Endometriosis can cause severe pain, regardless of which stage of the condition people have. People may experience pain during their period, during or after sex, or as a result of complications of the condition.

This article looks at what can cause severe pain in endometriosis, the type of pain people may experience, common treatment methods, and more.

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Pain is one of the most common symptoms of endometriosis. People may experience painful menstrual cramps that affect the abdomen and lower back. People may also feel pain during sex.

Endometriosis pain may feel like:

  • a deep, penetrating pain in the pelvic region below the belly button
  • abdominal cramping
  • intestinal pain
  • a prolonged, dull pain in the lower back and pelvis

Some people may also experience pain when they urinate or painful bowel movements when they are on their period. This pain may be present deep in the abdomen from the bladder or bowel.

Pain may affect each person differently and may range from mild to severe. Healthcare professionals classify endometriosis into four stages:

  • Stage 1 (minimal): Small, individual lesions are present, with no significant adhesions.
  • Stage 2 (mild): Lesions are less than 5 centimeters, with no significant adhesions.
  • Stage 3 (moderate): There are multiple, deep implants; thin adhesions; and small endometriomas on one or both ovaries.
  • Stage 4 (severe): There are multiple, deep implants; thick adhesions; and large endometriomas on one or both ovaries.

The stage of a person’s endometriosis does not always correlate to the level of pain they may experience.

People may have a more advanced or severe stage of endometriosis and experience few to no symptoms, while people with stage 1 endometriosis may experience severe pain.

In some cases, severe endometriosis pain may indicate a medical emergency.

Endometriosis can have symptoms similar to those of other conditions. Severe pelvic pain may be a symptom of another condition that requires immediate medical care, such as:

If someone experiences acute severe pain in the pelvic region, they should contact a healthcare professional as soon as possible.

Endometriosis may cause chronic pain in the lower back. People with severe endometriosis back pain may experience pain in the lower back that may radiate to the pelvic area and buttocks.

Lower back pain may occur in endometriosis as a result of:

Other possible causes of severe lower back pain include:

People will need to seek medical help if they have severe lower back pain along with:

  • fever
  • significant weight loss or gain
  • loss of function
  • weakness
  • bladder problems

Endometriosis can cause severe menstrual cramps.

This is because endometrial tissue bleeds in the same way as the lining of the uterus during a menstrual period, but the tissue and blood have no way to leave the body. This can cause pain, inflammation, and scarring.

Other possible causes of severe period pain include:

People may feel severe pain during or after sex. The pain may feel like it occurs deep within the body. It is not the same as feeling pain at the opening of the vagina at the start of penetration.

A person may also experience abdominal cramps during or after sex.

This pain may range from mild to severe. Sometimes the pain may be so severe that a person avoids sexual activity altogether.

If severe pain affects a person’s quality of life, they should contact a doctor.

Endometriosis may cause pain during sex if inflammation and adhesions cause the vagina and rectum to stick together.

Other conditions that may cause pain during sex include:

Endometriosis may cause severe leg pain, which may feel sharp or like a burning sensation.

Endometriosis may cause leg pain if it affects nerves in the pelvis, which can cause pain that radiates down into the leg.

Rarely, endometriosis may affect the sciatic nerve, which can cause leg pain.

Other conditions that may cause severe leg pain include:

A person should seek medical attention right away if they experience leg pain alongside:

Endometriosis may cause heavy bleeding during periods because the body has an increased amount of tissue and blood to shed.

If a person is bleeding for more than 7 days or bleeding heavily enough that they need to change a pad or tampon every hour, they will need to contact a doctor.

Other possible causes of severe vaginal bleeding are:

Endometriosis may lead to complications that can cause severe pain.

Ruptured cyst

Endometriosis can cause cysts to form on the ovaries. If a cyst ruptures, it may cause sudden pain in the lower abdomen or back, which may feel sharp or severe.

