Understanding Endometriosis: Symptoms, Causes & Blood Tests | Epicentre
Women's Health

Your Pain Is Not Normal.
It Might Be Endometriosis.

Endometriosis affects 1 in 10 women, but most spend years being told their symptoms are "just period pain." Blood tests cannot diagnose it alone – but they can fast-track the conversation with your doctor.

190 million
women affected globally
6 – 12 years
average time to diagnosis
1 in 10
women of reproductive age
By Aimee Zuccarini · · Updated April 2026 · 8 min read

Endometriosis happens when tissue similar to the lining of the uterus grows outside the womb – on the ovaries, fallopian tubes, pelvic lining, and sometimes the bowel or bladder. Each month, this tissue responds to your hormones: it thickens, breaks down, and bleeds. But unlike your period, it has nowhere to go. The result is chronic inflammation, scar tissue, adhesions, and pain that can affect every part of your life.

I was told for eight years that my pain was normal. One blood test showed my iron was depleted, my oestrogen was elevated, and my CRP was raised. That panel gave my gynaecologist enough to refer me for a laparoscopy. I wish I had tested sooner.

The symptoms most women recognise too late

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Severe period pain

Pain that stops you working, sleeping, or functioning – not "normal" cramping. Often worsens year by year.

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Chronic pelvic pain

Constant or cyclical pain not limited to your period. Often misdiagnosed as IBS or a urinary problem.

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Heavy or irregular bleeding

Soaking through protection, passing clots, or bleeding between periods. Slowly depletes your iron stores.

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Pain during sex

Deep pain during or after intercourse – one of the hallmark symptoms – caused by tissue on pelvic ligaments.

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Painful bowel or bladder

Cyclical pain when going to the toilet, especially during your period. Mimics digestive conditions.

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Difficulty conceiving

One of the leading causes of infertility. Affects egg quality, tube function, and implantation.

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Crushing fatigue

Not just tiredness. Chronic inflammation plus iron depletion from heavy periods creates bone-deep exhaustion.

The diagnostic trap. The only definitive diagnosis is through laparoscopy (keyhole surgery). But you should not need to wait years for that referral. A comprehensive blood panel gives your doctor objective data – hormonal imbalance, iron depletion, inflammation markers – that strengthens the case for investigation and rules out other causes.

What causes endometriosis?

  • Retrograde menstruation – menstrual blood flows backwards into the pelvic cavity. Occurs in 90% of women, but only 10% develop endometriosis
  • Genetics – first-degree relatives are 5 – 10 times more likely to develop it (Brandi Jones, 2025)
  • Hormonal imbalance – endometriosis is oestrogen-dependent. Higher or sustained oestrogen drives tissue growth
  • Immune dysfunction – the clearing mechanism for misplaced tissue may be impaired
  • Environmental factors – endocrine-disrupting chemicals may increase risk, a growing concern in South Africa

How blood tests accelerate diagnosis

Blood tests do not diagnose endometriosis. But arriving at your GP or gynaecologist with a comprehensive panel already completed gives your doctor a head start and can cut months or years from the diagnostic journey.

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FSH & LH

Assess ovarian function and the hormonal signals driving your cycle. Abnormal ratios indicate imbalance linked to endometriosis or PCOS.

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Oestradiol

Primary oestrogen. Endometriosis is oestrogen-dependent – elevated levels indicate the environment driving tissue growth.

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Progesterone

Low progesterone relative to oestrogen is associated with endometriosis. Assesses hormonal balance and ovulatory function.

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TSH (Thyroid)

Thyroid dysfunction mimics endo symptoms – fatigue, cycle changes, mood. Rules it out or identifies a co-existing condition.

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Ferritin & Iron

Heavy periods deplete iron long before you become "anaemic" on paper. Low ferritin with normal haemoglobin is frequently missed.

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AMH

Anti-Müllerian hormone measures ovarian reserve. Reduced by endometriomas – critical for fertility planning.

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CRP

Inflammation marker. Elevated CRP helps distinguish endometriosis from pelvic infection, which needs completely different treatment.

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FBC

Full blood count checks for anaemia from chronic blood loss and signs of infection or immune response.

The test that gives you answers

Recommended

Female Hormone Package

Maps your full endocrine system – the hormones, iron stores, and ovarian markers most relevant to investigating endometriosis, PCOS, perimenopause, and fertility.
FSHLHOestradiolProgesteroneTestosteroneTSHFerritinSHBGProlactinAMH
R3,011
or ~R753/mo with Payflex (4× interest-free) · Incl. VAT
Timing tip: Draw blood on Day 3 of your cycle (FSH, LH, oestradiol) or Day 21 (progesterone). Not sure? Your phlebotomist will advise.

PCOS Package

Hormone and metabolic panel for polycystic ovary syndrome – which shares symptoms with endometriosis and often co-exists.
InsulinCRPTSHFree TestosteroneDHEAS+12 more
R2,605
or ~R651/mo with Payflex · Incl. VAT

Results in 2 – 5 working days · No doctor's referral needed · Durban (Hillcrest) · Cape Town (Observatory) · Johannesburg (Parktown North)

Endometriosis across South Africa

Private healthcare

Shorter path to specialists, but diagnostic delays persist. Period pain is normalised even in private consultations. Arriving with blood results showing hormonal imbalance or iron depletion fast-tracks the gynaecology referral.

Public healthcare

Many community health centres have no gynaecologist. Referral waits stretch to months. Symptoms are dismissed or attributed to pelvic infection. Objective blood data can be the difference between a referral and another year of waiting.

Travellers & expats

Worsening symptoms during your time in SA? Walk into any Epicentre branch – no doctor's referral needed. Results are delivered digitally and can be shared with your gynaecologist anywhere in the world.

Living with endometriosis

There is no cure, but symptoms can be managed. Your doctor may recommend hormonal treatment to slow tissue growth, pain management strategies, or surgical removal of deposits. Lifestyle changes also make a real difference:

  • Anti-inflammatory diet – reduce processed foods and sugar; increase omega-3s, vegetables, and whole grains
  • Regular exercise – lowers oestrogen levels and improves pain tolerance
  • Stress management – yoga, meditation, and pelvic floor physiotherapy are evidence-based
  • Monitor your iron – check ferritin regularly if you have heavy periods. Depletion causes fatigue long before full anaemia
  • Track your symptoms – documenting timing, severity, and patterns helps your doctor build the case for diagnosis

Stop Waiting. Start With Data.

Map your hormones, check your iron, and give your doctor something to work with. No doctor's referral needed.

References

  1. World Health Organization (2023). Endometriosis fact sheet.
  2. Brandi Jones (2025). Endometriosis risk factors and genetics.
  3. Saunders, P.T.K. (2021). Endometriosis: aetiology, pathobiology, and therapeutic targets. Cell, 184(11), 2807 – 2824.
  4. Cochrane Database (2020). Blood biomarkers for the non-invasive diagnosis of endometriosis.
  5. Global Burden of Disease Study (2021). Prevalence and years lived with disability due to endometriosis.