endometriosis symptoms

Symptoms of Endometriosis

Dr. Jolene BrightenPublished: Last Reviewed: Endometriosis, Sex Hormones Leave a Comment

Endometriosis is a common health issue affecting women—one in ten women have it! And I would say that probably ten out of ten women have been dismissed by their doctor at some point in their journey. Because typically, you go to your doctor with signs and symptoms of endometriosis, and the first thing you're told is, “Oh, girl, just take the pill. Here's a painkiller; periods are meant to be painful and that's just the way it is.” In this article, we’re going to talk about the symptoms of endometriosis and some strategies to help you get the care you need.

Many women go for years struggling because doctors dismiss their symptoms and try to suppress them with medications—without getting to the root cause. Sometimes we have to use some form of hormonal contraceptive to treat a woman with symptoms of endometriosis, but that doesn’t mean we don’t ask why she has these symptoms.

What Is Endometriosis?

Endometrial tissue is normally only found lining the uterus. In women with endometriosis, however, there are endometrial implants in other areas of the body, such as the fallopian tubes, ovaries, intestines and more. It’s important to note that while similar, the endometrial implants are not exactly like the lining of your uterus. In fact, they tend to have more fibrous tissue and cysts.

Because the endometrium responds to the same hormones that result in your period, these tissues (regardless of where they are in the body) also bleed when you have your period. This causes inflammation, resulting in scar tissue and severe pain.

In time, your body tries to protect you, and adhesions (built-up connective tissue) begin to form in the reproductive organs, intestines, bladder, and other organs. These adhesions can cause problems anywhere in the body.

Endometriosis is both estrogen dependent and inflammatory. It can affect women at any stage of life.

Symptoms of Endometriosis

1. Pain

Pain in various forms is the number one symptom women with endometriosis report. Endo pain is characterized by the 3 P’s: Painful Periods, Pain with Sex, Pain Between Periods.

Painful Periods

I’m not just talking about a painful period. Popping a Mydol won’t help. Endometriosis cramps are debilitating—vomiting, hugging a water bottle debilitating. The cramps can last the entire period or even come on before then, which means that some women are having pain for more than 10 days out of the month.

Pain During Sex

Pain during intercourse is called dyspareunia, and it can be caused by adhesions. Like I said before, adhesions can form in the pelvis, but they can also form in other areas.

Pain with Urination or Bowel Movements

If you are a woman who has pain with urination or defecation (that's a fancy way of saying pooping), it's worth investigating whether you potentially have endometriosis. Because adhesions can be in the bowels as well.

Pain, Pain, Pain

So you can have pain with bowel movements, pain with urination, pain in the abdomen, pain in your lower back, pain in your thighs. Pain can be with periods and between periods with endometriosis. You ever get menstrual cramps and it radiates down your thighs? That can be signs of other things, but it may very well be endometriosis.

2.  Heavy Periods

Another possible symptom of endometriosis is having very heavy periods. In fact, in one study they found that 73% of women with endometriosis reported heavy periods and period pain compared to 20% of women in the control group.

3.  Difficulty Becoming Pregnant

As I talk about my book Beyond the Pill, endometriosis is estimated to be the cause of 10% or more of infertility cases—this is a big problem. When a young woman presents with period pain, doctors usually pass her hormonal birth control and that’s the end of it. There is no discussion about what might be going on, or even a mention that it could be endometriosis, which can end up causing problems with fertility if left unmanaged.

Endometriosis Symptom Quiz

Curious if you might have endometriosis? Use this quiz to check your symptoms.

  1. Without pain medication, my period pain prevents me from going about my normal daily activities.
  2. My period pain can make me nauseous or cause me to vomit.
  3. I often experience low back or pelvic pain before and during my period that prevents me from going to work, being social, or even doing chores around the house.
  4. I often have pain with bowel movements, especially before and during my period.
  5. I experience pain between my periods that restricts my activities.
  6. It is common for me to experience pain with sex.
  7. I avoid sex because of pain.
  8. I experience pain with urination.

If you answered yes to 1 or more of these questions, it is time to talk with your doctor. Write down your answers and take these to your next doctor’s appointment so you can discuss these key areas and get answers to your pain.

Being an Advocate for Yourself

There is a well-documented phenomenon known as medical gender bias i.e. your doctor steps into the room with assumptions about you, your health, and your symptoms. If you are a doctor, I'm not bagging on you, but there is research showing that women are more likely to have their pain dismissed and to receive inadequate treatment. They actually don't get treated correctly based solely on being a woman. It's 2019. How is this still a thing?

It’s therefore essential that you advocate for yourself. If you think that something's not normal, you're the only person who lives in your body, which means that you're the only one that has a barometer on what is normal for you.

