Most commonly, the symptoms of endometriosis start years after the menstrual period begins. Over the years, the symptoms tend to gradually increase as the endometriosis areas increase in size. After menopause, the abnormal implants shrink away and the symptoms subside.The most common symptom is pain, especially excessive menstrual cramps (dysmenorrhea) which may be felt in the abdomen or lower back or pain during or after sexual activity (dyspareunia). Infertility occurs in about 30 to 40 percent of women with endometriosis. Rarely, the irritation caused by endometrial implants may progress into infection or abscesses causing pain independent of the menstrual cycle. Endometrial patches may also be tender to touch or pressure, and intestinal pain may result from endometrial patches on the walls of the colon or intestine. The amount of pain is not always related to the severity of the disease - some women with severe endometriosis have no pain, while others with just a few small growths have incapacitating pain.
