Endometriosis can present in different ways, often including pelvic pain, painful periods, pain during sex, bowel or bladder symptoms, fatigue or fertility concerns. Symptoms deserve assessment even when previous tests have not provided a clear answer.
Diagnosis and management are individual. History, examination, imaging and referral decisions are chosen for the person’s symptoms and goals; no single test answers every endometriosis question.
Severe sudden pain, fainting, fever, vomiting, pregnancy-related pain or bleeding, or rapidly worsening symptoms need urgent assessment.
Written & reviewed by
Victoria Medical Clinical Team
GMC-registered physicians and specialist consultants
A symptom-led assessment
The clinician explores pain timing, impact on work and life, bowel and bladder symptoms, period pattern, fertility goals, previous treatment and prior investigations. This helps distinguish endometriosis from other possible causes of pelvic symptoms.
| Symptom context | Why it is explored | Potential next step |
|---|---|---|
| Cycle-related pain | May identify a pattern requiring gynaecology assessment | Clinical review and targeted imaging where appropriate |
| Bowel or bladder symptoms | May influence the differential diagnosis and referral pathway | Coordinated investigation or specialist input |
| Fertility concerns | Clarifies goals and timing of onward support | Individual fertility or gynaecology pathway |
Imaging and referral
Pelvic ultrasound can contribute to selected structural questions, but a normal scan does not exclude every possible cause of symptoms. Where needed, the clinician can discuss appropriate specialist referral and further investigation.
Care beyond one appointment
Endometriosis may require a plan that includes symptom management, imaging, fertility discussion, surgical opinion or other specialist input. The aim is to make the next step clear rather than to promise a single-test solution.
What to Expect at Your Appointment
Describe your symptoms
Share timing, severity and impact.
Agree the question
Identify what assessment or test could add.
Review findings
Understand results and their limits.
Plan ongoing care
Discuss follow-up or appropriate referral.
Frequently Asked Questions
References
- [1]Becker CM et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022.
- [2]Teede HJ et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction. 2023.
- [3]Munro MG et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes. International Journal of Gynecology & Obstetrics. 2018.
- [4]The North American Menopause Society. The 2022 hormone therapy position statement. Menopause. 2022.
- [5]Zondervan KT, Becker CM, Missmer SA. Endometriosis. New England Journal of Medicine. 2020.
- [6]NICE. Menopause: diagnosis and management (NG23). Updated guidance accessed August 2026.
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