What are the First Signs of Endometriosis?

Published: June 17, 2025
Updated: June 17, 2025
4 mins

Endometriosis is a chronic health condition that affects one in ten women globally. Women with endometriosis often experience severe pain during menstrual periods. Endometriosis-related menstrual pain can lead to additional symptoms that can make it difficult to move and get through work or a school day. The pain is often described as feeling like muscle spasms in the pelvic area.

It’s not unusual to feel some anxiety around your period when you have endometriosis. Still, many symptoms can occur throughout the month outside of your period. Despite its prevalence, health experts are still figuring out how to best diagnose and treat endometriosis.  

What Causes Endometriosis?

Health experts have several theories on what causes endometriosis in women. Generally, health experts agree that ectopic endometrial tissue growth causes endometriosis. 

Endometrial tissue can form as a result of the following:

• Retrograde menstruation: During retrograde menstruation, endometrial cells form outside the uterus after flowing back into the fallopian tubes and pelvic cavity through menstrual blood.

• Cellular metaplasia: Cells outside the uterus change into endometrial-like cells and grow.

• Stem cell growth: Stem cells can spread through blood and lymphatic vessels, leading to chronic conditions like endometriosis.

Genetics may also play a role in being diagnosed with endometriosis. Be sure to let your healthcare provider know if other women in your family have a history of endometriosis.

What are the Stages of Endometriosis?

Endometriosis treatment varies based on the severity of symptoms. Endometriosis is typically classified in four stages. However, women with stage four endometriosis may still not experience symptoms. 

The stages of endometriosis depend on where endometrial tissue grows in the body and how much it spreads. Stage four of endometriosis is the largest spread of endometrial tissue and often consists of large cysts on both ovaries.

Stage 1: Endometrial implants tend to be smaller at this stage.

Stage 2: Endometrial implants in this stage are deeper and may begin to produce scars.

Stage 3: Some people may develop cysts along with endometrial implants in this stage.

Stage 4: This stage of endometriosis is when endometrial tissue spreads the most and large cysts are more likely to form on the ovaries.

While this is a general classification of endometriosis stages, many cases don’t meet the description for each stage.

What are the Common Symptoms of Endometriosis?

One of the first signs of endometriosis is severe pain during the menstrual cycle. Endometrial tissue does not shed like healthy tissue on the uterine lining during your period. Many symptoms of endometriosis mimic severe menstrual period symptoms.

The following symptoms are commonly associated with endometriosis:

• Pain during or after sex

• Heavy bleeding during menstrual cycles

• Bloating

• Nausea

• Gastrointestinal issues

It’s not uncommon for women to stop or only experience milder endometriosis symptoms after menopause. 

What are the Less Common Symptoms of Endometriosis?

When it comes to your period, it can be difficult to know what’s considered normal when it comes to symptoms. Every experience with endometriosis is different, and some people may experience other symptoms even when it’s not close to their menstrual cycle.

Some women may also experience the following endometriosis symptoms:

• Fatigue

• Irregular periods

• Pain during urination

• Spotting in between periods

• Depression

How is Endometriosis Diagnosed?

Health experts have not yet developed a specialized test that exclusively checks for endometriosis, but imaging tests can help spot common signs. An ultrasound can help a healthcare provider get a better image of the inside of the pelvic area and reproductive organs. An MRI is another imaging test that uses magnetic waves to look at internal organs and tissue.

How is Endometriosis Treated?

There is no cure for endometriosis, but there are ways to manage the condition. The following medications can help manage pain and possibly slow the spread of endometrial tissue:

• NSAIDs (nonsteroidal anti-inflammatory drugs): OTC (over-the-counter) NSAIDs can help provide menstrual pain relief when symptoms arrive unexpectedly.

• Combined contraceptives: Taking birth control pills with both estrogen and progestin can help reduce the severity of some endometriosis symptoms.

• Gonadotrophin-releasing hormone (GnRH) agonists: This form of medication can help reduce inflammation and lesions associated with endometriosis.

• GnRH antagonists: Tablet forms of GnRH agonists that can help reduce the severity of endometriosis symptoms.

• Danazol: Danazol is an androgenic hormone medication that shrinks endometrial tissue in the uterus.

• Aromatase inhibitors (AIs): This medication is ideal for women still experiencing endometrial symptoms after menopause. Aromatase inhibitors lower estrogen levels to help prevent the spread of endometrial tissue.

In some cases, a healthcare provider may recommend surgery if medications are not effective in treating endometriosis symptoms. Surgery for endometriosis is a minimally invasive procedure where a healthcare provider makes small incisions into the abdomen. While not as common, some people may require a laparotomy (a larger incision) to remove scar tissue and endometrial tissue.

A hysterectomy is a surgical procedure that removes the uterus entirely. A healthcare provider may recommend a hysterectomy if other treatment options are not effective and the person doesn’t have any plans to get pregnant in the future. Still, there is a small chance that some women may still experience endometrial symptoms after getting a hysterectomy.

Where Can I Learn More About Living with Endometriosis?

Endometriosis symptoms may change in severity throughout different stages of your life. At LifeMD, licensed healthcare providers can offer guidance and assistance with learning more about endometriosis and other women’s health concerns.

Get started today by learning more about how to manage endometriosis in your everyday life.

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