Endometriosis affects people in different ways.
Endometriosis causes a range of symptoms: some people experience intense pain and digestive problems, while others may not have any noticeable symptoms.
Knowing what to look for and when to seek help can make a big difference in getting the right care early.
This guide, the second article in our endometriosis awareness series, covers:- how healthcare practitioners diagnose the condition
- what to do if you’re experiencing symptoms.
- understanding the basics
- treatment options and managing symptoms
- living with endometriosis
- fertility and family planning questions.
When should I get checked for endometriosis?
You should see a healthcare provider if you have pelvic pain that doesn’t go away with usual painkillers like paracetamol or ibuprofen.
Pain that stops you from doing your normal activities or affects your quality of life is a sign to get checked.
Pelvic pain can become persistent, especially if you experience most days for 3–6 months.
Over time, pain can make muscles tense, nerves more sensitive, and even affect your bladder, bowel, sleep, mood, and confidence. This makes getting help early really important.
Severe period pain is not normal, and other symptoms that should prompt a visit to a healthcare provider include:
- pain during or after sex
- bloating or pain when using the toilet
- heavy or irregular bleeding
- lower back or leg pain
- fatigue
- difficulty getting pregnant.
When you see your healthcare provider, they may ask about your periods, types of pain, other symptoms, family history, and fertility.
Keeping a diary of your symptoms—or using an app—can help you explain what’s happening.
Your doctor or nurse practitioner can do an initial check and may refer you for imaging or to a gynaecologist if needed.
Talking about your symptoms early can help speed up diagnosis and treatment.
✔ Key takeaway:
Don’t ignore persistent pelvic or period pain. Early discussions with a healthcare provider is the best way to get support and answers.
More in this series
What are the symptoms of endometriosis?
Symptoms can range from mild to severe pain. The severity of pain does not always match the extent of endometriosis.
Common symptoms:
- Pelvic or lower belly pain – pain can be sharp, aching, or burning, and may happen during periods, ovulation, or even all the time.
- Pain during or after sex.
- Pain with toilet visits – this can include pain when peeing or having a bowel movement, feeling bloated, or constipation and diarrhea.
- Heavy or abnormal periods – sometimes causing tiredness or low iron.
- Fatigue – feeling very tired even after resting.
- Back, hip, or leg pain.
- Difficulty getting pregnant – infertility can sometimes be linked to endometriosis.
Some people may also notice mood changes, anxiety, or depression linked to the ongoing pain.
Not everyone with endometriosis has symptoms, and some may have the disease without any pain.
✔ Key takeaway:
If symptoms interfere with daily life, get worse, or make you anxious, it’s important to see a healthcare provider.
How is endometriosis diagnosed?
Getting a diagnosis for endometriosis can take time.
The process often starts with a detailed discussion of symptoms, followed by physical exams, imaging tests, or, in some cases, laparoscopic surgery to confirm the diagnosis.
Symptoms such as painful periods or pelvic pain can be mistaken for other conditions, which is why some people may wait years for a correct diagnosis.
Pelvic exam
Your healthcare provider may start with a pelvic exam.
During this exam, they check for tenderness, thickened areas, or cysts in the ovaries or other parts of the pelvis.
Finding these signs can give your healthcare provider clues about endometriosis, but a pelvic exam alone can’t confirm the diagnosis.
Additional tests, such as imaging or surgery, may be needed for confirmation.
Ultrasound
Next, your healthcare provider may recommend an ultrasound to create images of your pelvis.
An ultrasound can be done through the:
- belly (transabdominal)
- vagina (transvaginal)
- rectum (transrectal).
A transvaginal ultrasound will give the clearest images.
Ultrasounds can usually detect ovarian cysts (endometriomas) and may detect deep endometriosis. However, it may miss very small or superficial areas.
The scan is safe and usually takes 15–30 minutes.
MRI (magnetic resonance imaging)
MRI uses magnets and radio waves to make detailed pictures of areas inside your body.
It may be recommended if an ultrasound cannot be performed or does not provide enough detail. This type of imaging is especially useful for viewing the bowel, bladder, or deeper areas affected by endometriosis.
Laparoscopy (keyhole surgery)
If imaging and other assessments suggest endometriosis or if the diagnosis remains uncertain, your healthcare provider may recommend laparoscopy, a small surgical procedure.
A thin camera is inserted through a tiny cut near the belly button to allow a direct look at the pelvic organs.
If endometriosis is found, in most cases it can be treated during the same procedure, and a small tissue sample will be sent to a lab to confirm the diagnosis.
Not everyone needs a laparoscopy.
Healthcare providers usually start by discussing your symptoms and performing imaging tests, such as ultrasounds. Based on these results, they may recommend treatment or, if needed, laparoscopy.
The decision to have surgery depends on your symptoms, your treatment goals, and whether you’re planning a pregnancy soon.
✔ Key takeaways:
- Diagnosis can take years because symptoms vary and may be mistaken for other conditions.
- Non-invasive scans like ultrasound and MRI are now often used before surgery.
- Early diagnosis helps you manage symptoms and improve your quality of life.
Are there less invasive ways to test for endometriosis?
Right now, the main ways to check for endometriosis are to talk to a healthcare provider about your symptoms, have imaging tests like an ultrasound or MRI, or have surgery if needed.
