Pelvic Pain with Endometriosis and Adenomyosis
Pelvic pain is one of the most common signs of endometriosis and adenomyosis: a deep ache, cramping or stabbing pain low in the belly that often flares with your cycle and can linger between periods. Common doesn't mean normal.
- How common
- Very common
- When
- Worst around your period
- Where
- Lower belly and pelvis
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Oct 2026
Where you feel it
Front view of the body. The pelvis, uterus and ovaries are highlighted, with dotted lines down the thighs, where pain can spread.
- Ovariescysts can form here
- Uterusadenomyosis grows here
- Hips & thighspain can spread here
When it flares
It often builds in the days before your period, peaks during bleeding and can spike around ovulation. Pain that's there all month still deserves a check.
Does this sound like you?
Tap any that fit. We'll turn them into a note you can bring to your visit.
None of these? If your pelvic pain worries you, it's still worth a conversation. Speak with us
When to get help
Pelvic pain that comes back with your period, or is there most days, is reason enough to see an endometriosis specialist, even if your tests were normal.
Keep track
For two or three cycles, note the cycle day, where it hurts, what makes it worse and what you've tried. It's the most useful thing to bring to your first visit.
Speak with Us
Book a visit if it:
- Comes back with your period
- Is there most days, or keeps coming back
- Comes with pain during sex, bowel movements or peeing
- Makes you miss work, school or plans
- Continues though your tests were normal
Your first visit
We go through your history and your notes, then map out next steps together, whether that's tests, imaging or treatment.
When it needs a specialist: Is surgery right for me?
What it feels like
How patients often describe it
- It's a deep, heavy ache low in my belly.
- My cramps feel like labor pains.
- It stabs when I move, have sex or use the bathroom.
- It spreads into my lower back and thighs.
It can ache, cramp, press, stab or burn, in the middle or to one side. Endometriosis pain often builds before your period, peaks during bleeding and can spike around ovulation. Adenomyosis pain is often centered in the uterus, with deep cramps and tenderness.
Why it happens
Endometriosis
Endometriosis is tissue like the uterine lining growing outside the uterus: on the ovaries, the pelvic lining, the ligaments behind the uterus and sometimes the bowel or bladder. It can inflame nearby tissue and irritate nerves, and scar tissue (adhesions) can tether organs together, so a full bladder, a bowel movement or sex can start to hurt.
Deep infiltrating endometriosis can grow into nerve-rich tissue and hurt with specific things, like bowel movements or peeing. Cysts on the ovaries (endometriomas) can ache or cause sharp pain.
Adenomyosis
Adenomyosis is tissue like the uterine lining growing into the uterus's muscle wall. The wall can thicken and the uterus contract harder during your period, causing deep, heavy cramping, pelvic pressure and a tender, sometimes enlarged uterus. It often comes with endometriosis.
When pain outlasts its cause
Pelvic floor muscles can tighten to guard against pain and not fully relax, and a nervous system that has hurt for years can turn the volume up. Pain can then continue even when the disease is quiet, so many people do best with a plan that treats both the disease and the pain.
Learn moreEndometriosisAdenomyosis
“Pelvic pain that keeps coming back isn't something to push through. How much it hurts doesn't tell us how much disease is there, so we look carefully, including the places standard scans miss.”
Why it's often missed
Pelvic pain is easily brushed off as bad periods, or labeled IBS, a bladder problem or pelvic floor tension. These can sit alongside endometriosis or adenomyosis, so finding one doesn't rule out the others. The clues are pain that follows your cycle and pain with sex, bowel movements or peeing.
Normal tests don't rule it out either: a standard ultrasound can miss surface endometriosis, and how bad the pain is doesn't reliably match how much disease a scan, or even surgery, finds.
How it's diagnosed
Track two or three cycles
Note where it hurts, when, and any pain with sex, bowel movements or peeing; these hint at where disease may be.
Rule out other causes
Ovarian cysts, infections, fibroids, and bladder, bowel or muscle problems can cause similar pain, and more than one can be present.
