Endometriosis symptoms | 6 common signs

Jana Stehler is a former Hyrox athlete, a queen of new beginnings, and someone affected by endometriosis. In this article, she takes us into her world and shares her experiences with the disease endometriosis. Particularly important to her are endometriosis symptoms, which are often overlooked or dismissed by doctors as normal cycle symptoms.
On Instagram, she educates about the disease and gives further insights into her daily life with endometriosis – feel free to check it out!

What is Endometriosis?

Endometriosis is a chronic inflammatory disease in which tissue similar to the uterine lining grows outside the uterine cavity – for example, on the ovaries, in the abdominal and pelvic cavity, on the intestines, bladder, ureters, and peritoneum. It can even occur outside the abdominal cavity, e.g., in the lungs. It is assumed that, just like the normal uterine lining, the endometriosis tissue also builds up and breaks down periodically during the cycle and bleeds. However, the tissue shed with the bleeding cannot leave the body. It accumulates in the body, e.g., in the abdominal cavity, in the form of endometriosis lesions or on the ovaries in the form of cysts. These cysts are also called "chocolate cysts" because of the bleeding inside them. This often causes severe pain and other endometriosis symptoms.

Your Knowledge To Go: Endometriosis Symptoms

• The symptoms of endometriosis can spread throughout the entire body and are not, as many assume, only recognizable by severe menstrual pain.

• Endometriosis symptoms and pain are often diagnosed late and frequently not taken seriously by doctors. If you feel like you’re not making progress, seek opinions from different experts and never give up.

• The most common signs of endometriosis: bloated abdomen (very swollen), extreme lower abdominal pain before/during the period, cycle-independent pain, digestive issues like severe bloating, pain during intercourse, reduced fertility, severe exhaustion.

• Endometriosis can occur on the ovaries, in the abdominal and pelvic cavity, on the intestines, on the bladder, and/or on the peritoneum. In rare cases, other body regions such as the lungs are affected.

My Endometriosis Experiences

Endometriosis is painful and often goes undetected for years – as it did with me. It has been exactly ten years since my first laparoscopy, and I only received the diagnosis six months ago. How is that possible?

In 2016, a chocolate cyst was removed from my ovaries, but after the surgery, I was not told that I had endometriosis. Six years ago, I stopped taking the pill to live hormone-free. Two years later, the pain before and during my period became unbearable, almost to the point of unconsciousness. Endometriosis symptoms are often dismissed as "normal menstrual pain." Such severe pain is not normal and should be taken seriously. Severe menstrual pain is a very common symptom – but the pain can occur both cycle-dependent and cycle-independent.

My endometriosis symptoms summarized: extreme endobelly, digestive issues (bloating, pain during bowel movements, etc.), unexplained exhaustion, extremely long menstrual cycles (sometimes up to 50 days), increasingly lighter periods, urine with a sharp smell (due to endometriosis on the bladder/ureters), pain during intercourse. And the worst were the endometriosis flare-up symptoms: I was lying there, unable to move, always close to calling an emergency doctor, and crawling on all fours to the medicine cabinet. It felt like I was about to lose consciousness at any moment.

In July 2025, I had another surgery, but only on suspicion, as nothing could be seen on the ultrasound. The result? An outpatient surgery turned into a hospital stay, and the suspicion became endometriosis stage 4 affecting the intestines, bladder, ureters, ovaries, peritoneum, and pelvis. And I thought the pain was from stress – no joke. I always thought I was exaggerating and that it was normal since I had struggled with severe pain during periods, irregular cycles, and spotting since childhood.

That’s why I want to tell you: pay attention to your body, and if it sends you signals, don’t stop investigating them.

Endometriosis Symptoms Explained in Detail

Cycle-dependent pain
The most common endometriosis symptoms include pain related to the menstrual cycle. This includes severe menstrual pain that goes beyond the usual and can increase over the years. The pain can occur in the lower abdomen, pelvic area, or lower back. Additionally, menstruation can be particularly heavy or very light.

Pain outside menstruation
Some affected individuals experience pain independent of their period. This pain can be constant or occur in certain situations, such as during intercourse or physical exertion. Spotting can also occur repeatedly.

Gastrointestinal and urinary tract complaints
Endometriosis can be accompanied by digestive issues such as bloating, diarrhea, or constipation, especially during menstruation. Pain during urination or bowel movements is also possible, depending on which organs are affected.

Fatigue and reduced performance
Many affected individuals report pronounced tiredness or exhaustion. This can be related both to the pain and the course of the disease.

Unfulfilled desire to have children
Endometriosis can impair fertility. Some women only seek medical evaluation after a longer period without becoming pregnant.

Different manifestations of endometriosis symptoms
The intensity of symptoms does not always directly correlate with the extent of endometriosis lesions. While some experience severe pain, others feel little or no symptoms.

Conclusion: Signs of Endometriosis

Endometriosis is often called the chameleon of gynecology. How endometriosis develops and the causes of the disease are still not fully understood, but the condition is gaining increasing attention. If you now notice that many endometriosis symptoms apply to you, don’t panic immediately. My tip: Write down all the symptoms you have and make a doctor’s appointment. If you are not taken seriously, look online for doctors in your area who specialize in endometriosis and get a second opinion.

Do you have questions? Then feel free to send us an email – we look forward to hearing from you! :)

The information shared in this article does not replace individual medical or nutritional advice.

Literature & Sources

1. AOK (2022). Diagnosis Endometriosis: How to Alleviate the Symptoms.
2. Endometriosis Association Germany e.V. (2025). What is Endometriosis
3. Ludwig Maximilian University of Munich (2025). Endometriosis: A Disease Affecting Millions.
4. NDR (2025). Endometriosis: Symptoms, Diagnosis, and Treatment. Health Guide.