Pelvic pain can be frustratingly difficult to decode. Is it coming from your reproductive organs? Your bladder? Your pelvic floor? Or more than one place at the same time?
Two conditions that can be particularly difficult to tell apart are endometriosis and interstitial cystitis (IC), also called bladder pain syndrome (IC/BPS). Both can cause chronic pelvic pain, discomfort during sex, pressure in the lower abdomen, and symptoms that may worsen around your period. Research also shows that the two conditions can coexist, which can make getting to the bottom of pelvic pain even more complicated.¹˒²
The good news is that there are clues that can help you and your healthcare provider better understand where your symptoms may be coming from.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. These lesions can contribute to inflammation, scarring, adhesions, and pain.
While everyone’s experience is different, endometriosis is often associated with:
Pain that follows a strong menstrual pattern can be an important clue. Severe dysmenorrhea, or painful menstruation, has a well-established association with endometriosis.³
But endometriosis isn’t always predictable. Some people experience pain throughout the month, and the location and severity of pain do not necessarily tell you how extensive the disease is.
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by pain, pressure, or discomfort perceived to be related to the bladder, often alongside changes in urination.
Common symptoms include:
Pain combined with urinary frequency and urgency is particularly characteristic of IC/BPS.⁴
Unlike a urinary tract infection (UTI), IC symptoms aren’t explained by a bacterial infection. Because conditions such as UTIs and other urinary disorders can cause similar symptoms, ruling out other possible causes is an important part of evaluation.
This is where things get tricky.
The bladder, uterus, pelvic floor, bowel, and surrounding structures are all located close together and share complex nerve pathways. When chronic pain develops in one area of the pelvis, it isn’t always experienced as a neat, clearly defined pain coming from one specific organ.
Both endometriosis and IC can cause pelvic pressure, abdominal discomfort, painful sex, and chronic pelvic pain. And while menstrual symptoms may point toward endometriosis, people with IC can also notice that their bladder and pelvic symptoms change around their menstrual cycle.¹˒²
That means timing alone doesn’t always provide the answer.
There is no single symptom that can definitively distinguish one condition from the other, but patterns can provide useful clues.
| More Suggestive of Endometriosis | More Suggestive of IC |
| Severe menstrual cramps | Pain or pressure related to the bladder |
| Pelvic pain strongly associated with menstruation | Frequent urination |
| Pain with bowel movements, especially during your period | Strong urinary urgency |
| Deep pain during sex | Pain or pressure as the bladder fills |
| Heavy or irregular menstrual bleeding | Temporary relief after urinating |
| Fertility difficulties | Waking frequently at night to urinate |
Think of this table as a guide rather than a diagnostic checklist. Having symptoms in both columns doesn’t necessarily mean something doesn’t add up. It could be a reason to investigate both conditions.
Yes.
This is one of the most important things to understand about chronic pelvic pain. Endometriosis and IC aren’t necessarily an either-or diagnosis.
A 2024 systematic review and meta-analysis found substantial overlap between endometriosis and IC/BPS among women with chronic pelvic pain, although estimates varied widely between studies. The authors concluded that IC/BPS should be considered when someone with endometriosis continues to experience pelvic pain despite treatment.¹
More recent research supports the connection. In a study of 533 female patients diagnosed with IC/BPS, about 20% also reported a history of endometriosis.⁵
This overlap matters because treating one source of pain may not completely resolve symptoms when another condition is also contributing.
For example, someone diagnosed with endometriosis might continue experiencing urinary urgency, bladder pressure, and pelvic pain after endometriosis treatment. Rather than assuming the treatment “failed,” persistent bladder-related symptoms may be a reason to investigate IC/BPS or another pelvic pain contributor.
Instead of focusing only on where it hurts, it can be helpful to pay attention to when and why symptoms change.
Ask yourself:
Does the pain change as my bladder fills?
Pain, pressure, or discomfort that becomes more noticeable with a fuller bladder may point toward a bladder-related component.