Period Pain May Be Common, But It’s Not Normal

It’s also important for all of us to recognize that when people see a doctor, they're usually sick and they have symptoms. So doctors are hearing daily from women with terribly painful periods, painful pooping, painful urination, painful intercourse, etc., and that can lead the doctor to say that’s therefore normal because he/she is hearing it all the time.

But it’s not normal. It’s common.

Some women are given antidepressants or anti-anxiety medication and sent to a counselor only to be told that they are being high-maintenance, a hypochondriac, or hysterical (yes, this word, despite its origins, still gets thrown around in medicine). But I am here to tell you that it's not in your head. You're not hysterical. If something's not right in your body, you have to advocate for yourself, and keep looking until you find a doctor who listens to you.

One of the first steps you can take in advocating for yourself is to track your symptoms throughout your cycle. Having the data recorded not only helps you (and your doctor) get clarity about the severity of the situation, it also makes it a lot harder for any gaslighting to go down in that treatment room.

Diagnosing Endometriosis

Currently, the gold standard for an endometriosis diagnosis is surgery, specifically a laparoscopy and biopsy. Even though it is a minimally invasive surgery compared to other procedures, it’s still surgery.

Nobody really wants to operate on a young woman’s pelvis when she presents with pain, which is why she is often given hormonal birth control. Women are often told that the birth control is the solution to her period problems, sometimes without a discussion about possible endometriosis. Women deserve to know that this is a possibility and may need to be investigated in the future.

Recently, a blood test has become available that claims to be able to detect 90% of cases of endometriosis. This test known as the Mitomic Endometriosis Test is showing promise for early diagnosis.

Root Causes of Endometriosis

The reality is we're not entirely sure what causes endometriosis—we need a whole lot more research on the condition. However, there are a few factors that we have learned play a role in endometriosis.

Estrogen Dominance

We've come to understand that there is a hormonal component. Estrogen is one of those hormones that can influence immune system regulation, and estrogen dominance can make your immune system get all hot and bothered, and also overstimulate endometrial tissue anywhere in the body to proliferate.

It was once thought that estrogen dominance was the cause of endometriosis. But the dance endo and estrogen are engaged in is much more complicated. Endometriosis is an inflammatory condition, which can lead to estrogen dominance. However, estrogen dominance can aggravate the immune system and lead to further inflammation. A bit of a chicken and the egg situation here, but the bottom line is that you must treat inflammation and estrogen dominance in endometriosis. In my practice we spend more time focused on creating harmony between hormones and the immune system then worrying who came first. Both need to be addressed.

Gut Dysbiosis

We also know how that endometriosis is an inflammatory condition that’s likely rooted in autoimmunity and gut dysbiosis (like just about everything it seems these days!). Dysbiosis essentially means that your gut is unhealthy, and there is intestinal hyperpermeability (or leaky gut). You probably have organisms growing in the gut that shouldn't be there.

When this occurs we see inflammation rises, hormone imbalances evolve, and pain can increase.

Environmental Toxins

Many experts have begun questioning the role of environmental toxins (chemicals like dioxins and PCBs) in endometriosis. They're thought to increase the risk of endometriosis, and they do this by altering cytokines, the chemical messengers of the immune system. You can think of them as hormones of the immune system, and they can also alter immune function. In fact, they can alter your hormones altogether and can lead to you creating more adhesions.

Liver Function

Environmental toxins also impact your liver function. I already mentioned the estrogen component with endometriosis, we also have to recognize that the way that you process your estrogen plays a really big role in how things grow in your body.

As I talk about in Chapter 5 of Beyond the Pill, your liver is responsible for making estrogen metabolites. It can make the nice, safe, wonderful 2-hydroxyestrone, or it can put it into the 4-hydroxy or the 16-hydroxy pathway. The 16-hydroxy pathway (you'll see this on a lab as 16-OHE1) in particular stimulates growth.

It's entirely possible that on your bloodwork it looks like you have low estrogen. But in reality, when we test metabolites using something like a Dutch test, we could see that you're making the wrong kind of metabolites and stimulating growth. So if environmental toxins are bogging down your liver, we're going to see issues in terms of your estrogen in general.

Using Hormonal Birth Control to Treat Endometriosis

Sometimes, hormonal birth control, like the pill, can help get a woman out of pain so that she can work on the root cause of endometriosis. However, there should be full acknowledgment that it is for symptom management only, and not actually a root cause solution.

By prescribing birth control with that vital information, a woman then understands that there is other work she has to do in order to manage her condition. She will not be under the impression that birth control will fix her endometriosis.

It’s important for women with endometriosis to get symptom relief so they can focus their energy on healing the root cause. Working toward healing takes energy. If birth control helps control her pain, she will have the energy do the root cause work of eating well and moving her body. Writhing in pain is not conducive to getting root cause work done.

