1. Dysmenorrhea Dysmenorrhea is the most typical symptom of endometriosis. The medical term for this is progressive increase in secondary dysmenorrhea. It starts with no pain and slowly develops over time with a gradual increase in dysmenorrhea. It can occur before, during and after menstruation. The initial phase is tolerable, and after several months or years some of the dysmenorrhea worsens requiring painkillers, and the severe phase is so painful that painkillers are increased or even ineffective. The pain is caused by the inflammatory response of the local tissues stimulated by bleeding within the endometriosis. Increased secretion of prostaglandins from the endometriosis lesion leads to contracture of the uterine muscles and the dysmenorrhea is bound to be more pronounced. After menstruation, the bleeding stops and the pain is relieved. Dysmenorrhea is not only related to the severity of the lesion but also to the site of endometriosis implantation. 2. Menstrual abnormalities can be manifested as excessive menstruation or cycle disorders. Most menstrual abnormalities are related to endometriosis affecting ovarian function. Patients with endometriosis may experience ovarian dysfunction, such as abnormal ovulation. 3. Infertility Patients with endometriosis are often associated with infertility. Infertility occurs in 40% to 50% of patients. Causes: Endometriosis can often cause adhesions around the fallopian tubes affecting oocyte pick-up; or ovarian lesions affecting ovulation. 4. Painful intercourse Endometriosis in the rectal fossa of the uterus and the vaginal rectal compartment can cause painful intercourse (deep tenderness), increased bowel movements and pain during menstruation (lining). 5. Other bladder irritation signs: Those with endometriosis to the bladder appear to have periodic urinary frequency, painful urination and hematuria. Endometriosis in the abdominal wall scar and umbilicus presents with periodic localized masses and pain.