Gynaecology · Endometriosis
Endometriosis symptoms: the signs worth taking seriously
Endometriosis affects around 1 in 7 Australian women by the age of 44 — yet many live with symptoms for years before being diagnosed. Here are the signs worth taking seriously and when to seek assessment.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus — on the ovaries, fallopian tubes, bowel, bladder or pelvic lining, and more rarely elsewhere. This tissue responds to the hormonal changes of the menstrual cycle, which can drive inflammation, scarring and adhesions. For a fuller overview of the condition, see our endometriosis page — this page focuses on recognising the symptoms.
What are the symptoms of endometriosis?
Symptoms vary widely from person to person. Importantly, the severity of symptoms doesn't always match the extent of disease: some women with extensive endometriosis have few symptoms, while others with relatively mild disease experience severe pain.
Painful periods (dysmenorrhoea)
Many women are told for years that severe period pain is normal. Mild discomfort can occur with menstruation, but pain that interferes with work, school, exercise, sleep or daily activities should not be ignored. It may include:
- cramping that starts before the period
- pelvic or lower back pain
- pain severe enough to need regular medication
- nausea or fatigue during periods
Pain during sex
Pain with deep penetration can be associated with endometriosis, particularly when disease involves the tissues behind the uterus.
Chronic pelvic pain
Some women experience ongoing pelvic pain even outside their menstrual cycle.
Bowel and bladder symptoms
Endometriosis can sometimes involve the bowel or bladder, leading to:
- pain opening the bowels during periods
- bloating
- diarrhoea or constipation around menstruation
- pain passing urine during periods
Many women with endometriosis have a prior or concurrent diagnosis of irritable bowel syndrome (IBS). Heavy or irregular periods can also occur — you can read more about heavy and irregular bleeding and related conditions such as fibroids.
Difficulty falling pregnant
Endometriosis may affect fertility in some women. That said, many women with endometriosis are still able to conceive naturally.
Why endometriosis is so often missed
Many women are told their symptoms are "just bad periods" or feel they should tolerate pain because friends or family experience something similar — and symptoms are often normalised, sometimes even within healthcare. Unfortunately, delays in diagnosis are common: in Australia, that delay is around eight years. If pelvic pain is affecting your quality of life, work, relationships, exercise or mental wellbeing, it is worth seeking assessment.
Can you have endometriosis with a normal ultrasound?
Yes. Diagnosis begins with a detailed history and examination. Ultrasound can identify some forms — particularly ovarian endometriomas or deep infiltrating disease — but a normal ultrasound does not exclude endometriosis. In some cases, laparoscopy (keyhole surgery) is recommended to confirm the diagnosis and treat disease at the same time.
Treatment options
Treatment depends on your symptoms, age, fertility goals and the extent of disease and often works best as a tailored, multidisciplinary approach. Options may include anti-inflammatory medications, hormonal treatments (such as the Mirena IUD, Slinda or the combined oral contraceptive pill), pelvic physiotherapy, lifestyle measures and laparoscopic surgery. You can read more on our endometriosis treatment and management page.
When should you see a specialist?
It's worth considering assessment if:
- period pain is impacting your daily life
- you frequently miss work or school because of periods
- you have persistent pelvic pain
- intercourse is painful
- you are struggling with fertility concerns
- you feel your symptoms have been dismissed or overlooked
Early assessment can help provide clarity, symptom relief and a long-term management plan.
Seeing an endometriosis specialist on Sydney's North Shore
Dr David Krones consults from North Shore Private Hospital, Level 3, Suite 3A/3 Westbourne St, St Leonards, and operates at North Shore Private and The Mater Hospital — within easy reach of Crows Nest, Chatswood, Lane Cove, Willoughby, North Sydney and the wider North Shore. If you're concerned about symptoms of endometriosis, speaking with your GP is an important first step and a referral lets you book a specialist assessment.
Frequently asked questions
What are the first signs of endometriosis?
Often the earliest sign is period pain that goes beyond normal discomfort — cramping that starts before bleeding or pain severe enough to interfere with work, study, sleep or exercise. Pelvic pain outside your period, pain during sex and bowel or bladder symptoms around menstruation can also be early clues.
Can you have endometriosis with a normal ultrasound scan?
Yes. Ultrasound can detect some forms of endometriosis, such as ovarian endometriomas or deep infiltrating disease but a normal scan does not rule it out. If your imaging is clear but symptoms persist, it's worth continuing to seek assessment.
How long does it take to be diagnosed with endometriosis in Australia?
On average, diagnosis in Australia takes around eight years from when symptoms begin. Much of that delay comes from symptoms being normalised or mistaken for ordinary period pain, which is why seeking assessment early matters.
Does endometriosis affect fertility?
It can affect fertility in some women but many women with endometriosis conceive naturally. If you're having difficulty falling pregnant alongside pelvic symptoms, it's worth discussing with your GP or a specialist.
Is severe period pain normal?
Mild discomfort with periods is common but pain that regularly interferes with work, school, sleep or daily life is not something you simply have to accept. Persistent or severe period pain is worth having assessed.
Where can I see an endometriosis specialist on Sydney's North Shore?
Dr David Krones consults at North Shore Private Hospital, Level 3, Suite 3A/3 Westbourne St, St Leonards, with operating privileges at North Shore Private and The Mater Hospital. The rooms are convenient to Crows Nest, Chatswood, Lane Cove and North Sydney. Ask your GP for a referral, or phone 02 9053 1245.
More questions? See our gynaecology FAQ, or read adenomyosis vs endometriosis.
Concerned about symptoms of endometriosis?
Dr David Krones is a specialist obstetrician and gynaecologist consulting on Sydney's North Shore, with a subspecialty interest in endometriosis, pelvic pain and advanced laparoscopic surgery. If any of these symptoms sound familiar, speak with your GP about a referral for assessment.
Phone 02 9053 1245 · Request an appointment · admin@drdavidkrones.com.au
Written by Dr David Krones, FRANZCOG · Last updated 1 July 2026. This article is general educational information only and does not replace individual medical advice. It does not establish a doctor–patient relationship.
References
- RANZCOG – Australian Living Evidence Guideline: Endometriosis.
- Australian Institute of Health and Welfare. Endometriosis in Australia: prevalence and hospitalisations.