Do I feel better after urinating?
Temporary relief after emptying the bladder can be another useful clue for IC.
Does my pain consistently worsen around my period?
Strongly cyclical pelvic pain, particularly severe menstrual pain, may raise suspicion for endometriosis.
Do I have urinary urgency or frequency even when I don’t have a UTI?
Persistent bladder symptoms without infection deserve further investigation.
Does it hurt to have a bowel movement during my period?
Cyclical bowel pain can occur with endometriosis, particularly depending on where lesions are located.³
Keeping a symptom diary that tracks your menstrual cycle, urination, bowel symptoms, sexual activity, foods and drinks, and pain can make patterns easier to recognize.
Neither condition can reliably be diagnosed from symptoms alone.
For suspected endometriosis, evaluation may involve a detailed medical history, pelvic examination, and imaging such as ultrasound or MRI depending on the circumstances. Your healthcare provider can determine whether additional evaluation or treatment is appropriate.
For suspected IC/BPS, the process typically begins with a detailed history and physical examination and ruling out other potential explanations for symptoms, including infection. Cystoscopy or other testing may be appropriate in certain cases, but cystoscopy isn’t automatically required for every uncomplicated presentation.⁶
Because pelvic pain can have multiple contributors, recent expert consensus on IC/BPS emphasizes evaluating gynecological conditions, pelvic floor dysfunction, sexual pain, and other potential sources of symptoms rather than viewing bladder pain in isolation.²
Treating endometriosis doesn’t always mean pelvic pain disappears completely. Over time, chronic pain can involve more than the endometriosis lesions themselves.
The pelvic floor muscles may become tight or overactive after months or years of guarding against pain. Nerves in the pelvis can also become more sensitive, meaning sensations that normally wouldn’t hurt may begin to feel painful or uncomfortable. Scar tissue, bowel symptoms, bladder sensitivity, and other overlapping pelvic pain conditions can add another layer.
This is why persistent symptoms don’t necessarily mean endometriosis has returned or progressed. Instead, it may be helpful to ask what else could now be contributing to the pain?
For example, ongoing urinary urgency, frequency, bladder pressure, or pain related to bladder filling may point toward a bladder component such as IC/BPS, while muscle tenderness or pain with certain movements may warrant assessment of the pelvic floor.
For people with chronic pelvic pain, finding the right treatment sometimes means addressing several contributors rather than searching for one single cause.
Endometriosis and interstitial cystitis can look remarkably similar, but there are clues.
Pain closely tied to menstruation, painful periods, and cyclical bowel symptoms may lean toward endometriosis. Bladder filling pain, urinary urgency, and frequent urination may lean toward IC.
But your body doesn’t have to choose one column.
The two conditions can coexist, and pelvic floor dysfunction or other sources of pelvic pain may also contribute to symptoms. If your pelvic pain has been difficult to explain, or treatment for one condition hasn’t addressed all of your symptoms, looking at the whole pelvic picture may help you and your healthcare team identify what’s been missed.
Getting more specific about when pain happens, what triggers it, and what relieves it can be an important first step toward finding care that better fits your symptoms.
Photodynamic therapy is a treatment typically used in the treatment of acne, warts, and a range of cancers, including mouth (oral), head and neck, lung,
The HPV Infection: Do I Have It? But…I’ve never noticed any symptoms so I couldn’t have gotten an HPV infection? Most strains of HPV are low-risk strains that
Are you worried about HPV? Are you unclear as to what exactly HPV is? We at Papillex understand your concerns. HPV can be scary! That’s
Human beings are naturally programmed to eat foods that are healing and beneficial for our bodies. However, we all know that it isn’t always easy
Easy Delivery. Effortless Wellness.
Subscribe for:
By signing up for a Wellex subscription, you authorize use of the credit card you have on file and shipping at the frequency you have selected. Rest assured you can change or cancel at any time.