You can also ask your healthcare provider about research studies or clinics testing new non-surgical methods.
Researchers are working on blood and saliva tests that could help find endometriosis without surgery.
The blood test, called PromarkerEndo, is being developed in Australia and might be available soon, but it’s not widely offered yet.
Saliva tests exist in some other countries but aren’t available in Australia.
What is endo belly?
“Endo belly” is a term people with endometriosis often use to describe abdominal bloating or swelling.
It isn’t a medical diagnosis, but it’s a very real symptom for many.
People with endometriosis may notice their stomach suddenly looks bigger or feels tight, sometimes even appearing “pregnant.”
This bloating can happen before or during periods, though it can also occur at other times.
Endo belly occurs when endometriosis causes inflammation, irritates the bowel, affects digestion, or causes fluid to build up in the body.
Some people find that diet changes or working with a nutritionist can help reduce discomfort. It’s helpful to start by keeping a food and alcohol diary so you can help to identify any triggers for these symptoms and discuss them further with your healthcare team.
✔ Key takeaway:
It’s important to remember that symptoms of endometriosis vary. Some people experience severe endo belly and other digestive issues, while others have few or none.
What is the relationship between endometriosis and bowel symptoms?
Many people with endometriosis also notice changes in their bowel habits.
This can include:
- pain when going to the toilet
- constipation
- diarrhoea
- bloating
- cramping
- feeling an urgent need to go
- sometimes, rare bleeding from the bowel can happen.
These symptoms often get worse during periods, which can be an important clue that endometriosis may be involved.
Not everyone with these bowel symptoms has endometriosis, and not everyone with endometriosis will have bowel issues.
Symptoms can occur when endometrial-like tissue grows on or near the bowel, or when inflammation in the pelvic area affects nearby nerves. In some severe cases, endometriosis can grow directly into the bowel wall.
Because these symptoms can look like irritable bowel syndrome (IBS), people often see a gut specialist first. This can delay a correct diagnosis of endometriosis by several years.
Health professionals are encouraged to ask about menstrual patterns alongside digestive symptoms to help identify the cause.
Managing bowel symptoms linked to endometriosis may involve hormonal treatments, pain management, dietary changes, pelvic physiotherapy or, in some cases, surgery.
✔ Key takeaway:
Bowel symptoms are common in endometriosis, especially when they change with your period. Recognising that bowel changes can be part of endometriosis is key to getting the right care.
What is an endometrioma (or “chocolate cyst”)?
An endometrioma is a type of cyst that can form on the ovary in people with endometriosis.
It’s sometimes called a “chocolate cyst” because it often contains thick, brown fluid that looks like chocolate.
Endometriomas:
- grow inside the ovary, which can make it larger
- have a thick wall
- contain old blood and tissue.
Endometriomas can usually be seen on an ultrasound and may be managed surgically with treatment options taking into consideration your symptoms, personal circumstances and goals.
Endometriomas are usually linked to more severe endometriosis and can cause pain or affect fertility, but not everyone with an endometrioma will have symptoms.
Call your healthcare provider or go to the hospital if you notice:
- Sudden, severe belly pain – this could be a sign that the cyst has ruptured or twisted.
- Nausea or vomiting with pain – sometimes happens if the ovary twists.
- Fever, chills, or feeling very unwell – could indicate infection.
- Heavy or unusual bleeding – if it’s sudden or much heavier than normal.
✔ Key takeaway:
Endometriomas can feel worrying, but with the right medical follow-up and individualised care, outcomes can be optimised.
What do I do if I don't get an endometriosis diagnosis?
Sometimes, even if you have symptoms, healthcare providers might not find endometriosis.
This doesn’t mean your pain isn’t real.
Tests and scans can miss it, and some types of endometrioses can only be seen with surgery.
Australian health organisations agree that if you don’t get a diagnosis, you can still take action.
Here’s what you do
- Keep getting care: Don’t stop seeing your healthcare provider. Other causes of pelvic pain—like bladder problems, bowel issues, or muscle and nerve pain—can be investigated and treated.
- Manage your symptoms: You can start treatments like physiotherapy, pain management, and lifestyle changes even without a confirmed diagnosis.
- Track your symptoms: Writing down your pain and other signs can help your healthcare providers understand what’s happening and may help with future diagnosis.
- Access support: Multidisciplinary care, including specialist nurses, physiotherapists, dietitians, and mental health support is available whether or not you have a confirmed diagnosis.
✔ Key takeaway:
Your pain is real, tests aren’t perfect, and there are ways to get help and manage symptoms even if endometriosis hasn’t been officially diagnosed.
Support is available
Living with unexplained pain or changes in your body can feel isolating, but you’re not alone.
Understanding your symptoms, talking openly with your healthcare provider, and tracking what’s happening can help you get the support and treatment you need.
Whether your endometriosis has been diagnosed or is still under investigation, early care and symptom management can improve your daily life and wellbeing.
If you’re experiencing persistent pelvic pain, heavy periods, digestive changes, or other symptoms of endometriosis, don’t wait.
Book an appointment with a health professional or connect with your closest True Clinic, where experienced staff can guide you through your options and provide personalised care. Keep a record of your symptoms and ask about imaging or specialist referrals.
