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1. Infertility
About 50% of endometriosis patients are infertile. Among all women with infertility, 30 to 40 percent of them suffer endometriosis. For women who have both endometriosis and infertility, the infertility is often caused by pelvic adhesions, pelvic fluid, tubal blockage, imcomplete development of follicle, ovulation failure, etc..Even getting pregnant can help restrain and even counter the developing of endometriosis, habitual abortion in some cases is caused by endometriosis.

2. Pain with menses
This symptom can be progressive, and this is a typical sign of endometriosis. Most patients doesn’t suffer any pain with menses but it occurs once endometriosis occurs, and the pain often aggravates with the cycle carries on. The pain can also occur before or after menstrual period on a small group of patients. Some may have extremely severe pain that they cannot even get up and painkillers are needed. In China, however, it is reported that there’re still 21% of patients don’t have any pain even they have endometriosis.

3. Periodical rectal discomfort
Periodical rectal discomfort seldom occur on other gynecological diseases, thus it is one of the major distinction of this condition. Symptoms may include: rectal pain, anal pain, bulge feeling at perineum area, urge for bowel movement, increased times of bowel movement. These symptoms aggravates with the menatrusl cycle carries on as well, and may ease after menstrual period.

4. Irregular menses
Women with endometriosis may have a shorter or longer menstrual cycle, and a heavy flow. Irregular menses is not a typical symptom of endometriosis so it’s not significant when diagnosing this condition.

5. Pain with sex
This symptom occur on some patients whose lesion develops near the vagina, Douglas pouch, or under the uterus.

6. Acute abdominal diseases before or after menses
ABDs often occur on women whose lesion grows in the uterus, and the lesion can break through ovary. Emergency operation is occasionally needed. The surgery may probably be helpful as well as destructive, because possible pelvic adhesion and scar tissue which develops after surgery cause recurrence of ABDs.

7. Periodical lower abdominal discomfort
This is a more common symptom than pain with menses. Endometriosis patients who don’t have any pain with menses may suffer from lower abdominal discomfort. This often occurs on those whose condition is very slight. Some of the endometriosis sufferers doesn’t develop pain with menses but they may experience from lower back pain with menses and bulge feeling of lower abdomen.

8. Periodical pain at local lump
If the lesion develops at any abdominal scar or navel, local lump with pain may occur.

9. Enlarged uterine
Inner endometriosis (adenomyosis) patients often have a enlarged uterus, but seldom larger than 12 weeks pregnancy. If this condition occurs on women with retroposition of uterus, adhesions is often found on them.

10. Periodical bladder irritation
When the lesion grows near or even inside the the muscle of bladder, urgent and frequent need of urination may occur. If it grows in the mucous membrane of urinary bladder, perodical blood in urine and pain with urination may occur.

11. Small hard knottings at Douglas pouch, Douglas' lieaments, or posterior cervical wall
One or more hard knottings can be found at Douglas pouch, Douglas' lieaments, or posterior cervical wall, their sizes are always very small(3-5mm diameter). Patient can feel pain when touch the knotting especially via rectal exam. For women with ovarian cyst, their cysts can grow as big as a fist. Pelvic adhesions is commonly found on this case.

source : http://www.drleetcmclinic.com/Information_Center/Endometriosis/2013/0906/115.html