A careful exam and imaging
A specialist's exam can find tender spots or an enlarged uterus, and an endometriosis-focused ultrasound or MRI can show cysts, deep disease and adenomyosis. Small surface lesions may not show.
See an endometriosis specialist
An endometriosis-focused evaluation decides whether laparoscopy makes sense; it can confirm and remove endometriosis in one operation. Bring your notes.
Treatment options
Treatment often combines several approaches, matched to what's driving your pain.
- Medical
Hormonal therapy
Can calm flares for some, though it doesn't remove endometriosis or suit everyone.
Hormonal Therapy - Medical
Pain relief
Matched to your kind of pain, from anti-inflammatories to nerve-pain medicines.
Pain Management - Surgical
Excision surgery
Removes endometriosis at the root when pain persists or imaging shows deep disease, cysts or adhesions.
Surgery overview - Surgical
Treating adenomyosis
Options range from hormonal therapy and uterus-sparing treatment to hysterectomy in select cases.
Adenomyosis care - Support
Pelvic floor therapy
Helps muscles tightened by chronic pain relax, which can ease pain with sex and bowel movements.
Pelvic Floor Therapy - Support
Everyday relief
Heat, TENS, pacing, sleep and stress support can ease flares alongside treatment.
Integrative Medicine
Pelvic pain that keeps coming back?
We look for endometriosis and adenomyosis where they're often missed, and treat the pain itself too.
Schedule a ConsultationPrefer to talk it through? Call or text us.
Questions people ask
What does an endometriosis flare feel like?
An endometriosis flare typically feels like a noticeable spike in pain, such as deep pelvic cramping, pressure or sharp, stabbing pains. It may also include bloating, low back or leg pain, painful bowel movements or urination, fatigue and nausea.
Can you have both endometriosis and adenomyosis?
Yes, many patients can have both endometriosis and adenomyosis at the same time. Their symptoms may blend together, and having both can affect treatment planning because endometriosis is outside the uterus while adenomyosis is within the uterine muscle.
Why does pelvic nerve pain persist between periods or spread?
Pelvic nerve pain can persist between periods or sometimes feel like it’s spreading because repeated pain can make the nervous system more sensitive. Pelvic floor muscle guarding and shared nerve pathways between organs can keep the pain cycle going.
Can pelvic floor dysfunction worsen pelvic pain?
Yes, tight or overactive pelvic floor muscles can amplify pain signals and make pelvic pain more intense and constant. This can worsen pain with sex, bowel movements, urination, or sitting, and pain may persist after the original trigger has quieted down.
Is pelvic pain always caused by endometriosis or adenomyosis?
No, pelvic pain is not always caused by endometriosis or adenomyosis. Other causes can include pelvic floor dysfunction, bladder pain syndrome, bowel disorders, fibroids, ovarian cysts or infections, and more than one issue can be present at the same time.
Can endometriosis develop later in life?
Yes, endometriosis can develop or become noticeable later in life, including during perimenopause and, less commonly, after menopause. Symptoms may include more constant pelvic pain, bloating, bowel changes, or bladder discomfort rather than cycle-linked pain.
Often happens with
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Sources & medical review
Reviewed by Dr. Steven Vasilev, MD, Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute. Last reviewed Oct 2026; next review Oct 2027.
- Coxon L, Horne AW, Vincent K. Pathophysiology of endometriosis-associated pain: a review of pelvic and central nervous system mechanisms. Best Pract Res Clin Obstet Gynaecol. 2018;51:53–67.
- Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453–461.
- Piriyev E, Mennicken C, Schiermeier S, Römer T. Symptom burden in adenomyosis: a comparative analysis with peritoneal and deep infiltrating endometriosis. In Vivo. 2026;40(3):1614–1620.
- Fraga MV, Oliveira Brito LG, Yela DA, et al. Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: an underestimated association. Int J Clin Pract. 2021;75(8):e14350.