8 Textbook Signs of Endometriosis

This painful health problem is a leading cause of infertility in the U.S.

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Many women with painful periods may simply accept them as a bit of bad luck (and deal with them by stocking up on ibuprofen and heating pads). For some, it’s not until years later (perhaps not until they’re trying to get pregnant), that they realize those gut-wrenching cramps were a sign of a serious medical condition: endometriosis.

For women with endometriosis, the uterine lining grows outside of the uterus, developing tissue on the ovaries, fallopian tubes, bladder, intestines, or rectum. This may cause severe pelvic pain and even infertility as the tissue becomes inflamed, scarred, irritated, and swollen. This painful condition affects one in 10 U.S. women of reproductive age, according to the Endometriosis Foundation of America.

Many women suffer with endometriosis for years, not realizing their cramps are symptom of a serious condition. Other women with this illness experience no symptoms at all, at least not until they’re trying to get pregnant. (That explains why the average age of diagnosis of endometriosis tends to fall between 25 and 35.) For women who do experience symptoms of endometriosis, here is what they typically report.

  1. Severe menstrual cramps: While all women experience a wide range of cramp severity, those with endometriosis often have “killer” cramps, a condition known as secondary dysmenorrhea (period pain caused by another disorder). Cramps are worse than usual because of the bleeding and inflammation of the uterine lining, according to the American College of Obstetricians and Gynecologists. Learn what causes menstrual cramps here.

  2. Long and heavy periods: The average menstrual cycle lasts about 25 to 30 days, with an average of four to six days of menstrual flow. A period longer than eight days is considered abnormal and may be a good reason to check with your ob-gyn. (Here are more surprising facts about your period.)

  3. Pain during sex: Because of scar tissue and inflammation in the uterine lining, sex may be painful, especially if it’s close to the time of menstruation.

  4. Trouble getting pregnant (infertility): Around 40 percent of infertility cases are caused by endometriosis, according to ACOG. The inflammation can disrupt the sperm’s ability to find an egg or move through the uterus. Scar tissue may even obstruct the fallopian tubes in more severe cases.

  5. Nausea or vomiting: These symptoms usually occur just prior to getting your period, as the uterus begins to contract to prepare to shed the uterine lining.

  6. Pelvic or lower back pain: This pain usually starts before the monthly period, and will worsen just after the end of the flow, according to Johns Hopkins Medicine.

  7. Spotting between periods: Because of the abnormal tissue growth, inflammation, and bleeding occurring around the uterus, patients may experience spotting.

  8. Bowel issues, like constipation, diarrhea, or bloating: Around a third of endometriosis patients experience constipation and two-thirds have diarrhea, according to the Endometriosis Foundation of America. Not surprisingly, endometriosis can often get misdiagnosed as irritable bowel syndrome. Just like with most women without endometriosis, bowel issues often worsen during menstruation.

While there is no cure for endometriosis, surgeries and birth control (especially hormonal IUDs) can help relieve pain, and hormone therapy can increase the chances of fertility.  Learn more about IUDs, or intrauterine devices, here.