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The symptoms
of endometriosis

Endometriosis is responsible for pain during or around the time of menstruation

Endometriosis lesions are responsible for a variety of painful symptoms, which initially occur during menstruation. Over the years, these symptoms can also be felt when not having a period, but nevertheless their intensity remains at its highest during or around the period. The classic symptoms are pain in the lower abdomen (pelvic pain), pain during sexual intercourse felt deep in the pelvis, pain when having a bowel movement or urinating, pain in the chest or shoulders, pain on the path of the sciatic nerves.

Endometriosis can also cause infertility. Infertility associated with the above-mentioned painful symptoms is a good reason to look for endometriosis.


Dysmenorrhea: or painful periods

In the majority of cases, dysmenorrhea is chronologically the first painful symptom, often appearing at the time of the first periods. They can lead to school or work absenteeism, and are characterized by :

  • Dull pain in the hypogastrium, in the iliac fossae, but also in the sides or lower back.
  • The frequent (partial or total) analgesic action of anti-inflammatory drugs, indicative of the inflammatory mechanism of the pain.
  • Their improvement (or even disappearance) by taking a contraceptive pill
  • A frequent association with menorrhagia (heavy periods)


Deep dyspareunia or pain during sexual intercourse

These are ballistic dyspareunia, triggered by deep penetration, generally in the posterior pouch. This symptom can have a negative impact on a couple’s sexual life and reduce the chances of spontaneous conception.

They may be due to deep retrocervical endometriosis, uterosacral ligaments or vaginal pouches, but also to superficial endometriosis of the pouch of Douglas, as well as to adenomyosis.

Digestive symptoms

Digestive symptoms associated with menstruation are varied and non-specific:

Pain with defecation or distension of the rectum, sometimes increased during menstruation. Catamenial diarrhea, or conversely severe catamenial constipation and exacerbated abdominal bloating, all these are signs that may suggest endometriosis, without being specific.

Their presence justifies investigation of digestive locations of endometriosis, particularly in the rectum or sigmoid colon, which together represent 2/3 of digestive disorders.

Nevertheless, the digestive symptoms may simply be due to an irritation effect of the superficial or deep endometriosis lesions on the digestive tract or on the nerves which are responsible for its contractile activity.

More rarely and in advanced forms, acute intestinal occlusion may disclose severe endometriosis, requiring emergency surgical treatment.

Urinary symptoms

Catamenial cystalgia, daytime and nocturnal frequent urination, as well as the impression of regularly having a urinary infection (but without proven infection from bacteriological examination of the urine) during menstruation are grounds for looking for deep endometriosis of the bladder.
However, like the digestive symptoms, these urinary symptoms may be linked to an irritation effect of endometriosis lesions.
The nodules of deep endometriosis can infiltrate or even envelop the ureters. This can result in episodes of back pain, but most often these lesions are asymptomatic for a long time. They may lead to stenosis of the ureter, or even to ureteral and pyelocaliceal dilation upstream, complicated in extreme cases by low-level renal atrophy and complete destruction of the kidney.

Other catamenial symptoms

Any painful or embarrassing symptom that occurs cyclically and is concomitant with menstruation may suggest endometriosis:

  • Scapular or basi-thoracic pain (most often right-sided) may be an indication of endometriosis lesions in the diaphragm.
  • Pain in the buttocks, perineum or sciatica may be due to compression of the sacral roots by deep endometriosis
  • Catamenial dysuria (difficulty in urinating, sensation of incomplete micturition) may be the result of the impact of deep endometriosis lesions of the vagina on the splanchnic motor nerves of the bladder
  • Episodes of catamenial pneumothorax are grounds for looking for diaphragmatic, pleural or pulmonary parenchymal endometriosis

Intermenstrual pain

These are pains that occur between periods and can lead to chronic, daily pain that is resistant to the usual analgesic drugs. They are often associated with advanced endometriosis, intra-abdominal adhesions, but also with associated neuropathic mechanisms which make management more complex, with often a lessened efficacy of proposed treatments.


Endometriosis is a risk factor for infertility; it is found in one third of women seeking treatment for infertility lasting more than one year.

The mechanisms causing infertility in endometriosis which can be isolated or associated are the following:

  • Intraperitoneal and intratubal inflammation that can adversely affect egg-sperm interaction
  • Intra-tubal or tubo-ovarian obstruction preventing gamete encounter
  • Dyspareunia and asthenia secondary to chronic pain which can considerably reduce the number of sexual encounters, thus limiting fertility
  • Alteration of the ovarian reserve linked to endometrioma which destroy ovarian parenchyma, and whose surgical removal may aggravate pre-existing ovarian insufficiency.
  • Adenomyosis, which is a factor in embryo implantation failure.

In extreme cases, endometriosis lesions can lead to dramatic complications, such as complete destruction of the kidneys, intestinal obstruction, pneumothorax or loss of voluntary bladder control.

Bibliography : Roman H, et al. Hum Reprod. 2012 Dec;27(12):3440-9

The symptoms
in numbers


of women suffering from infertility and chronic pain have endometriosis


have their sex life affected by the disease


consider that their professional career has been affected by the disease

Source :
1. The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril 2004; 92(Suppl1),40 45.


What is endometriosis?

Types of endometriosis

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The diagnosis

How is endometriosis diagnosed?


What are the treatments for endometriosis?

Get support and advice from endometriosis specialists

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Last updated on May 4, 2021 @ 08:24