Nearly 1 in 10 people who menstruate have endometriosis, and many simply endure the pain and other symptoms that can interfere with their everyday lives.

Endometriosis occurs when the tissue that lines the uterus each month ventures to places it shouldn’t be, such as the ovaries, fallopian tubes, and bowels. Then, when it’s time to menstruate, that tissue has nowhere to go—and that causes the hallmark symptoms of endometriosis.

“Many patients with endometriosis who come to see me have been suffering for a long time because they’ve been told their symptoms are ‘normal,’” says Kathy Huang, MD, a minimally invasive gynecologic surgeon and director of NYU Langone’s Endometriosis Center. “But pain is not normal.”

Here are six symptoms of endometriosis you should not ignore.

Period Pain That Impacts Your Daily Activities

Painful periods, especially in the days leading up to and the first few days of a period, are a common symptom of endometriosis. “Some level of cramping is normal in a period, but it’s not normal to have substantial pain during your period that impacts your quality of life,” says Kelsey Kossl, MD, a minimally invasive gynecologic surgeon at the Endometriosis Center. If period pain keeps you from going to work or school or sends you to bed for just even a day or two each month, see an endometriosis specialist. “That level of period pain is a red flag,” Dr. Kossl says.

Pelvic Pain

Pelvic pain that occurs throughout the month, and not just with your period, is another common symptom of endometriosis. The pelvic floor is a network of muscles and nerves that support your bladder, bowel, and reproductive organs. Endometriosis can cause inflammation in the pelvic floor that leads to pain and muscle spasms in this region. “When the pelvic floor is impacted by endometriosis, it can feel like having a muscle spasm in your pelvis, especially after intercourse,” says Dr. Kossl. “Pain that radiates from your pelvis into your legs or back can also signal endometriosis.”

Painful Sex

Endometriosis most often occurs on or around organs in the pelvis. Due to the formation of scar tissue and inflammation, endometriosis can cause painful sex. “Patients have reported painful intercourse to the point that they want to avoid intercourse altogether,” says Dr. Huang.

Bowel and Bladder Symptoms

Inflammatory proteins from endometriosis can travel to the bladder and bowels, causing nausea during your period as well as diarrhea, constipation, or pain with urination throughout the month. “There’s also overlap between endometriosis and conditions such as irritable bowel syndrome,” Dr. Kossl says. “If you have irritable bowel syndrome, endometriosis can make your symptoms worse, especially around the time of your period.”

Unexplained Infertility

If you’re trying to conceive but nothing is working, including in vitro fertilization (IVF), it’s worth investigating whether endometriosis might be the cause. Roughly 4 in 10 women with infertility have endometriosis, according to the American College of Obstetricians and Gynecologists.

To make an appointment with one of our endometriosis specialists, visit the Endometriosis Center.

Inflammation and scar tissue from endometriosis may damage the egg or sperm or interfere with their movement through the fallopian tubes or uterus. “Surgery for endometriosis can increase your chances of conceiving and even improve the IVF success rate,” Dr. Huang says.

Mental Health Challenges

Women with endometriosis pain report feeling depressed or anxious, especially during their period, according to a study in Frontiers in Global Women’s Health, more so than women without the condition. “Many women with endometriosis symptoms go a very long time without getting a diagnosis, which can impact their mental health,” Dr. Kossl says.

Overall, every woman with endometriosis is unique. “Endometriosis can impact the quality of life for some women 30 out of 30 days a month or only just during their period. In either case, it should be addressed by a physician,” Dr. Kossl says.

Seek an Endometriosis Expert

No woman should have to live with painful periods, pelvic pain, and other endometriosis symptoms. At the Endometriosis Center, located at NYU Langone Obstetrics and Gynecology Associates, we offer the most comprehensive and noninvasive imaging tests to accurately diagnose endometriosis, including a pelvic abdominal MRI. Treatment options can include medications, surgery, pelvic floor and physical therapy, and lifestyle changes.

Could you have endometriosis? We encourage you to take our endometriosis symptom questionnaire to connect with one of our experts and learn more about diagnosis and treatment options.