Period pain deserves evaluation when it is severe, getting worse, causes fainting or vomiting, repeatedly keeps you from school, work, exercise or normal activities, or is not adequately controlled with usual measures. Pain that disrupts your life should not simply be accepted as “normal.”

Endometriosis can cause pain low in the abdomen or pelvis before, during or between periods. Pain may be aching, cramping, sharp or persistent. Some people develop chronic pelvic pain that continues even when they are not menstruating.

Deep pain during or after vaginal intercourse can occur with endometriosis, particularly when disease affects tissues behind the uterus, the pelvic sidewalls or other deep pelvic structures. Painful sex should be discussed with a healthcare professional rather than silently endured.

Endometriosis may cause painful bowel movements, constipation, diarrhea, bloating or rectal discomfort, especially when symptoms become worse around menstruation. Some patients may also notice occasional blood in the stool (rectal bleeding), particularly during or around their period. Deep endometriosis can involve the bowel, but bowel symptoms and rectal bleeding can also have other causes and should be medically evaluated.

Pain with urination, urgency or blood in urine can have several causes and needs assessment. Endometriosis can affect the bladder or ureter; ureteral obstruction can sometimes cause few symptoms. Do not assume urinary symptoms or bleeding are due to endometriosis.

Heavy periods or bleeding that is difficult to manage can occur in people with endometriosis, although heavy bleeding also has many other causes, including adenomyosis and fibroids. Heavy bleeding can lead to iron deficiency and contribute to fatigue.

Fatigue is common and can be substantial. Chronic pain, disturbed sleep, inflammation, heavy bleeding with iron deficiency, and the emotional burden of living with persistent symptoms may all contribute. Persistent fatigue deserves attention rather than being dismissed.

Some people first learn they may have endometriosis while being evaluated for difficulty becoming pregnant. Endometriosis is associated with infertility, but having endometriosis does not mean pregnancy is impossible. Many women with endometriosis conceive naturally or with appropriate fertility treatment.

Endometriosis can begin in adolescence, sometimes soon after periods start. Severe period pain, repeated school absence, pelvic pain, bowel or bladder symptoms around periods, or pain that does not improve with usual treatment should not be dismissed because of young age. Early recognition can reduce years of unnecessary suffering.

Symptoms often improve after menopause, but endometriosis can remain active or symptomatic in some women. New or persistent pelvic pain, bleeding, or a pelvic mass after menopause should be evaluated because other conditions must also be considered.

Endometriosis can occur outside the pelvis. Recurring shoulder/chest symptoms or a painful scar nodule warrant assessment. Sudden chest pain, severe breathlessness or collapse needs emergency care immediately, even around a period. Do not wait for a specialist appointment.