Endometriosis is one of the most common chronic diseases to fertile women and in some cases women beyond menopause. In many cases the illness is diagnosed very late or not at all. Looking at German speaking countries there are up to 7 years between the first symptoms and a diagnosis. A lot of women who suffer from heavy pain and strong bleeding during period are unaware that their symptoms are unusual. Associated problems are often made taboo or trivialized by friends and family. But problems like heavy pain and the unfulfilled desire to have children are leading symptoms for one of the most frequent chronic illness to women between menarche and menopause: Endometriosis. An estimated 10-15% of European women between the age of 15 and 45 suffer from the illness – with estimates for women with an unfulfilled desire to have children significantly higher.  


Pain and an unfulfilled desire to have children are the leading symptoms of Endometriosis. On this page you will find an overview of the pain symptoms.

Pain shortly previous or during menstruation (dysmenorrhea):

Although mothers used to tell their daughters otherwise: Pain associated with menstruation can be avoided and is not normal! You should get to the bottom of it. Healthy women usually don’t have complications in their lower pelvis. An Endometriosis, e.g. the appearance of endometrium outside the uterus might be the source of your pain. The Endometriosis lesions act just the same as the endometrium inside the uterus. They grow and bleed cyclical. This cyclic behaviour can cause heavy pain during menstruation inside the underbelly (dysmenorrhea).

Pain during sex (dyspareunia):

The experience of pain during sex can be another symptom for Endometriosis. If that is the case for you, such pain can be a further indication for Endometriosis. Pain during intercourse could be caused by Endometriosis located on the elastic suspension of the uterus inside the small belly (sacrouterine ligaments). As a consequence, the mechanical movement of organs during sexual intercourse create pain. Furthermore endometriotic lesions in the vagina, between the uterus and bladder respectively between the cervix of the uterus and the intestines can cause pain too.

Chronic pain in the abdomen:

It is also possible that pain appears permanently, independent of the regular cycle. Reactions from sore tissue in connection with Endometriosis can cause permanent pain in the underbelly. Through adhesions of different organs, for example between the ovary, the colon and the wall of the uterus these organs are kept from moving. This can cause permanent pain.

Other conditions:

Endometriosis can cause pain during urination (Endometriosis lesions inside the bladder) and bowel movement (Endometriosis lesions inside or next to the intestine). Dashes of blood in the urine or stool are possible to occur cyclical. Take the symptoms seriously! We highly recommend to observe the symptoms closely. You can make our “Endo-Test” right here. The test can give you a first opinion whether you might have Endometriosis. Depending on the result you should immediately visit a doctor. Please keep in mind that you do not need to bear the pain. Before going to a doctor you can visit our section on diagnosis where you will find information on the procedure of the gynaecologist.


70 – 80% of women with chronic pain in their underbelly are diagnosed with endometriosis. Unfortunately, such a diagnosis often takes a lot of time because chronic pain in that area is sometimes neglected as a symptom for Endometriosis. In the following paragraph you will learn how the gynacologist will proceed to diagnose Endometriosis.

1. Getting to the diagnosis

The start is made by a medical history – an extensive conversation between you and your doctor about the disease pattern and the symptoms. It is important that the doctor is thoroughly informed about your pain. The gynaecologist should ask for:
  • Cyclical pain in the lower belly
  • Pain during sexual intercourse
  • Pain during urination
  • Pain during bowel movement
  • Dashes of blood in urine and stool
Leading symptom: Experience of pain shortly before or during menstruation (dysmenorrhoa).

2. Primary gynaecological examination

The medical history is followed by a gynaecological examination. This procedure includes:
  • The vaginal palpation which provides insights on palpable resistances of endometriosis, i.e. in the pouch of douglas and might give hints for adhesions.
  • The rectovaginal examination (from vagina and intestines) to assess whether ‚spread pain’ occurs and see whether there are lesions inside or next to the bowel. Such an occurrence would be a sign for endometriosis on the elastic suspensions of the uterus which causes pain during movement.
An additional ultrasound scan of the abdomen can reveal the presence of
  • Cysts
  • Larger nodules of Endometriosis inside the abdomen or thickening of the uterine wall as hint for endometriosis in the muscle (adenomyosis)

3. Additional examinations

If the examination suggest the presence of endometriosis additional examinations might be necessary. Laparoscopy: The laparoscopy is gold standard in definitively diagnosing endometriosis. This procedure is gentle and not very complex but nonetheless of crucial importance. Besides revealing the presence of endometriosis the laparoscopy can assess the extent of the illness and often apply immediate therapy. The surgical procedure is done as follows:
  • During anaesthesia the laparoscope (with usually two or three additional tools) is inducted into the abdomen through 2–3 small incisions respectively the belly button.
  • For enhanced visibility the abdomen is ‘inflated’ with CO2 gas.
  • The doctor is able to illuminate and examine every spot of the abdomen. The doctor is also able to ablate tissue from unusual spots that are examined by a pathologist afterwards.


Endometriosis can be treated. Today there are several forms of treatment available. However, Endometriosis is a chronic and recurring disease: In up to 50% of all cases the illness reappears after successful therapy. Endometriosis should – where possible – be removed completely. The medical therapy is able to alleviate symptoms and can be used as a prophylaxis against recurrence. Additional therapies are homeopathy and acupuncture. Many women suffer not only physically but also psychologically therefore psychosomatic therapy is often very useful too.

Choosing a therapy:

The Endometriosis is a chronic and recurring illness. Surgery is usually the treatment of choice as first step. Depending on symptoms, a wish to conceive and other factors, medical treatment can be an option after surgery or when symptoms reoccur.  In order to avoid multiple surgeries, an individual treatment plan should be established together with the patient.

Guidelines and aim of the therapy:

In order to improve the treatment of Endometriosis, specific suggestions for therapy and its different stages were developed both from infertility societies (i.e. ESHRE) and from endometriosis societies (EEL; SEF).