Chest Pain

Chest pain means discomfort anywhere in the chest—behind the breastbone, along the ribs, or near the diaphragm (the muscle under your lungs that helps you breathe). In the context of endometriosis, chest pain may occur when endometrial-like tissue grows outside the pelvis and irritates the diaphragm, chest wall, or (more rarely) the lining around the lungs. This is sometimes called thoracic endometriosis and can show up as sharp, stabbing pain with breathing or a deep ache that feels “high” in the abdomen or under the ribs. Learn more about the disease overall here: endometriosis.

While adenomyosis itself is limited to the uterus, it can still be part of the story. Many patients have both adenomyosis and endometriosis, and adenomyosis can amplify overall inflammation, heavy bleeding, and pelvic pain—contributing to a body-wide pain sensitization that can make other pain signals (including chest/upper abdominal pain) feel more intense. If you suspect adenomyosis based on heavy, painful periods, this overview may help: adenomyosis.

A key clue that chest pain could be related to endometriosis is timing: pain that worsens right before or during your period, and sometimes around ovulation, is a pattern many patients report. Another clue is location and radiation—pain that starts under the right rib cage or “behind the breast” and may travel to the shoulder or neck, especially with deep breaths. Because chest pain can also come from heart, lung, stomach, gallbladder, or muscle causes, it’s important not to self-diagnose; a careful differential workup matters (see Related Conditions).

Living with recurring chest pain can be frightening and disruptive—impacting sleep, work, exercise, and your sense of safety in your own body. If you’ve been told “everything looks normal” but your pain keeps returning—especially in a cyclical pattern—you deserve an evaluation that considers less-common presentations like diaphragmatic or thoracic endometriosis. Lotus’ patient-centered approach begins with listening and targeted workup: Evaluation & Diagnosis.

People describe endometriosis-related chest pain in many ways: sharp or stabbing with deep breaths, a tight band around the ribs, a burning or pulling sensation near the sternum, or a deep ache under the right rib cage. Some notice it most when coughing, laughing, stretching, or lying flat—because the diaphragm and chest wall move with breathing and posture.

For some, the pain feels “like heartburn,” “a pulled muscle,” or even anxiety—especially when it comes with a racing heart from pain or stress. Others notice it as upper abdominal pain that climbs into the chest, or pain that radiates to the shoulder (often the right shoulder) or upper back. If you also experience shoulder symptoms, see the related pattern in Diaphragmatic Endometriosis.

Symptoms can vary month to month. Some people only have chest pain during their period; others have a longer flare window—starting in the days leading up to bleeding and easing afterward. If you’re on hormonal suppression, the pattern may blur, but “breakthrough” cyclical flares can still happen.

If chest pain is severe, new, or paired with shortness of breath, fainting, or sweating, don’t assume it’s endometriosis—seek urgent evaluation first.

Chest pain is not one of the most common endometriosis symptoms overall, because most endometriosis occurs in the pelvis. However, endometriosis can involve the diaphragm, and more rarely the chest cavity (thoracic endometriosis). Among people with known endometriosis—especially those with deep disease—diaphragmatic involvement is considered uncommon but likely underdiagnosed, in part because symptoms can mimic reflux, gallbladder issues, or musculoskeletal pain.

Research suggests thoracic endometriosis syndrome is rare in the general endometriosis population, but it is disproportionately seen in patients who already have moderate-to-severe or deep infiltrating endometriosis and those with symptoms like cyclical shoulder pain or shortness of breath. Symptom presence does not perfectly correlate with “stage” because staging often reflects pelvic findings and may miss upper-abdominal/chest disease.

In adenomyosis, chest pain is typically indirect—more related to coexisting endometriosis, heightened inflammatory signaling, anemia from heavy bleeding, or central sensitization—rather than adenomyosis tissue traveling to the chest (which it does not do).

