Period Pain or Endometriosis? When to See a Doctor

Cramps most months, some bad enough to write off the day. And the question of whether that is still normal or could be endometriosis. Nobody can settle that at home, and no checklist or app can either. Until your appointment, you can keep pain days on paper or in Sam's symptom diary, which shows them with period days from cycle tracking on one month calendar.

This post covers what guidelines say about the difference, and when period pain is worth a doctor's visit. For how to describe your symptoms in detail, see Endometriosis: Prepare Your Symptoms for the Doctor. What Sam keeps for this condition is on the endometriosis page. If pain is severe, comes on suddenly and intensely or keeps getting worse, do not wait for an appointment; the emergency signs are in the section "When should you see a doctor about period pain?".

Can you tell for yourself whether it is endometriosis?

No. The WHO describes the symptoms of endometriosis as varied and broad, and some people with it have none at all. The German S2k guideline calls chronic lower abdominal pain a non-specific symptom. In other words, it can have many causes.

No home test can settle it, and no blood test is suitable either. The same guideline states that biomarkers are not suitable for diagnosing endometriosis. A doctor works it out, starting with a detailed conversation, a pelvic exam and usually a transvaginal ultrasound. A normal exam and scan do not rule endometriosis out, as both NICE in the UK and the European ESHRE guideline point out.

Your own records do not answer the question either, in Sam or on paper. What they give the conversation is something concrete: which days hurt and what you could not do on them.

How common is period pain, and what is primary dysmenorrhea?

Very common. ACOG, the American College of Obstetricians and Gynecologists, says more than half of women who menstruate have some pain for 1 to 2 days a month, usually mild. IQWiG, Germany's health information institute, adds a harder number. For 1 in 10 women, the pain is so bad that they cannot manage their usual day on 1 to 3 days a month.

Doctors separate two types:

• Primary dysmenorrhea comes from the womb contracting during your period. Hormone-like substances called prostaglandins play an important role. IQWiG says it is more common under 30 and with heavy periods.
• Secondary dysmenorrhea has another cause, often benign growths such as fibroids or polyps. Severe period pain can also be a sign of endometriosis.

The NHS says period pain usually lasts up to 3 days and is often a normal part of the cycle. That sentence tells you nothing about your own pain. IQWiG is clear on one point. Severe pain that affects everyday life on several days a month is not something you just have to live with because it is "natural". The WHO lists severe pain during periods among the symptoms of endometriosis.

What makes doctors think of endometriosis?

The NICE guideline tells doctors when to suspect endometriosis, including in girls aged 17 and under. Its list includes:

• Chronic pelvic pain.
• Period pain that affects daily activities and quality of life.
• Deep pain during or after sex.
• Bowel symptoms that come with your period or cycle, in particular painful bowel movements.
• Urinary symptoms that come with your period or cycle, in particular blood in the urine or pain passing urine.

The European ESHRE guideline adds tiredness and symptoms outside the pelvis, such as a cyclical cough or chest pain.

IQWiG and ACOG also describe how pain with another cause often behaves. It often starts after you have had periods for some years. It can come outside your period, for example a few days before it starts, and it may not stop when the period ends. ACOG says it tends to get worse over time and lasts longer than ordinary cramps.

These are pointers for doctors, not a test you can run on yourself. If none of them fits, that is not an all-clear. If one fits, that is not a diagnosis.

Endometriosis can start in the teenage years. Up to two thirds of adult women with surgically confirmed endometriosis say their pain began then, the German S2k guideline reports. It states that any persistent lower abdominal pain in adolescence can be a symptom, period pain included. ESHRE says doctors may consider endometriosis in young women who repeatedly miss school around their period. At the same time, IQWiG notes that period pain is usually worse before 20 and often eases a few years after the first period. Both are true. So age alone should not decide whether you get it checked.

What else can cause bad period pain?

Endometriosis is only one possible cause. For painful periods, the NHS names:

• Adenomyosis, where tissue like the womb lining grows into the muscle wall of the womb (description from ACOG).
• Fibroids, non-cancerous growths in and around the womb.
• Pelvic inflammatory disease, an infection of the womb, fallopian tubes and ovaries.

IQWiG adds polyps in the womb. Pelvic pain in general can also come from constipation, irritable bowel syndrome or a urinary tract infection, the NHS says. Some causes are serious and need urgent care. Endometriosis and irritable bowel syndrome can also occur together, according to the German guideline.

The NHS is direct about it: do not self-diagnose. Your doctor works out where your pain comes from. That can take several tests, because the symptoms of these conditions overlap.

When should you see a doctor about period pain?

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) for pelvic pain that is severe or comes on suddenly and intensely. The same applies if it is getting worse or hurts when you move or touch the area, or if it comes with:

• Feeling faint, dizzy or lightheaded, or passing out.
• Pain in the tip of your shoulder.
• Difficulty breathing.
• Heavy bleeding from the vagina.
• Sudden confusion.
• A high temperature, or feeling hot, cold or shivery.

Severe difficulty breathing, sudden chest pain that does not go away, or chest pain with shortness of breath, sweating, feeling sick or light-headed also needs an emergency call, including around your period. The NHS notes that endometriosis is sometimes found in the chest. Do not wait for it to pass. Call your local emergency number too if you cough up more than a few spots or streaks of blood, or if you cough up blood and find it hard to breathe, have a very fast heartbeat or have pain in your chest or upper back. A few small spots or streaks of blood, or blood in your phlegm or handkerchief, need urgent help.

