- Twelve cyclical signs — most crossing specialties.
- Three or more warrant a specialist referral.
- Ask for MRI with endometriosis protocol.
The 12 signs
Painful periods that stop you working, pain with intercourse (deep dyspareunia), cyclical bowel pain or bleeding, cyclical bladder pain or blood, chronic pelvic pain outside periods, chronic fatigue, low back pain during periods, painful ovulation, heavy periods, infertility, cyclical leg or shoulder-tip pain, cyclical rectal or perineal pain.
- Period pain needing prescription analgesia
- Pain with penetrative sex (deep, not entry)
- Cyclical bowel symptoms — pain, bleeding, or bloating
- Cyclical bladder pain or blood in urine
- Cyclical shoulder-tip or leg pain
- Infertility despite regular cycles
What to do with a positive checklist
Three or more cyclical symptoms warrants a specialist opinion — not another course of the pill. Ask specifically for pelvic MRI with endometriosis protocol and a review by a surgeon who does excision, not ablation.
Frequently asked questions
Can endometriosis be silent?
Yes — around 25% of women with endometriosis have minimal symptoms and are diagnosed during fertility investigation.
Do symptoms always follow the cycle?
Cyclical patterns are typical, but deeply infiltrating disease can cause daily pain.
Is bowel bleeding always cancer?
No — cyclical rectal bleeding is a classic sign of bowel endometriosis. It still needs investigation.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation