Endometriosis Causes Debilitating Fatigue That’s Often Overlooked

A new study suggests endometriosis doubles the chances of experiencing chronic, excessive fatigue. Despite this, doctors often overlook this troublesome symptom, leaving many women feeling dismissed.

If you are a woman who is experiencing severe fatigue, painful periods, infertility, or other symptoms that impair your daily activities, you might be wondering if you have endometriosis. This health condition often results in a lot of pain and discomfort and, if left untreated, can increase other serious health risks. Keep reading to learn the signs and symptoms of endometriosis, how fatigue plays a role, as well as how to be diagnosed. Then, we'll talk about functional treatments available.

What is Endometriosis?

Endometriosis is a reproductive disorder whose symptoms are caused by endometrial tissue—which is normally only found in the uterus—growing in surrounding areas within the abdomen and pelvic area. Endometrial tissue is made of cells that respond to hormones just like the lining of the uterus, meaning it thickens and sheds during your menstrual cycle. When this occurs outside of the uterus, it can cause pain, swelling, inflammation, and the buildup of scar tissue known as adhesions.

Endometriosis is one of the least understood conditions in women's health that affects reproductive organs. And as a result, people who suffer from this condition have been left with few options to alleviate the pain and other side effects that can negatively interfere with daily life in a big way. Understanding what endometriosis feels like is the first step toward advocating for a diagnosis that can improve your quality of life, and increase awareness for others experiencing similar struggles.

Related: 10 Signs You Have Estrogen Dominance

Endometriosis symptoms

Not all people with endometriosis will experience every symptom, and symptom severity can vary significantly. That is, some women who suffer from endometriosis will not experience pain, while others may experience few or mild symptoms.

Abdominal or pelvic pain

Pain is one of the main symptoms of endometriosis. Adhesions in the abdominal cavity, uterus, or pelvic region cause pain with a variety of activities, including sex, urination, bowel movements, and before/during your menstrual cycle. Pain can be so severe that it causes nausea or vomiting.

Read: Get Relief for Endo Pain + Inflammation

Chronic fatigue

Fatigue is a common, but often dismissed, symptom in endometriosis patients. Patients describe feeling “exhausted, drained, tired, lethargic, worn out, and/or weak” (1).

Heavy menstrual periods

Bleeding for more than 7 days, needing to 'double up' on menstrual products, or needing to change menstrual products less than every 2 hours are all signs of what should be considered heavy menstrual periods.

Other common symptoms of endometriosis include:

  • Painful menstrual cramps, sometimes debilitating
  • Severe PMS
  • Pelvic pain, sometimes unrelenting
  • Pain with sex
  • Infertility
  • Heavy bleeding or bleeding that lasts for more than 7 days
  • Estrogen dominance
  • Nausea before or during period
  • Diarrhea, painful bowel movements, or painful urination during period
  • Bloating during period
  • Dizziness, light-headedness, or headaches with period
  • Low progesterone after ovulation, or abnormal ovulation

If you're experiencing two or more of these symptoms—or if any symptom is severe—a conversation with your integrative provider will help shed more light on hormonal health and the possibility of endometriosis.

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Early endometriosis symptoms

About 6% of women of reproductive age in America suffer from endometriosis, but it's often tricky to diagnose--and especially in its early stages (1). As such, researchers believe many milder cases go unreported, putting the 6% figure into question. Since many young girls begin birth control for pain or irregular periods, hormonal contraceptives likely mask the symptoms only to reappear much later when she discontinues birth control (2).

One study reported that up to 70% of teenage girls with chronic pelvic pain will later be diagnosed with endometriosis (3). If you have a female family member who has endometriosis, you’re up to seven times more likely to have endometriosis as well (4).

The symptoms of endometriosis may vary greatly from one person to another, but the most common among those with endometriosis is pain: abdominal pain, menstrual pain that prevents you from normal daily tasks before or during your period, pain with sex, and/or pain with urination.

Learn more about other factors affecting endometriosis symptoms.

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Women with endometriosis experience greater fatigue

Fatigue can be a frequent and debilitating symptom for women with endometriosis, yet its severity is often underestimated. Endo-related fatigue may be a result of the condition itself, or as a side effect of an inflammatory response. More about what’s causing this fatigue in a moment.

One study published in the journal Human Reproduction in 2018, found that nearly twice as many women with endometriosis experienced fatigue compared with women who did not have endo. And this remained true even after researchers factored in other causes of tiredness such as parenting, stress, depression, and insomnia (5).

Endometriosis is also associated with additional symptoms like insomnia, depression, and stress — all of which ramp up fatigue regardless of the presence of hormonal issues.

