The tissue surrounding the implant can begin to break down and bleed. But if active endometriosis becomes trapped beneath adhesions, enormous pain and pressure can result. Then degeneration and destruction of the localized blood can create a cystic mass called an endometriomas. They can also grow very large, up to the size of a softball. Invasion of nearby structures including the bowel, bladder and urethras can occur.
Advanced endometriosis can result in pelvises frozen with adhesions.
This means that organs designed to float freely within the pelvis are stuck together. Although many women with Endometriosis do not experience symptoms, those who do report varying degrees of pain, especially around the time of menstruation when endometrial tissue engorges. Other common symptoms of Endometriosis include pain during intercourse, abnormal vaginal bleeding, and heavy menstrual flow. This question has no universal answer. Some women with advanced-stages have had no pain, and some with minimal disease are incapacitated by pain.