That time of the month is uncomfortable for most women, but how much pain is normal and how do you spot signs that something else may be going on?

The reason is because during a typical menstrual cycle, the lining inside the uterus. or the endometrium, builds up and is then shed.

However, for those with endometriosis that lining grows outside of the uterus - usually around the ovaries or beneath the uterus in an area called the posterior cul-de-sac.

According to John Hopkins Medicine, as that lining builds up and breaks down, it causes small amounts of bleeding inside the pelvis and this leads to pain, inflammation, swelling and scarring.

It can be a daunting process to investigate if you have endometriosis, but there are certain symptoms that you should be keeping an eye out for if your pain is particularly bad - and you should consult with your doctor about your options.

Johns Hopkins gynaecologist Khara Simpson, M.D., has identified five of the most prevalent signs of endometriosis that women should be aware of:

Painful Periods

While many experience cramps during menstruation, women with endometriosis often suffer from severe pain that can disrupt their ability to work or care for themselves and their families. 

Dr. Simpson emphasises that "mild discomfort with periods may be normal, but pain that stops a woman from working or going to school or other daily activities is not normal and should be evaluated by a gynaecologist."

Chronic Pelvic Pain

Some women endure chronic, severe pelvic pain even outside their menstrual periods. This persistent pain may indicate advanced or refractory endometriosis and scarring.

Painful Intercourse 

Known as dyspareunia, this symptom can result from endometriosis located beneath the uterus. Women with this condition may experience sharp, localised pain during penetration.

Ovarian Cysts

While many ovarian cysts are harmless and resolve on their own, endometriosis-related cysts (endometriomas) are a significant indicator of the disease. These cysts can grow large and cause pain, sometimes requiring surgical removal.

Infertility

Defined as the inability to conceive after a year of regular, unprotected intercourse, infertility affects 25% to 50% of women with endometriosis. The disease can cause scar tissue, damage, and inflammation to the fallopian tubes, and research shows it can also affect egg quality and quantity.

Dr. Simpson notes that these symptoms are not exclusive to endometriosis, other classic symptoms include:

• Bowel Problems (bloating, constipation, painful bowel movements)
• Fatigue
• Premenstrual Syndrome (PMS)
• Abnormal Menstrual Bleeding
• Painful Urination

She advises: "It is difficult to determine based on symptoms alone what the source of pain is -  endometriosis versus other conditions - which is why I advise all patients to see a medical practitioner if you have pain with your periods. 

“Additional symptoms that may suggest endometriosis can include dyspareunia - pain with intercourse - and/or dyschesia (pain with bowel movements)." 

Pelvic pain can also stem from scar tissue, previous infections, pelvic floor myalgia, or other non-gynaecological issues like painful bladder syndrome and irritable or inflammatory bowel syndromes.

"Importantly," Dr. Simpson adds, "many women with endometriosis do not have pain or symptoms."

READ MORE:

• Understanding Endometriosis: Expert explains symptoms, treatment and dispels myths
• ‘After multiple endometriosis surgeries and still no concrete treatment plan, I’m just left waiting’
• Adenomyosis: The condition that impacts women more than endometriosis