Endometriosis Bleeding: Patterns, After Sex, and Relief

Endometriosis is a chronic condition affecting up to 11% of people who menstruate. About 6.5 million people in the United States have endometriosis.

Each month, the lining of the uterus sheds during your period. When endometrial cells grow on other organs (ovaries, fallopian tubes, bowel, etc.), they form lesions that swell, which can lead to severe pain, bleeding, and scarring.

This article discusses the types of bleeding associated with endometriosis and how to treat it. 

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The Theory of Retrograde Menstruation

The exact cause of endometriosis is unknown. One possible factor is retrograde menstruation. This occurs when the blood and tissues in your period flow back up the fallopian tube instead of being shed through the vagina. Blood and tissue from the uterus flow into the pelvic area. When this happens, endometrial tissue can attach to other organs, leading to endometriosis. 

Retrograde menstruation is relatively common. Many people who experience it do not have endometriosis. Other factors that may raise the risk of endometriosis include a suppressed immune system and a history of abdominal surgery.

Endometriosis Bleeding Patterns

Endometriosis is known to cause heavy or irregular bleeding during your menstrual cycle and throughout the month. 

Flow Consistency

People with endometriosis may notice that their period feels heavy, and the flow is consistently fast.

Quantity

It is common for people with endometriosis to shed more blood each month than the average period. The excessive amount of blood is from tissue shed from the uterus. 

Timing and Length 

Because people with endometriosis have more to shed each month, their periods tend to last longer than average. An average period length is about five to seven days. People with endometriosis often experience periods that last longer than seven days.

Internal Bleeding and Scar Tissue

Endometriosis growth can lead to scar tissue formation and internal bleeding. The bleeding is not typically life-threatening, but it can lead to problems including pain, scar tissue, and inflammation.

In rare cases, endometrial tissue may grow into the intestines or urinary tract, causing blockages. When endometrial cells swell and bleed each month, scar tissue can form (adhesions), which can attach to organs and may cause them to stick together. 

After Sex

It is possible to experience bleeding after sex when you have endometriosis. You may also experience pelvic pain after sex. 

Spotting Between Periods

People with endometriosis may also bleed at other times of the month. It is possible to notice spotting or light bleeding in between periods. Talk with your healthcare provider immediately if you experience heavy bleeding between periods.

Absent Periods

In addition to heavy periods, it’s possible to experience irregular or absent periods (amenorrhea). You may notice your menstrual cycles becoming longer or shorter, making it hard to predict when you will get your period. Fortunately, there are treatments available to help regulate your cycle. 

Rectal Bleeding

Although rare, some people with endometriosis experience rectal bleeding. Talk to your healthcare provider if you notice pain when going to the bathroom or drops of blood in the toilet or on toilet paper after a bowel movement.

Related Endometriosis Symptoms 

Bleeding is not the only symptom caused by endometriosis. Other common symptoms may include:

What Is Adenomyosis?

Adenomyosis is another chronic condition that affects the uterine lining and is often confused with endometriosis. In endometriosis, cells from the uterine lining grow in other areas of the body. In adenomyosis, cells from the uterus lining grow into the uterus's muscular wall. 

Ways to Regulate Endometriosis Bleeding 

There is no cure for endometriosis, but there are treatment options that can significantly reduce the symptoms and risk of complications.

Natural Remedies

You may prefer to try natural remedies before beginning prescription medications or other medical treatments. Natural remedies that may improve endometriosis symptoms include:

  • Physical activity: Exercise may be a protective factor against endometriosis. Aim for at least 30 minutes of physical activity on most days of the week.
  • Healthy diet: Eating a diet rich in fiber (vegetables, fruits, whole grains, legumes such as beans, nuts, and peas) can help improve endometriosis symptoms and reduce inflammation and excess estrogen in the body.
  • Stress management: Relaxation techniques can improve endometriosis pain. Try different methods, such as meditation or deep breathing exercises, to find one that works for you.

Birth Control

Hormonal birth control is a standard treatment for those with endometriosis because it decreases the hormonal stimulation that can make endometriosis grow. Birth control pills can be taken for years and can significantly relieve most symptoms. They do not repair any damage that has already occurred but can stop endometriosis from worsening.

Other forms of birth control, including progesterone pills, injections, and intrauterine devices (IUDs), can also treat endometriosis.

Hormonal birth control pills are not for everyone, and it’s important to discuss the possible risks with your healthcare provider. 

Other Hormone Therapies

Gonadotropin-releasing hormone (GnRH) medications stop the ovaries from producing estrogen, which puts the body into a temporary state of menopause. This helps control the growth of endometrial tissue and improves pain and abnormal bleeding.

Surgery

Your healthcare provider may recommend surgery when other therapies cannot improve severe endometriosis symptoms. The surgeries used to address endometrial pain and bleeding include:

  • Laparoscopy: Can be used to diagnose endometriosis and remove growths and scar tissue. It only requires a small cut in the belly, so recovery time is usually quick. 
  • Laparotomy: Requires a large incision in the belly to remove growths and scar tissue. This is major surgery, and recovery time will be longer than with a laparoscopy.
  • Hysterectomy: Surgery to remove the uterus. It can also be combined with surgery to remove fallopian tubes and ovaries. It results in immediate menopause and is only considered when severe symptoms cannot be controlled.

Daily Tips for Managing Bleeding Pains 

For many, endometriosis causes daily symptoms that affect your quality of life. Fortunately, there are daily practices that you can implement to start feeling better. To manage endometriosis, try:

  • Heat: Try placing a heating pad on your lower abdomen to help ease cramps and pelvic pain.
  • Activity: Try gentle exercises such as a short walk or swimming when in pain.
  • Therapy: Consider meeting with a therapist to learn stress reduction techniques.
  • Rest: Remember to let your body rest when you need it. 
  • Pain medications: Try Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen).
  • Healthcare appointments: Be sure to see your healthcare provider every six to 12 months.

Summary 

Endometriosis is a chronic condition that causes cells from the uterus lining to grow in other areas of the body, such as the ovaries and fallopian tubes. In addition to severe pain, endometriosis can cause heavy or abnormal bleeding. It is possible to experience bleeding between periods, after sex, or with bowel movements. Your periods may become heavier too. Treatment includes natural remedies, hormonal therapies, and surgery. 

A Word From Verywell 

Being diagnosed with endometriosis is an overwhelming experience. You may be feeling frustrated that this is happening to you. It might be helpful to remember that endometriosis is treatable. Many people find relief with hormonal birth control and over-the-counter pain medications. Talk with your healthcare provider about your symptoms and how best to address them. 

Frequently Asked Questions

  • Does birth control mask the symptoms of endometriosis?

    Birth control medications can help to relieve endometriosis symptoms by regulating hormone levels in the body. Once you stop taking birth control, your endometriosis symptoms will return or worsen.

  • How common is bleeding from bowel endometriosis?

    Bleeding from bowel endometriosis is rare. Common endometriosis symptoms include pelvic pain, cramping, and heavy or irregular periods. 

  • Does endometriosis cause multiple monthly periods?

    People with endometriosis may experience irregular periods. You may notice that your menstrual cycle becomes either shorter or longer each month. It’s also possible to experience spotting or bleeding between periods.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.