Treating Endometriosis Without Birth Control

It is possible to treat endometriosis without birth control and live a joyful life. I’ve helped many patients in my practice eliminate pain, increase their energy, and improve their periods without birth control. It takes a team approach and depending on your individual factors and disease progression, it may take some time to achieve this.

Best Treatments for Endometriosis

To be clear: When it comes to endometriosis, and all chronic disease, you have to take a multifactorial approach. It isn’t simply a matter of changing your diet and boom! endo healed. You need to have a health care team.

In addition to having a naturopathic physician or functional medicine doctor working with you on the root cause of your endometriosis, the following providers can help you work on other areas of your life. This list is in no way exhaustive, but it gives you a sense of the kind of providers that can help.  

Create a Health Care Team

Mental and Emotional Support

Having a counselor or somebody who's supporting your mental and emotional health is a must. Women with chronic pain tend to be at higher risk for depression and anxiety. If you can't even poop without being in pain (and we have to poop daily to get estrogen out), that's going to weigh on your psychological health.

Additionally, we know the thoughts we think have a big impact on health, including inflammation. It is important to have support in this area of health.

Registered Dietitian, Certified Nutrition Practitioner, Nutrition Therapy Practitioner

You're likely going to need a diet upgrade. Working with a registered dietitian, a certified nutrition practitioner, or nutritional therapy practitioner can help you take the necessary steps to create a diet that lowers inflammation and improves your hormones. They make a wonderful adjunctive provider to help support you on your journey.

Massage Therapist, Physical Therapist or Personal Trainer

A massage therapist who can work on adhesions is also highly beneficial because when we're in pain, the body will start shifting and changing in a way to safeguard us against pain. Having a physical therapist, personal trainer, and massage therapist can be highly beneficial to overall health.

Specialized Surgeon

Some women with endometriosis need to have surgery. There's no shame in that. There's no shame in doing whatever you can to feel amazing in your body. Whether that is using hormonal birth control temporarily, getting surgery done, or making sure that you have some other support networks in your life—whatever it takes for you to feel whole in your body and to be able to enjoy your life: more power to you.

But even if you're not planning surgery now, you want to spend some time investigating a surgeon and finding somebody that you can partner with. So if it does come down to surgery, you have already formed a relationship, making the process seamless.

As stated above, laparoscopy is the gold standard for endometriosis diagnosis. Having the diagnostic surgery with a surgeon who specializes in endometriosis can help you get the diagnosis and you can have treatment at the same time. Excision surgery, where the lesions are removed, may help eliminate symptoms like pain. You can use nutrition, lifestyle, supplement, and medication therapies in conjunction with surgery. And you'll find many of the nutrition recommendations in this article can also help with post-op recovery.

Endometriosis Managing Pain

While getting out of pain initially is not generally a root cause solution, it is a very necessary part of the healing process. I'm all about trying to make you feel better as soon as possible, while we also work on the root cause.

The following is a list of remedies that can help reduce pain associated with endometriosis and address root cause issues associated with endo. By employing natural therapies you may be able to reduce or eliminate the need for NSAIDs and other pain relievers. You can read here why you want to avoid NSAIDs for hormone balance.

1. Melatonin

Research has shown that melatonin can help reduce menstrual pain, pain with sex, pain with urination, and pain with bowel movements.

In Beyond the Pill, I teach you how to bump your melatonin naturally and make sure that we're supporting it. Melatonin can also help with keeping your ovaries healthy and protecting you against breast cancer. Although it helps us sleep, it's also an antioxidant.

You can also boost your melatonin naturally by wearing amber glasses, sleeping in a completely dark room, and eating certain foods. Pineapples, bananas, and oranges can help increase melatonin levels.

2. Magnesium Bisyglycinate

Magnesium is involved in 300+ metabolic pathways. It is also an essential part of how we convert tryptophan into melatonin.

Magnesium can help reduce pain and it can help with you processing out your estrogen so avoiding estrogen dominance.

If you are a woman sitting in my clinic struggling with menstrual cramps of any kind, magnesium is definitely something we'll start.

Why? Because it helps lower prostaglandins. Those are the hormone-like substances that cause cramping, which can be severe and debilitating. Elevated levels of prostaglandins are associated with more painful menstrual cramps.

Magnesium Plus 300-600 mg daily is what I commonly use in my practice.

3. Vitamin B Complex

B vitamins are important for estrogen metabolism, liver detoxification, and hormone production. B5 specifically helps support our adrenal glands so that they can produce inflammation lowering cortisol. B6 is essential for progesterone production, which keeps estrogen in check.

To create melatonin, you need B6. You therefore need to take a quality vitamin B complex daily. I never recommend taking one B vitamin only. That’s because if you increase just one B vitamin, you can ramp up part of the metabolic pathway, and you start using up other B vitamins but you're not replenishing or replacing them.

