversation with your doctor is key to identifying the most suitable treatment strategy for your unique situation.”