What are the first signs of endometriosis?

Endometriosis is tissue similar to the womb lining growing outside the womb. It can irritate nearby pelvic areas and cause pain that follows a menstrual cycle. Early symptoms may be mild, but pain that increasingly limits work, sleep, movement, or relationships is worth discussing.

Some people mainly notice pain with bowel movements or urination during a period. Others first seek help because of [Trouble Getting Pregnant](/symptoms/trouble-getting-pregnant/). These symptoms can also occur with other conditions, so symptoms alone cannot confirm endometriosis.

Track pain location, timing, severity in everyday terms, bleeding, bowel or bladder changes, and medicines tried. Bring the record to an appointment and explain what activities you avoid. A clinician may arrange an examination, imaging, or referral. Treatment choices can include anti-inflammatory medicine, hormonal options such as the [Combined Pill](/treatments/contraception-and-family-planning/combined-pill/) or [Hormonal Coil](/treatments/contraception-and-family-planning/hormonal-coil/), and sometimes surgery.

Arrange an appointment when period pain is severe, newly worsening, or not controlled by your usual measures, especially if it affects daily activities or fertility plans. Seek urgent help for sudden severe pelvic pain, fainting, heavy bleeding with weakness, fever, or possible pregnancy with pain or bleeding.

Could my cycle-linked symptoms have more than one explanation? What assessment is suitable? Which treatment fits my pregnancy plans, and when would specialist surgery or [Laparoscopic Excision of Endometriosis](/treatments/gynaecological-surgery/laparoscopic-excision-of-endometriosis/) be considered?