What happens when I have menstrual cramps and hematuria at the same time as my period? It is likely that the patient has endometriosis of the bladder when this happens. Ectopic endometriosis involving the bladder is relatively uncommon in endometriosis, accounting for only 1 – 2 percent of these cases. In patients with bladder endometriosis, the majority of pelvic endometriosis lesions are more extensive. Patients may have painful urination and periodic hematuria, and endometriosis in the bladder regurgitant folds is often caused by implantation during cesarean delivery to close the peritoneal regurgitant folds of the bladder. If the muscle layer of the bladder is involved, further bladder mucosa may be involved and painful urination and hematuria may occur during menstruation, but no symptoms may normally occur. Such patients require cystoscopy to further diagnose and confirm the diagnosis. Under cystoscopy, several purple-blue elevations resembling grapes with bleeding can be seen. After menstruation the lesions become smaller and orange in color. If there is a combination of pelvic endometriosis and the presence of urinary tract symptoms associated with menstruation, the condition can be highly suspected but should be differentiated from bladder hemangiomas, polyps and inflammatory conditions. Patients with significant symptoms of bladder endometriosis can be treated with medications that can reduce symptoms but are prone to recurrence. Focal resection or partial cystectomy is recommended in the following cases: (1) lesions limited to the bladder; (2) bladder involvement with involvement of other pelvic organs; (3) bladder involvement with ureteral involvement and malignancy. Post-operative drug therapy can reduce recurrence. If over radical surgery that does not require preservation of reproductive function, bilateral ovaries, uterus and ectopic endometrial lesions are removed with good efficacy, but the patient also loses hormonal secretion.