Some women with severe endometriosis may be asymptomatic while others with minimal disease may have incapacitating pain. The most common symptom of endometriosis is pain before and during menstrual periods (usually worse than "normal" menstrual cramps). Many women with endometriosis report severe pain with intercourse or exercising, or pain with bowel movements. The pain may be dull and throbbing, or sharp and stabbing, or a combination of both. Since pain is so individual, each woman with this condition may report different types of pain, depending on the location of endometriosis and the type of activity she undertakes. Other symptoms that may occur during menstrual periods are; fatigue, painful bowel movements, lower back pain, diarrhea, constipation and other intestinal upsets. Endometriosis may also cause profuse menstrual bleeding and unexplained infertility.

Diagnosis of endometriosis is generally considered uncertain until proven by laparoscopy. The first step in diagnosing endometriosis is getting through a checkup by a gynecologist or other doctor experienced in treating women’s health issues. The doctor will ask a number of questions about your symptoms, including your pain, pain with intercourse, and any bowel or bladder problems you may have. You may also be asked about plans for children and your activities throughout the day. Try to be as specific as possible when answering the questions. If it hurts every time you do aerobics, or reach for a glass, or have sex in a certain position, tell your doctor so as much information as possible can be used to help you. Doctors are used to discussing these types of issues and there is certainly no need to be embarrassed. Next, you will most likely have a physical exam performed, including a pelvic (internal) exam, and, sometimes a rectal exam. A doctor can often feel the endometrial implants upon palpation. They will feel your ovaries, uterus, and the ligaments between your rectum and vagina. Secondly, you will have to go through a laparoscopy to be certain of the diagnosis. Laparoscopy  is a minor surgical procedure done under anesthesia in which your abdomen is distended with carbon dioxide gas to make the organs easier to see and a laparoscope (a tube with a light in it) is inserted into a tiny incision in the abdomen. By moving the laparoscope around the abdomen, the surgeon can check the condition of the abdominal organs see the endometrial implants if care and thoroughness are used. Laparoscopy is not absolutely necessary before attempting treatment though. Some patients refuse surgery, and sometimes the symptoms are not bad enough to the patient to require surgery.