What Are Common Endometriosis Symptoms and How Is It Diagnosed?

Endometriosis affects about 1 in 10 females worldwide (and is behind an estimated 40% of infertility cases), yet it often goes unrecognized, despite debilitating symptoms including pain. Many live with symptoms for years—sometimes decades—before receiving a diagnosis. While we can’t speed up your ability to get an official diagnosis, we can share some of the symptoms (and how to manage them) so you can recognize them, and hopefully get relief sooner. Here’s an introduction to endometriosis symptoms, diagnosis, and tips to manage it.

Endometriosis is a chronic gynecologic condition where endometrial tissue (which lines your uterus and sheds each month with your period) grows outside the uterus (where it’s not supposed to be). This often leads to inflammation, pain, and, for some, challenges with fertility.

There isn’t one single known cause of endometriosis. We do know it develops through a combination of factors involving hormones, the immune system, microbiome, and inflammation—and each person’s experience can look different. One well-known theory is retrograde menstruation, where menstrual blood flows backward into the pelvis, allowing endometrial-like cells to implant outside the uterus. But because this occurs in many people who never develop endometriosis, it’s only part of the picture. In women with endometriosis, the immune system may not be as effective at clearing these cells, estrogen can fuel their growth, and progesterone resistance may allow inflammation to continue and sometimes worsen.

Another theory shows a link between the gut microbiome and endometriosis. Endometriosis often shows low lactobacilli bacteria (that’s the good bacteria) and high inflammatory and estrogen-regulating bacteria (like Gardnerella or Streptococcus), creating an imbalance that can lead to chronic inflammation, immune dysregulation, and estrogen-driven lesion growth. Basically, the perfect foundation for endometriosis to thrive.

Genetics and early developmental factors may also play a role, and endometriosis often runs in families. Having a mother or sister with endometriosis can increase your own risk.

One major reason endometriosis is often diagnosed late is that many of its symptoms—especially painful periods—are commonly treated with hormonal birth control. When someone reports severe cramps, heavy bleeding, or cycle-related pain, birth control is frequently prescribed to manage symptoms. For many, this does help reduce pain, but it can also unintentionally mask endometriosis.

As a result, symptoms may feel “controlled” for years, even though the disease itself is still present. It’s often not until someone stops birth control—frequently when trying to conceive—that symptoms return or fertility challenges arise, prompting further evaluation. At that point, endometriosis may finally be diagnosed after years of being overlooked.

• Painful periods

• Heavy bleeding

• Pelvic pain between cycles

• Pain during sex

• Painful bowel movements

• Lower back pain

• Bloating

• Constipation

• Diarrhea

• Nausea (especially around your period)

• Fatigue (even with plenty of rest)

• A family history of endometriosis

Because the gold standard to identify endometriosis is laparoscopic surgery (more on that in a bit), doctors will usually try to get a better view of the big picture first: your history, a physical exam, lab work, and imaging.

• Your history: A conversation with your doctor that includes questions about your periods, pain, digestion, sex, fatigue—basically, how life’s been feeling. 
• The physical exam: During this, sometimes tender spots or unusual lumps can be detected. 
• Lab work: Labs, bloodwork, and hormone panels won’t diagnose endometriosis on their own, but they help rule out other stuff.
  
• Imaging: Ultrasounds or MRIs can catch bigger lesions or cysts (called endometriomas). 
• Surgery: A definitive endometriosis diagnosis comes from a laparoscopy, a surgery where a camera is placed directly inside your abdomen to check for endometriosis and lesions are removed in real time. 

Laparoscopy is a minimally invasive surgery and is still the gold standard for diagnosing and treating endometriosis, and it’s usually done by a gynecologist.

During the procedure, the surgeon makes a few small incisions in the abdomen and inserts a tiny camera. Carbon dioxide (CO₂) gas is used to gently inflate the belly so the surgeon can clearly see what’s going on inside—your uterus, ovaries, fallopian tubes, bowel, and surrounding tissues. This visibility is key, because endometriosis can hide in places that imaging (like ultrasound) often misses.

