Endometriosis: more than a bad period

By Shweta Arora, MD, board-certified physician · Medically reviewed by Robin Arora, MD · Updated October 2026

Many women with endometriosis are told for years that their pain is normal, that it’s IBS, or, in their 40s, that it’s just perimenopause. Knowing the signs can shorten that wait.

What is endometriosis?

Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the uterus, causing inflammation and pain. The World Health Organization estimates it affects about 10% of women and girls of reproductive age worldwide, roughly 190 million people. There is no cure yet, but treatment can control symptoms.

Symptoms that go beyond painful periods

• Period pain that disrupts work, school or daily life
• Pelvic pain between periods
• Deep pain during or after sex
• Painful bowel movements, or bloating, constipation or diarrhea that follows your cycle
• Painful urination or bladder symptoms around your period
• Low back or hip pain, and fatigue
• Trouble getting pregnant

Why diagnosis often takes years

The WHO reports that the average time to diagnosis is 4 to 12 years. Symptoms often get labeled as IBS, a bladder problem or “normal” periods. Women with endometriosis are about three times as likely to also have an IBS diagnosis, and one doesn’t rule out the other.

A normal pelvic exam or routine ultrasound doesn’t rule endometriosis out either. Guidelines say a normal result shouldn’t end the conversation if symptoms continue.

Endometriosis in your late 30s and 40s

Perimenopause can blur the picture. Heavier, less predictable periods, poor sleep and mood changes can come from shifting hormones, while pain that follows your cycle, painful bowel movements and deep pain with sex point more toward endometriosis. Both can be true at once. See our perimenopause guide.

Endometriosis can also change the menopause timeline. In a 2025 analysis of nearly 280,000 women, those with endometriosis reached natural menopause a few months earlier on average and were much more likely to have surgical menopause.

How endometriosis is diagnosed today

Surgery is no longer always the first step. The European Society of Human Reproduction and Embryology (ESHRE) 2022 guideline recommends ultrasound or MRI as part of the workup, and says treatment can be started based on symptoms and imaging when appropriate. Specialized imaging read by an experienced team is more useful than a routine scan. Diagnosis and treatment decisions belong with a gynecologist or endometriosis specialist.

When to see a gynecologist or endometriosis specialist

• Pain that’s severe, keeps coming back or doesn’t improve with first treatments
• Bowel or bladder symptoms that follow your cycle
• A cyst on an ovary, or a pelvic mass on exam
• Trouble getting pregnant
• Symptoms that return after surgery

Track your whole cycle, not just bleeding

For 2 to 3 cycles, note each day: pain from 0 to 10, bowel and bladder symptoms, pain with sex, energy, sleep, mood, bleeding and any pain medicine you used. Mark which days fall before, during and after your period. Patterns help your care team see what’s going on.

How a physician-led team can support you

We don’t perform surgery or diagnose endometriosis surgically. We can help you track symptoms, coordinate referrals and records with a gynecologist or endometriosis specialist, support pain, sleep and quality of life, check heart and bone health, and plan midlife hormone care that takes endometriosis into account. Exams happen in person; some follow-up visits can be done by telehealth.

Every plan is individualized, and treatment is recommended only when it’s right for you after your consultation.

Related reading: Perimenopause: symptoms, diagnosis and treatment · Do I need my hormones tested? · Mood, sleep & brain fog in midlife. Browse the full Women’s Health Library.

See us in person or by video

Visit our physician-led team at our Hudson, Ohio or Barboursville, West Virginia office, or meet Dr. Robin Arora by telehealth from anywhere in Ohio, West Virginia, Kentucky or Florida.

Go to the ER or call 911 for sudden severe pelvic or abdominal pain (especially with vomiting), pelvic pain with fever, very heavy bleeding (soaking a pad or tampon every hour for 2 hours or more), fainting, pelvic pain or bleeding when you could be pregnant, or being unable to pass urine, stool or gas.

Sources: World Health Organization, Endometriosis fact sheet (2025); ESHRE guideline: endometriosis, Human Reproduction Open 2022; NICE guideline NG73, Endometriosis: diagnosis and management; Nabi et al., Frontiers in Medicine 2022; Chung et al., Human Reproduction 2025; EMAS clinical guide, Maturitas 2025. This page is general education, not medical advice.