The Overlooked Endometriosis Symptom Most People Have Never Heard Of
Most people have never heard about this symptom.
Kass
Image by Zoa Photo / Stocksy July 23, 2026 Years of unexplained migraines. Chronic bloating. Anxiety that doesn't quite make sense. For some women, these are separate conditions. But in others, they are all part of endometriosis. New research on how endometriosis symptoms cluster found that the condition presents in four distinct ways, and one of them looks nothing like the pelvic pain most people associate with the disease.
About the study
Endometriosis is a condition that causes tissue that normally lines the inside of the uterus to start growing on organs outside the uterus, like the ovaries, fallopian tubes, and other areas of the pelvis. It affects around one in ten women of reproductive age, but it often takes years to get a diagnosis after symptoms first show up.
A big reason for this gap in care is because the condition has traditionally been identified based on what a surgeon sees during a laparoscopic procedure, which requires a small camera to be inserted through the abdomen and into the uterus to get better imaging.
Researchers wanted to see if they could expand the definition of endometriosis and help more women consider if they might have this condition. They tapped into the All of Us Research Program, one of the largest health databases in the U.S., and analyzed data from more than 22,000 women with endometriosis. They looked at 19 symptoms and conditions commonly tied to the disease, including pelvic pain, gut issues, migraines, anxiety, depression, and fatigue, to see if natural groupings emerged.
The four profiles of endometriosis
Four distinct symptom profiles emerged when looking at premenopausal women with endometriosis for this study. Here, you can see how these women may have very different experiences of the condition:
Why the psychological & neurological profiles matter
When migraines, anxiety, or depression are your most prominent symptoms, you're far more likely to see a neurologist or therapist than a gynecologist. These practitioners will likely treat the symptoms as best they can, never thinking a gynecological condition won't be on their radar. Most women's path to diagnosis will likely get stuck here.
The study calls out this profile specifically, noting that women with these non-traditional symptoms should be screened for endometriosis earlier, rather than waiting for pelvic pain to trigger a workup. Catching it sooner could make a real difference in how quickly women get answers.
When endometriosis & adenomyosis overlap
The study also looked at women who had both endometriosis and adenomyosis, a related condition where tissue similar to the uterine lining grows into the muscular wall of the uterus, causing severe pain and heavy bleeding.
Women with both conditions were concentrated in the highest-burden symptom profiles, with no low-symptom group presenting among them at all. This points to a higher overall disease burden and a likely need for more individualized, closely monitored care for women struggling with both of these conditions.
What to do if this sounds all too familiar
This research doesn't mean you have to worry that every migraine or anxious day is a symptom of endometriosis. But if multiple symptoms consistently come up, and tend to appear around your cycle, it's worth discussing with your doctor. If you want to walk into your next appointment with more information and better questions, think about these three things.
The takeaway
For the roughly one-third of premenopausal women whose most prominent endometriosis symptoms are neurological or psychological, the path to diagnosis has historically run through the wrong specialists. Recognizing these patterns earlier is what could finally change that.
The hope is that studies like this one show that endometriosis can look very different from one person to the next, and that new technology continues to make it easier to identify this notoriously difficult condition.