Get urgent help for period or pelvic pain that is severe or worse than usual. This applies all the more if painkillers have not helped. The same goes for pelvic pain with:

• Blood in your pee or poo.
• Trouble peeing or pooing.
• Pain when peeing, or needing to pee more than usual.
• Unusual discharge or bleeding from the vagina.
• Vomiting and diarrhoea, or feeling sick.
• A pregnancy or possible pregnancy.

In the UK, that means an urgent GP appointment or NHS 111. Elsewhere, ask your doctor's office for an urgent appointment or use an out-of-hours service. These lists come from different sources and overlap. If in doubt, go with the more urgent option. The doctor visit post uses the same tiers.

For everything else, the NHS points you to a GP, and ACOG to an ob-gyn. Book a regular appointment if:

• You think you might have endometriosis.
• You have pelvic pain that comes and goes or does not go away.
• Period pain stops you doing your usual daily activities.
• Your symptoms affect everyday life, work or relationships.
• Your periods become more painful, heavier or irregular.
• Sex, peeing or pooing hurts.
• You bleed between periods.
• You change a pad or tampon every 1 to 2 hours, or bleed through your clothes.
• You notice a change in how much you pee or poo, or your tummy is swollen.
• Bloating, diarrhoea or constipation does not go away.
• You are losing weight without trying, feel full quickly or have no appetite.
• Treatment has not helped.

If none of these fits but you are worried, you can still have your symptoms checked at any time. If symptoms get worse, do not wait for that appointment. Sam replaces neither an emergency call nor an examination.

Told it is "just period pain" while it runs your month? See When your doctor does not take your symptoms seriously.

What should you note about your period pain before the visit?

For this question, details across several cycles help most:

• Which days hurt: only while bleeding, days before, after, or in between.
• What you could not do on those days, such as work, school or plans.
• Whether a painkiller helped, with the name from the pack.
• Whether sex, peeing or pooing hurts.
• How long it has been like this, and whether it is getting worse.

The doctor visit post shows how to phrase each point. For what a useful record contains, see Symptom Diary: Paper Template or App?.

Sam has no ready-made entry for period pain. In the symptom diary you add it under "Other" as your own symptom, in your own words. Or you use ready-made entries such as Abdominal cramps or Pelvic pain. Each symptom gets one entry per day: mild, moderate or severe. There is no time of day, no 0 to 10 scale and no free-text note.

Bleeding goes into cycle tracking, with the flow from Spotting to Heavy. Under "How it went" you pick preset options such as "Changed my plans" or "Woke me at night". There is no note field here either. Under "Also noticing" you can add Abdominal cramps in the same step; they are saved as a symptom in the symptom diary. If you have allowed Apple Health access, Sam brings in period days stored there from up to two years back.

In Health History, symptom days and period days show as dots on the same month calendar. Painkillers you take as needed go into your medication list. You tick them off on today's symptom sheet under "Took something?". The catalog is a selection, not a recommendation, so check the strength on your pack. Whether a dose helped stays on paper. Sam does not place symptoms on cycle days and cannot tell you whether your pain is normal or endometriosis.

Log period pain and period days in Sam

You walk in with counted pain days instead of a feeling that it is "bad every month".

• Instead of scraps of paper: you rate period pain per day as mild, moderate or severe, as your own symptom in your own words. Abdominal cramps and Pelvic pain are ready-made entries.
• Instead of two separate lists: period days from cycle tracking and symptom days sit on one month calendar in Health History. Past periods from Apple Health come in too.
• Instead of counting back in the waiting room: the Cycle report PDF counts cycles and bleeding days per period. It also counts the days where you picked options such as "Changed my plans".

Times of day, a 0 to 10 scale and notes stay on paper; Sam cannot tell you whether it is endometriosis. More on the endometriosis page.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Endometriosis: Prepare Your Symptoms for the Doctor
• Which Doctor for Endometriosis: GP, Specialist, Referral
• Symptom Diary: Paper Template or App?
• When your doctor does not take your symptoms seriously
• Doctor Appointment Checklist for a Chronic Condition

Sources

Updated: October 2026

• NICE: Endometriosis: diagnosis and management (NG73), Recommendations (last updated 11 November 2024), recommendations 1.3.1 and 1.5.4
• ESHRE Endometriosis Guideline Group: ESHRE guideline: endometriosis. Human Reproduction Open 2022(2):hoac009, chapters on diagnosis and on adolescence
• DGGG, OEGGG and SGGG: Diagnosis and Therapy of Endometriosis, S2k guideline, AWMF 015/045 (version April 2025; published in Geburtshilfe und Frauenheilkunde 2026;86(2):133-188), recommendation 3.E7, statements 3.S8, 7.S21 and 7.S25
• WHO: Endometriosis, fact sheet (15 October 2025)
• IQWiG (InformedHealth.org): Period pain (updated 12 May 2023)
• ACOG: Dysmenorrhea: Painful Periods (last reviewed January 2022)
• NHS: Period pain (reviewed 18 March 2026) and Pelvic pain (reviewed 24 November 2025)
• NHS: Endometriosis (reviewed 27 August 2024)
• NHS: Chest pain (reviewed 8 August 2023), Shortness of breath (reviewed 30 January 2024) and Coughing up blood (reviewed 13 June 2024)
• Techniker Krankenkasse: Akuter Bauch (Abdomen, akutes) (22 December 2020, in German)
• European Commission, Your Europe: Emergency number 112