About 1 in 10 women of reproductive age has endometriosis. That is roughly 190 million women worldwide [1] and an estimated 6.5 million in the United States [2]. Many of them do not know what is causing their symptoms [1].
That is changing. Under ACOG’s 2026 guidance, a diagnosis based on your symptoms and a physical exam is enough to begin treatment [5][6]. There are recognized signs, and you can learn them.
If this sounds like you, keep reading:
- Your periods are painful enough to disrupt your work, school or plans.
- Pelvic pain continues outside of your period.
- Sex, bowel movements or urination hurt.
- You are trying to get pregnant, and it has not happened.
- You have been told your pain is normal, and you do not believe it.
Below, you will find the signs to look for, how endometriosis is diagnosed, and when to ask for help.
THE SHORT ANSWER
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside it, most often in the pelvis. Common signs include painful periods, chronic pelvic pain, pain during sex, and pain with bowel movements or urination. If these symptoms disrupt your life, it is worth seeing a specialist.
What Is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside of it. That tissue responds to hormones, drives inflammation, and can form scar tissue and adhesions that bind organs together.
The American College of Obstetricians and Gynecologists (ACOG) estimates that about 10% of reproductive-age women have endometriosis [3]. The likelihood is higher when pain or difficulty getting pregnant is present.
It is also more than a pelvic condition. Endometriosis can affect the bowel, ureters and bladder, and it creates an inflammatory state that can bring fatigue or low mood on top of pain. That is why our team does not think of it as a “period problem.”
Common Symptoms of Endometriosis
Symptoms vary from person to person. You may have one of these or several.
1. Painful periods
Cramps that are severe, sometimes debilitating, and may get worse over time. Pain that feels unbearable, or that conflicts with your daily schedule, is a reason to speak with a doctor [3].
2. Chronic pelvic pain
Pelvic pain that continues well beyond your cycle.
3. Pain during or after sex
Also called dyspareunia. It is one of the symptoms ACOG lists when clinicians should suspect endometriosis [5].
4. Pain with bowel movements or urination
These symptoms can be more noticeable during your period, and they can appear when the disease involves the bowel or bladder [3][5].
5. Heavy periods or bleeding between periods
Some women have heavy periods, premenstrual spotting, or bleeding between periods [3].
6. Fatigue and low mood
The inflammation that comes with endometriosis can contribute to exhaustion and, for some women, depression.
7. Difficulty getting pregnant
For many women, trouble conceiving is the first reason they suspect something is wrong. ACOG includes infertility among the signs that should prompt clinicians to consider endometriosis [5].
Endometriosis Pain vs. Normal Period Cramps
Many people are unsure where ordinary period discomfort ends and something more begins. This comparison can help you decide what to raise with a doctor.
| PAIN YOU CAN USUALLY MANAGE | PAIN WORTH DISCUSSING |
| Cramps that are manageable and do not disrupt your day | Pain that is unbearable or conflicts with your daily schedule |
| Discomfort that stays within your period | Pain that continues beyond your period or appears at other points in your cycle |
| Sex, bowel movements and urination are not painful | Pain during sex, bowel movements or urination |
| Pain that stays about the same from cycle to cycle | Pain that gets worse over time |
| You carry on with work, school and plans | You miss work, school or plans because of pain |
Does Pain Show How Advanced Endometriosis Is?
No. Endometriosis is staged from I to IV based on how much disease is present, how deep it goes and how much scar tissue has formed. But stage does not equal pain. A patient with stage I disease can have severe pain, and a patient with stage IV may have few symptoms. A stage should never be used to judge how much someone is suffering.
Why Does Endometriosis Take So Long to Diagnose?
A study of about 6,950 women in France with self-reported endometriosis or adenomyosis found an average diagnostic delay of 10 years for endometriosis [4]. By the time many patients reach a specialist, they have spent years looking for an answer. Many have been told their pain is normal. Some have already had surgery that did not last.
The World Health Organization notes that many people, families and health professionals do not recognize that chronic pelvic pain from endometriosis is not normal [1]. Missed or delayed diagnoses are a major reason prevalence is likely underestimated [2].
If that is your experience, you are not imagining it, and you do not have to keep explaining it to people who will not listen.
How Is Endometriosis Diagnosed?
For years, confirming endometriosis meant surgery. That has changed. In 2026, ACOG updated its guidance on diagnosing endometriosis. Based on press coverage of that guidance [5][6]:
- A diagnosis based on your symptoms and a physical exam is enough to begin medical treatment. Surgery is not required first.
- Transvaginal ultrasound is the recommended first imaging test. A pelvic MRI may be used when more detail about deep disease is needed to plan treatment.