How long the surgery takes really depends on what’s happening in your pelvis. If the disease is mild, the procedure may be fairly quick. But with more advanced endometriosis—especially when there’s significant scarring or organs stuck together (called adhesions)—surgery can take several hours. In more complex cases, additional surgeons, like a general or colorectal surgeon, may be involved to safely treat all areas affected.

In 2026, the American College of Obstetrics and Gynecologists updated the endometriosis diagnosis criteria: Surgery is no longer a requirement to get a diagnosis and access to treatment.

This is big news—it means that more people can get access to care and treatment sooner, since surgery was a big barrier (along with all the appointments, tests, and procedures that went along with it) to getting care. Now, a clinical diagnosis (based on a physical examination and symptoms) is enough to get an official endometriosis diagnosis and to start treatment.

Getting an endometriosis diagnosis can be lengthy, and researchers are working hard to make diagnosis faster and less invasive. This has led to a couple of exciting advancements in the world of endo diagnosis.

EndomTest™

EndomTest™ is a blood test recently launched in the United States that measures specific biomarkers (like BDNF and CA‑125) alongside clinical history to help doctors “rule in” endometriosis without surgery. It’s the first commercially available non‑surgical test of its kind and represents a step toward earlier answers for people who might otherwise wait years for a diagnosis.

BCL6 Testing

This endometrial biopsy looks for elevated levels of a protein associated with inflammation in the uterine lining. It’s often used in fertility clinics—especially for people with unexplained infertility or recurrent IVF failures—as BCL6 overexpression is linked to endometriosis‑related inflammation.

Laparoscopy with tissue confirmation is still considered the gold standard for a definitive endometriosis diagnosis, but these newer lab‑based tests are part of a growing body of research designed to make diagnosis less invasive and more accessible. Scientists are continually exploring new biomarkers and molecular signatures in blood, tissue, and other samples to make future endometriosis diagnostics even more seamless and timely.

Reduce inflammation

• Opt for anti-inflammatory foods like colorful fruits and vegetables, whole grains, beans, nuts, and seeds

• Reduce foods known to contribute to inflammation like red meat, processed foods, and trans fats

• Supplements like Omega-3, Vitamin D, Magnesium, Curcumin, and NAC can help manage pain and inflammation

Increase fiber

For patients with endometriosis, fiber intake can actually play a role in hormone balance—especially estrogen.

Estrogen doesn’t just disappear after your body uses it. It’s processed by the liver and sent to the gut to be eliminated. When fiber intake is low, estrogen can get reabsorbed in the intestines and cycle back into the bloodstream, potentially fueling estrogen-driven conditions like endometriosis. Fiber helps bind estrogen in the gut and supports its removal from the body, which may help prevent excess estrogen from circulating.

Fiber also supports a healthy gut microbiome, which matters because gut bacteria influence how estrogen is metabolized (often referred to as the estrobolome). A more balanced gut environment may help reduce systemic inflammation—another key driver of endometriosis symptoms.

Some easy, fiber-rich foods to work into your meals:

• Beans and lentils
  

• Berries and pears
  

• Quinoa
  

• Sweet potatoes
  

• Broccoli and other cruciferous veggies
  

You don’t need to overhaul your entire diet overnight. Small, consistent increases in fiber—paired with good hydration—can support hormone metabolism, gut health, and overall inflammation, all of which matter when managing endometriosis.

Stay hydrated

When you increase fiber, hydration becomes non-negotiable. Fiber works by absorbing water and adding bulk to stool—without enough fluid, it can actually slow things down and lead to bloating or constipation.Drinking enough water helps fiber do its job: 

• keeps digestion moving

• supports estrogen elimination

• reduces GI discomfort (especially important for endometriosis patients who already deal with bloating, constipation, or pelvic pressure)

If you’re adding more high-fiber foods, make sure you’re also increasing fluids throughout the day. Think steady sipping, not chugging at night. A simple rule of thumb: if fiber goes up, water should too.

Get gentle exercise

Make sure to move your body, which can help reduce cramps and fatigue. Think: Walking, yoga, pilates, and more

Gain insight

Keeping a symptom-food journal is a great way to stay on top of your symptoms—it helps identify personal triggers, and gives you more insight to manage your daily life in a way that supports relief from your endometriosis symptoms. 

While none of these replace medical treatment, combining them with a thoughtful fertility plan can make a real difference in managing symptoms.