In my clinical practice I use B-Active Plus supplement.

4. Apply Heat

Placing a hot water bottle on the abdomen or low back can help reduce pain. You can also consider taking a hot bath with epsom salt to help alleviate pain.

You can learn about other ways to reduce endometriosis pain here.

5. Use Turmeric

Turmeric is a potent anti-inflammatory that can also support healthy estrogen metabolism.

When selecting a turmeric supplement, it's important that you find one that's highly bioavailable. This means that your body will actually be able to absorb it and utilize it. Unfortunately, many turmeric supplements that are available on the market are poorly absorbed which means although you’re taking it, you won’t really see the benefits.

Turmeric is also highly beneficial for liver detoxification and optimizes the health of your cells. When inflammation goes high it is harder to use our hormones at the cellular level. This is another way turmeric can support hormone health.

6. Eat a Hormone Balancing Diet

If we suspect that there is an autoimmune component to endometriosis, then we can shift the diet and begin healing the gut. While dietary changes are a super important piece of the puzzle, they alone are not enough. A change in diet is absolutely necessary, but I don't want you to feel frustrated or like you did something wrong if you change your diet and don’t see much improvement. I've provided you with a meal plan & recipe guide to help balance hormones here.

Can Diet Help Endometriosis Symptoms?

There are a lot of people out there promising that a quick diet fix can make endo be gone for good. Sadly, this just isn’t the case. Diet is a very important piece of the puzzle, but it is only one piece.

Endometriosis has an inflammatory component, and I therefore generally recommend eliminating key inflammatory foods initially.

Eliminate Aggravating Foods

Eliminating the following foods has been helpful for many of my endometriosis patients:

  • Gluten
  • Dairy
  • Soy

Does that mean that you can't ever eat a cheese again? No. But you have to test what is true for you by eliminating it temporarily.

I'm also going to be real with you here. I do not like to focus on taking out foods. Instead, my focus is always on building nutrient-dense diets. By consuming as many nutrient-dense foods as possible, we basically crowd out the foods that aren't serving us. I have a free meal plan & recipe guide to help you get started on this.

Increase Your Daily Vegetables

You also need to eat as many greens as possible every single day. The goal? Six to nine servings of vegetables a day. It might sound crazy—that’s a lot of vegetables! So start small. Add one serving of vegetables to your diet every single day for a week. The next week, an additional serving, until you get to six to nine servings of vegetables a day.

Starting small increases your chances of making changes that stick. Very few people are successful with making dietary changes when they just change everything overnight. Be gentle with yourself and always remind yourself of why you are doing this.

7. Support Gut Health

While we eliminate potentially aggravating foods in my practice we also get to work on healing the gut. I recommend using a high quality probiotic like Women's Probiotic.

Eating garlic, onions, cruciferous vegetables, and fermented foods help support metabolizing your hormones, as well as support the immune system (because they support the intestines, which supports those good gut bugs).

8. Adrenal Love is a Must

Your adrenal glands produce cortisol, which helps lower inflammation. In addition they help with energy, moods, and more. However, in HPA dysregulation (aka adrenal fatigue) the brain can signal to your glands to produce cortisol at the expense of progesterone, which can lead to estrogen dominance and more period problems.

As discussed previously, supporting estrogen elimination, boosting adrenal function, and ensuring a healthy gut is essential to any period problem with endo being no exception. This is why the Period Problems Kit™ is formulated with Balance Women's Hormone Support, Adrenal Support & a spore based probiotic. By supporting these three systems I've found women have much better outcomes in a a shorter period of time.

How Long Should It Take Before I Feel Better?

Healing takes time and patience is probably the hardest part of healing from a chronic conditon.

A good way to gauge how long it will take is to look at how long you've had symptoms. Say you've had symptoms for 12 years. We can expect 12 months of you really dialing in your diet, your lifestyle, supplements, the whole works, to start to see resolution of what is going on.

Does that mean it will take you 12 months to feel better? Absolutely not. But it's a good mindset practice to be realistic about what it takes to heal the body naturally, because it's not like using a pharmaceutical.

A pharmaceutical basically makes your body submit. But if you're using natural therapies, you're working with your body, so you’ll have to start working with your intuition as well to know when it is time to rest and when it is time to move forward and when it is time to change things. It’s a lot of responsibility, but it’s also tremendously empowering.

Endometriosis—Get Root Cause Solutions

Looking for root cause solutions to your lady part problems that don't require birth control? Or maybe you're on birth control and want to ensure you don't have to go through the side effects that come with it. Either way, I've got your back. I encourage you to grab a copy of Beyond the Pill and start your healing journey today! Plus, when you get your copy you can also grab the over $250 in gratitude bonuses!

Learn more about endometriosis symptoms & root cause solutions in this video.


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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.