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Symptoms

Timing of Pain. Pain at the time of menstruation (dysmenorrhea) is the primary symptom and occurs in nearly all girls and women with endometriosis. Studies suggest that endometriosis is the cause of about 15% of cases of pain in the pelvic region in women. Most women with endometriosis report pain within 2 days after their menstrual periods start.

In addition to menstruation, endometrial pain can occur at other times of the month. Adolescents are more likely to have pain that occurs both during their periods and at other times in the cycle, while in older women endometrial pain is more likely to occur during menstruation.

About half of women with endometriosis report pain in the middle of the menstrual cycle. (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through.) About 20% of women report continuous pain throughout the cycle. In addition, many women with endometriosis have pain during sex.

Location of Pain. Pain occurs in the pelvic area (the lower part of the trunk of the body) in nearly all women with endometrial pain. The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs.

Occasionally, however, pain may also occur in other regions if endometriosis affects other part of the pelvic area, such as the bladder or intestine.

Severity of Pain. The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.