Endometriosis affects 1 in 10 women of reproductive age—approximately 190 million globally. In Romania, the average time to a correct diagnosis is 7–10 years. The reason? Symptoms are frequently normalized or misinterpreted—both by the women who live with them and by many doctors.
In this article you will learn the 5 most common symptoms of endometriosis—the warning signs you should no longer ignore. If you recognize at least 2 of them, it is time to see a gynecologist with expertise in endometriosis.
Endometriosis is a progressive disease. Left untreated, endometriosis is associated with progression toward pelvic adhesions, ovarian endometriomas, involvement of the bowel or bladder (per ESHRE 2022 guideline), and infertility. Early diagnosis means appropriate treatment, better quality of life, and much higher chances of preserving fertility.
1. Severe menstrual pain (dysmenorrhea)
Periods can be unpleasant—but pain that keeps you from functioning normally is NOT normal. It is the leading warning sign for endometriosis.
What does endometriosis pain look like?
- Begins 1–2 days before your period and lasts throughout it
- Does not respond, or responds poorly, to standard anti-inflammatories (ibuprofen, acetaminophen)
- Worsens from one cycle to the next (progressive)
- Radiates to the lower back, thighs, or anus
- May be accompanied by nausea, vomiting, cold sweats, or fainting
- Affects your activities: you miss work, school, or social events
Why does it happen?
Endometrial tissue outside the uterus responds to hormonal fluctuations—it thickens and bleeds, but has nowhere to go. The result: acute inflammation in the pelvic cavity, activation of pain receptors, and muscle spasms.
— Dr. Alin Constantin, VP European Endometriosis League
2. Chronic pelvic pain (not just during your period)
Unlike ordinary dysmenorrhea that appears only with your period, the pain of advanced endometriosis can be present all the time or worsen at specific points in the cycle.
Typical locations:
- Lower abdomen, on the left or right side
- Deep pelvic area
- Lower back
- Perineum (between the vagina and the anus)
When does it worsen?
- At ovulation (mid-cycle)
- In the second half of the cycle (after ovulation)
- With intense physical activity
- After sexual intercourse
- With bowel movements or urination
3. Deep dyspareunia (pain during sexual intercourse)
This is an often underreported symptom—many women feel embarrassed to discuss it, and some doctors do not ask about it directly. Yet it is one of the most specific signs of deep infiltrating endometriosis (DIE).
How does it present?
- Pain on deep penetration, not at entry
- Worsens in certain positions
- May persist for hours or days after intercourse
- Leads to avoidance of intercourse and strain in the relationship
Why does it happen?
Deep endometriosis can involve:
- The uterosacral ligaments
- The pouch of Douglas (the space between the uterus and the rectum)
- The rectovaginal septum
With deep penetration, these areas are compressed → intense pain.
Many women are referred to a psychologist for "unexplained pelvic pain" or "dyspareunia." While psychological support is helpful, the real cause is organic—deep infiltrating endometriosis, detectable through specialized transvaginal ultrasound performed per IDEA protocol.
4. Cyclic digestive and urinary symptoms
Endometriosis can involve the bowel, bladder, or ureters—not just the reproductive organs. Symptoms that are cyclic (worse around your period) are a very specific clue.
Digestive symptoms:
- Severe bloating—"endo belly"—especially premenstrually and during your period
- Pain with bowel movements
- Cyclic constipation or diarrhea
- Blood in the stool (in advanced cases)
- A feeling of fullness or abdominal heaviness
Urinary symptoms:
- Frequent urination (especially at night)
- Pain with urination
- Blood in the urine (during your period)
- A feeling of incomplete bladder emptying
— Dr. Alin Constantin
5. Infertility and difficulty conceiving
30–50% of women with endometriosis experience difficulty conceiving. Sometimes it is the first symptom that brings them to a doctor—after years of pain being normalized.
How does endometriosis affect fertility?
- Pelvic adhesions—organs stuck together, distorting anatomy
- Blocked or poorly functioning fallopian tubes
- Ovarian endometriomas—reducing ovarian reserve
- Reduced oocyte quality
- Chronic inflammation that affects embryo implantation
Endometriosis does NOT mean guaranteed infertility. 60–70% of women conceive naturally, and the rest can benefit from:
- Appropriate surgery (excision of lesions + ovarian preservation)
- Assisted reproduction (IVF)
- A combination of surgery + IVF
When to see a specialist
Book a Pre-Consultation with a gynecologist specialized in endometriosis if:
- You have at least 2 of the 5 symptoms described above
- Anti-inflammatories do not relieve your pain
- Symptoms affect your quality of life
- You have not conceived after 12 months of trying (6 months if you are over 35)
- You have a family history of endometriosis
- You have already received a diagnosis but symptoms are not improving
What to expect at your first consultation
- Detailed medical history—menstrual history, symptoms, family history
- Specialized transvaginal ultrasound (IDEA protocol)—for non-invasive diagnosis
- Personalized treatment plan—medical, surgical, or combined
- Monitoring and follow-up recommendations
Dr. Alin Constantin, Vice President of the European Endometriosis League, offers complete evaluations with IDEA protocol at Monza Hospital Bucharest.
📅 Book Pre-Consultation →Related articles
- What is endometriosis—complete guide 2026
- Transvaginal ultrasound in the diagnosis of endometriosis
- Da Vinci robotic surgery for deep endometriosis
Last updated: July 2026 • Author: Dr. Alin Constantin, VP European Endometriosis League