- A normal ultrasound does not rule out endometriosis. Ultrasound can miss small nodules and lesions.
- ACOG recommends against using blood, urine or other biomarker tests to diagnose it.
- Whether to proceed to diagnostic laparoscopy is a shared decision between you and your doctor.
When Should You See a Doctor About Endometriosis?
You do not need a diagnosis, or a certain level of pain, to ask for help. Book a visit if:
- Your period pain is severe, or it is getting worse over time.
- Pelvic pain continues outside of your period.
- You have pain during sex, bowel movements or urination.
- Pain or fatigue is affecting your work, relationships or daily life.
- You are trying to conceive and it has not happened.
- You have been told your pain is normal, and you do not believe it.
SEEK URGENT CARE Sudden, severe pelvic pain, fainting, fever with pelvic pain, or very heavy bleeding needs prompt medical attention. Do not wait for an appointment.
What to Expect at Your First Endometriosis Visit
At Viva Eve, every endometriosis patient begins with an Endometriosis New Patient Visit (ENDO NPV). It lasts 60 minutes, so you have time to be heard. The visit covers:
- History and records. Your menstrual and non-menstrual pain, prior treatment, and questions.
- Your goals. Symptom relief, preserving your uterus, readiness for surgery and any plans to have a child.
- A focused examination when it is clinically useful.
- An imaging plan. Most patients are referred for an MRI, and an ultrasound can be done in the office.
- A plan you agree on together: medical care, surgery, or a fertility-focused approach.
How to prepare
- Note when your pain happens, how severe it is, and how it relates to your cycle.
- Bring your medical history and any imaging reports. If you have had an MRI in the past 30 days, bring it or ask for it to be sent ahead.
Not every patient needs surgery. A concierge guides you from your first call through each step of your care.
How Is Endometriosis Treated?
Treatment depends on your symptoms, your goals and what your evaluation shows. Options include medical management, surgery, or a plan built around fertility goals.
Our endometriosis care is led by Dr. Theodoros (Theo) Kapetanakis, Director of Minimally Invasive Gynecologic Surgery (MIGS) Services. He completed an 18-month accredited MIGS fellowship and has performed more than 450 complex excisions. He advocates for laparoscopic excision rather than ablation, which burns only the surface of a lesion. His goal is complete excision in a single surgery, coordinated with colorectal, urology and other specialists when your case needs them.
Dr. Kapetanakis begins seeing patients at our Madison Avenue location on December 23, 2026.
Frequently Asked Questions
What are the first signs of endometriosis?
The most common early signs are painful periods, pelvic pain that continues outside your period, and pain during sex. Some women first notice pain with bowel movements or urination, or trouble getting pregnant.
Can you have endometriosis without painful periods?
Yes. Symptoms vary. For some women, difficulty conceiving or pain during sex is the first sign.
Is endometriosis pain different from period cramps?
It can be. Endometriosis pain is often more severe, may continue beyond your period, and can come with pain during sex, bowel movements or urination. Cramps that are unbearable or disrupt your daily life are worth discussing with a doctor.
Do I need surgery to be diagnosed?
Not necessarily. ACOG’s 2026 guidance says a clinical diagnosis based on your symptoms and exam is enough to begin medical treatment. Whether to have diagnostic laparoscopy is decided together with your doctor.
What kind of doctor treats endometriosis?
An OB/GYN can evaluate your symptoms. For complex or deeply infiltrating disease, a fellowship-trained minimally invasive gynecologic surgeon has additional expertise in excision surgery.
Can endometriosis affect fertility?
It can make getting pregnant more difficult, and ACOG lists infertility among the signs that should prompt clinicians to consider endometriosis. Your first visit includes a conversation about your reproductive goals.
Take the Next Step
You deserve to live your life free of pain and discomfort. If your symptoms sound familiar, you do not have to wait for a diagnosis to ask for help. Book an endometriosis new patient visit at Viva Eve, 635 Madison Avenue, 6th Floor, New York, or call (212) 988-2111.
We can help.
This article is for educational purposes and is not a substitute for medical advice. If you have symptoms, speak with a qualified healthcare provider.
Sources
[1] World Health Organization, Endometriosis fact sheet (March 2023)
[2] Society for Women’s Health Research, Endometriosis Advocacy Toolkit (2024)
[3] Wake Forest Health, “The Symptoms of Endometriosis” (cites ACOG on prevalence)
[5] Healio, “ACOG updates guidance on diagnosing endometriosis” (February 20, 2026)[6] Hackensack Meridian Health, “New guidelines could change how endometriosis is diagnosed” (April 16, 2026)