Related: What is PCOS and How Is It treated?

Why does endometriosis cause fatigue?

In this case, experts think there are a few possible causes for fatigue.

First, inflammation contributes to feeling exhausted. The body releases pro-inflammatory cytokines in an attempt to heal the adhesions (6). This can lead to an immune system response and thus the cascade of chronic inflammation. Think about when your immune system is battling an illness—you’re likely to feel drained, tired, and fatigued—and this is a similar process kicked off by chronic inflammation. Help resolve inflammation with SPM Active

Second, pain also negatively affects sleep, which exacerbates feeling tired for obvious reasons. Multiple studies have found higher rates of insomnia, subthreshold insomnia, and poor sleep quality in women with endometriosis compared to control groups (7).

Third, heavy periods associated with endo can result in anemia (low iron levels), which also includes feeling tired as a primary complaint.
Diagnosing and treating fatigue in women with suspected endometriosis can be complex, but growing research backs up that addressing the accompanying symptoms like fatigue, pain, and other inflammatory issues is key (8).

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How is endometriosis diagnosed?

The only way to officially diagnose endometriosis is to do laparoscopic surgery and a biopsy. Because a diagnosis requires a biopsy, many women aren’t diagnosed until their 30s or 40s when severity has progressed, and this can significantly impact fertility.

For girls who are younger than 19, one study showed that it took an average of 12 years after symptom onset to be diagnosed (9).

This issue is so harmful to women that in 2019 the Journal of American Obstetrics and Gynecology published a call to action. The authors stated that endometriosis diagnosis should shift from focusing primarily on surgical findings and instead focus on signs, symptoms, and other clinical findings to result in earlier diagnosis and improved quality of life.

Learn more about conditions we treat: Endometriosis

Stages of Endometriosis

When diagnosing endo, doctors rate its progression in stages based on criteria including severity, location of adhesions, size, and involvement of other organs. The four stages are:

  • Stage 1: Minimal
  • Stage 2: Mild
  • Stage 3: Moderate
  • Stage 4: Severe

The stage of this condition does not necessarily reflect the level of pain experienced. That is, someone with stage 1 could experience excruciating pain, while someone with a more “severe” case may experience minimal pain.

Is there a cure for endometriosis?

There isn’t a comprehensive cure for endometriosis, but treatment can significantly improve symptoms.

What should I do if I think I have endometriosis?

If you think you might have endometriosis, the first step is to see your integrative gynecologist who specializes in women’s reproductive health.

Be honest with your healthcare provider, and come prepared to describe your symptoms, including how long you’ve been experiencing them, how severe they are, how long and when they happen, and anything that makes them worse or better.

In the meantime, it can be helpful to keep a “symptom diary” for 2-3 months in advance of your appointment. Your health care provider will likely do a physical exam or a pelvic exam and may order one or more of the following tests:

  • Ultrasound
  • MRI
  • Laparoscopy

Treatment decisions are incredibly individualized and will depend on factors such as your symptoms, stage of the disease, desire to have children, and any personal preferences.

Related: Why You Should See an Integrative OB/GYN

Endometriosis treatment with functional medicine

Laparoscopy to remove adhesions is effective to reduce pain

The buildup of scar tissue on the bladder, abdominal wall, uterus, and elsewhere can cause pain until they’re removed. Depending on your individual situation, your doctor may recommend excision to remove areas of endometriosis via a surgical procedure.

Somewhere between 20-50% of women need a second surgery within 2 to 5 years, but this type of intervention does result in long-term relief in up to 80% of patients (10). Clearly, conventional methods leave much room for opportunity to better treat endometriosis, but much progress has been made in the last few decades.

Endometriosis doctor near me

Endometriosis is a frustrating disease. It’s hard to live with, to get diagnosed, and to get treated properly. If you are a woman suffering from endometriosis, pain and fatigue are likely among your most bothersome symptoms, but there is hope. An integrative doctor will work with you to develop an individualized approach to treatment, using both conventional and functional medicine approaches. If you are struggling with endometriosis-related fatigue, working with an integrative medicine physician may be the best step you can take toward healing.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203274/
  2. https://www.independent.co.uk/voices/endometriosis-periods-pill-symptoms-contraception-research-brain-hormones-a9164521.html
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712662/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911462/
  5. https://academic.oup.com/humrep/article/33/8/1459/504062
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737931/
  7. https://jcsm.aasm.org/doi/10.5664/jcsm.8464
  8. https://www.sciencedirect.com/science/article/pii/S000293781930002X
  9. https://academic.oup.com/humrep/article/18/4/756/596537
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073694/


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