Can endometriosis cause infertility and pelvic pain in your 20s?

Yes. Endometriosis can absolutely show up in your late 20s and it can be a driver of both chronic pelvic pain and fertility challenges. Pain can include severe or worsening period cramps, pain with sex, bowel or bladder pain, and “flare” patterns that track with your cycle—although symptom severity doesn’t always match how much disease is present.

Endometriosis can affect fertility in several ways, including adhesions that distort tubo‑ovarian anatomy, inflammation and immune signaling that interferes with fertilization or embryo development, and ovarian factors—especially when endometriomas are involved. For some patients, the uterine environment also matters, particularly when adenomyosis is present alongside endometriosis. In our practice, we focus on listening to your full symptom and fertility story and then building an evaluation that looks for endometriosis while also checking for common look‑alikes or coexisting issues, so we can tailor a plan to your goals—whether that’s pain relief, preserving fertility, or both.