In endometriosis, chest pain is most often linked to diaphragmatic endometriosis—endometrial-like implants on or within the diaphragm that trigger inflammation, irritation, and sometimes scar tissue. Because the diaphragm is richly innervated and constantly moving, even small areas of inflammation can cause significant pain, particularly with deep breathing, coughing, or twisting.

In rarer cases, endometriosis affects structures within the chest (thoracic endometriosis), such as the pleura (lining around the lungs). This can contribute to cyclical chest pain and—more urgently—can be associated with catamenial pneumothorax (collapsed lung around the time of menstruation). Not every patient will have a dramatic emergency event; some experience recurrent, unexplained cyclical chest discomfort for years before the pattern is recognized.

Adenomyosis contributes through systemic and pelvic mechanisms: heavy bleeding can lead to iron-deficiency anemia, which may cause fatigue, palpitations, and shortness of breath that can be perceived as chest discomfort. Ongoing inflammation and repeated pain signaling can also lead to nerve sensitization, making the chest wall and diaphragm more reactive to normal movement and pressure.

Common factors that worsen symptoms include hormonal cycling, stress, poor sleep, and high inflammatory load during flares. Conversely, suppressing cyclical bleeding (when appropriate), targeted pain management, and treating coexisting pelvic disease can reduce the intensity and frequency of chest pain episodes.

Because chest pain can be dangerous, the first step is always appropriate medical evaluation to rule out heart and lung emergencies. Once urgent causes are excluded and a cyclical pattern suggests endometriosis, treatment usually focuses on (1) reducing hormonal cycling and inflammation and (2) addressing disease directly.

Medical options may include hormonal suppression to reduce bleeding and cycling activity (e.g., continuous combined hormonal contraception, progestins, or other therapies depending on your goals and history). These approaches can lessen flares but may not eliminate disease and can have side effects; an individualized plan matters. Learn more about options here: Hormonal Therapy. For symptom control and flare planning, see Pain Management.

Surgical treatment can be important when chest/diaphragm symptoms are persistent, progressive, or clearly cyclical—especially if pelvic endometriosis is also suspected. In general, excision surgery is considered the gold standard for removing endometriosis lesions (rather than simply burning the surface). When diaphragmatic disease is suspected, surgical planning may involve specialized imaging and, in select cases, collaboration with thoracic surgery. Explore approach and philosophy here: Surgery & Advanced Excision and Why Choose Lotus - Dr. Steven Vasilev MD.

Lifestyle and integrative support can help lower flare intensity and improve resilience: anti-inflammatory nutrition, pacing, gentle movement that supports rib/diaphragm mobility, stress regulation, and sleep optimization. Some patients find benefit from acupuncture, breathwork, and targeted supplementation—especially when used alongside medical care. See Integrative Medicine & Lifestyle Care for evidence-informed options.

What to expect: many patients need a combination plan—short-term symptom relief while you pursue a clearer diagnosis and long-term strategy. If thoracic/diaphragmatic endometriosis is part of your picture, it’s especially important to work with a team experienced in complex and extra-pelvic disease.

Seek emergency care now (call emergency services or go to the ER) for chest pain with any of the following: trouble breathing, fainting, blue lips, coughing up blood, new one-sided chest pain with sudden shortness of breath, pressure/heaviness radiating to the jaw/arm, sweating, confusion, or a sense of impending doom. Even if you have endometriosis, these symptoms must be treated as urgent until proven otherwise.

Schedule a specialist appointment if you notice chest or upper-rib pain that repeats with your cycle, especially if it’s paired with Shoulder Pain patterns, Shortness of Breath, or a history of difficult-to-treat pelvic symptoms like painful periods, painful sex, bowel/bladder pain, or infertility. A helpful way to advocate for yourself is to bring a brief log: dates of pain, cycle day, triggers (breathing, movement), and any associated symptoms.

If you’re ready for a deeper evaluation—especially if you suspect diaphragmatic/thoracic endometriosis—consider schedule a consultation with Lotus Endometriosis Institute. Our team can guide you through next diagnostic steps and discuss medical, integrative, and surgical options tailored to your goals.