People will need to seek emergency help if they have severe pain alongside:

  • fever
  • heavy vaginal bleeding
  • severe nausea and vomiting
  • faint or dizzy feelings

Scar tissue

According to a 2020 review, scar tissue may cause compression of surrounding nerves, leading to pelvic pain.

Research has found an association between greater levels of nerve compression and higher pain scores.


Adhesions are bands of scar tissue that can make organs stick together. These can occur as a result of endometrial inflammation.

Endometriosis adhesions may commonly affect the ovaries, fallopian tubes, abdominal wall, bladder, and uterus.

Adhesions may cause chronic pelvic pain and negatively affect a person’s quality of life. Pain from adhesions may feel intense, sharp, stabbing, or nauseating.

Bladder and bowel problems

Depending on where in the body endometriosis occurs, the growth of endometrial tissue and inflammation may affect the bladder and bowels.

Endometriosis can cause pain when urinating or during bowel movements when people are on their period. In rare cases, there may be blood in stools or urine.

People may also experience:

  • diarrhea
  • constipation
  • bloating
  • nausea

Surgery complications

People may require laparoscopy, a type of surgery, to remove endometrial tissue, cysts, or scar tissue.

Although healthcare professionals will perform the surgery while a person is under general anesthesia, a person may experience some pain after the procedure.

Additionally, some complications of endometriosis surgery can cause severe pain.

Possible complications of surgery that may cause pain include:

  • bleeding from a surgical incision
  • infection
  • damage to abdominal organs
  • carbon dioxide gas remaining in the body

People will need to contact a doctor if they have severe pain alongside:

  • fever
  • nausea and vomiting
  • heavy vaginal bleeding
  • faint or dizzy feelings

After surgery, people will need to contact a doctor if they have:

  • fever or chills
  • continued or increased abdominal pain or pain around the incision
  • swelling, redness, bleeding, or any drainage from the incision
  • vomiting
  • difficulty urinating

Hormonal medication may help reduce pain. For example, hormonal birth control pills can make periods lighter and less painful. However, hormonal treatments may not be effective for people experiencing severe pain.

A person may find that general over-the-counter pain relievers, such as ibuprofen, are not enough to address severe pain. In this case, a doctor may prescribe stronger pain medication.

For severe pain, if other treatments are not effective, people may require surgery to remove endometrial tissue and scar tissue or to restore typical anatomy.

People may want to try alternative treatment methods, but some of these may have less research behind them:

People with persistent, severe pain from endometriosis may need surgery to remove endometrial growths and scar tissue.

The severity of the disease may affect how successful surgery is in relieving pain. Early diagnosis and treatment may help slow down or prevent progression of the disease.

The overall outlook for endometriosis is favorable, although it is possible for endometriosis to return after surgery.

This section answers some frequently asked questions about endometriosis and severe pain.

When should I be concerned about endometriosis pain?

Endometriosis can cause chronic pelvic pain, but sudden severe pain may be a cause for concern.

People will need to seek emergency medical attention if they have severe abdominal pain alongside:

  • fever
  • faint or dizzy feelings
  • nausea or vomiting
  • heavy vaginal bleeding

Sudden, severe abdominal pain could indicate a medical emergency such as ovarian torsion or ectopic pregnancy.

What is the most severe form of endometriosis?

Stage 4 endometriosis is the most severe form of the condition, although it may not cause the most severe pain. Stage 4 has increased severity of endometrial tissue, thicker adhesions, and larger cysts present.

Endometriosis symptoms do not necessarily relate to the stage of endometriosis. People can have severe symptoms at any stage of the condition.

Severe pain in endometriosis can result from the inflammation, scarring, and bleeding that endometrial growths can cause. Endometriosis can also increase prostaglandins and cause nerve compression, which can lead to pain.

If people have severe, sudden abdominal pain, they will need to contact a doctor because they may require immediate medical care.

People will need to seek emergency medical attention if they have severe pain along with fever, nausea and vomiting, heavy vaginal bleeding, or dizziness.