Uncommon, or less talked about, symptoms of endometriosis can include gastrointestinal symptoms, urinary symptoms, pain while having sex, and nerve pain.

Endometriosis is a condition in which cells that line the uterus — the endometrium — grow outside of the uterus in other parts of the body.

While the pelvis is the most common site for endometriosis, it can also affect structures and organs inside and outside of the pelvis, such as the gastrointestinal tract, urinary system, and nerves.

Because of the location variability of cell implants, endometriosis may present with lesser-known symptoms other than pelvic pain and painful periods.

This article explores uncommon symptoms of endometriosis and conditions that cause similar symptoms to endometriosis.

A person reading a book while sat on a bench. Uncommon symptoms of endometriosis include fatigue and pain during sex.Share on Pinterest
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Fatigue is a less recognized, but significant symptom, of endometriosis. Pain and other symptoms often accompany it.

It can cause major distress and negatively affect the quality of a person’s life and daily activities. There is often an association between fatigue and insomnia, depression, or occupational stress.

Painful intercourse — or dyspareunia — is another potential symptom of endometriosis. It can occur during penetrative sex and be superficial, with pain at initial entry felt at the vulvar region, or deep, with perceived pain in the vaginal canal or pelvic region. Deep dyspareunia affects about 50% of women with endometriosis.

People describe the pain as a drawing, dragging pain that radiates down their thighs, while others report it as a sharp, stabbing pain during intercourse that persists days afterward.

While people typically feel endometriosis pain in their body tissues, about 40% of people with endometriosis report feeling pain in their nerves — also referred to as neuropathic pain. People describe this type of pain as tingling or stabbing.

Nerve pain may result from previous endometriosis surgery, damaged nerve fibers from endometrial tissue ablation, or prolonged exposure to proteins that promote inflammation in the body.

One case study reported two individuals with endometriosis that affected the sciatic nerve, which caused mobility problems and a loss of muscle mass.

Thoracic or pleural endometriosis is the most common location of endometriosis outside of the pelvis. Thoracic endometriosis affects a person’s chest cavity, such as in the diaphragm or the lungs.

It commonly causes symptoms that occur with menstruation, including:

In a 2021 case study, a 34-year-old woman reported right-sided chest pain occurring at the same time as her period every month, with the absence of a cough, sputum, fever, or weight loss due to endometriosis.

People with endometriosis also report lower urinary tract symptoms significantly more often than those without the condition.

We explore some of these symptoms below.

Painful urination

Pain during urination — or dysuria — is the most common symptom when endometriosis affects the bladder.

In a 2021 qualitative study, participants described painful urination due to endometriosis as a burning sensation, similar to experiencing a urinary tract infection. It also tended to be worse in the mornings, especially when the bladder was full.

Blood in the urine

Blood in a person’s urine during menstruation — known as cyclical menstrual hematuria — can be a sign of bladder endometriosis. However, it only occurs in 20% of people with bladder endometriosis.

Other symptoms

Other lower urinary tract symptoms can include:

  • difficulty passing urine
  • feeling as though the bladder is still full after urination
  • having to urinate again within minutes of urinating
  • feeling pain when the bladder is full

Rarely, endometriosis may affect the upper urinary tract, which includes the ureters, known as ureteral endometriosis, and kidneys, known as renal endometriosis.

Flank pain is a common symptom of renal endometriosis, with about 25% of people with ureteral endometriosis reporting flank pain.

Learn more about the causes of flank pain.

Gastrointestinal symptoms are almost as common as gynecological symptoms in people with endometriosis, with bowel involvement seen in 5–12% of women.

People with endometriosis are 13 times more likely to report abdominal pain than people without the condition.

A person with endometriosis may experience the following gastrointestinal symptoms:

Endometriosis is a multi-organ disease that can present a diagnostic challenge due to its tendency to mimic other conditions.

Below are some conditions that can cause chronic pelvic pain similar to endometriosis:

The migration of endometrial tissue to different organs and structures in the body can cause endometriosis to have a wide range of symptoms beyond chronic pelvic pain. These symptoms can also be mistaken for other conditions.

For example, doctors can misdiagnose renal endometriosis as a renal tumor. Endometriosis may also mimic symptoms of appendicitis.

People should speak with a healthcare professional if they have symptoms of endometriosis, especially if those symptoms significantly impact their life.

It is difficult to diagnose endometriosis because of its variable symptoms and conditions that cause similar symptoms. Therefore, it can be helpful for people to take note of the symptoms they experience.

A healthcare professional usually performs a physical exam of the abdomen and vagina. They will possibly do further tests, such as an ultrasound or laparoscopy, to help diagnose the condition.

Learn more about endometriosis diagnosis.

Endometriosis is a chronic condition that affects many females of reproductive age.

Diagnosis can be challenging because some symptoms can mimic those of other conditions or are less well known, such as nerve pain and urinary and gastrointestinal symptoms.

A healthcare professional can help diagnose the condition and recommend treatment options. Keeping a log of one’s symptoms may also be beneficial, as this can help healthcare professionals better understand the health concern and provide appropriate treatments.