Endometriosis is a condition where tissue similar to the endometrium (the lining of the uterus) is found outside of the uterus. This tissue can be found on the ovaries, fallopian tubes, and other pelvic structures. One of the most common symptoms of endometriosis is painful periods, but many women also experience abnormal uterine bleeding. So do women with endometriosis bleed constantly? Let’s take a closer look at the details.
What is considered constant bleeding with endometriosis?
There is no strict medical definition for constant bleeding when it comes to endometriosis. However, many doctors would consider bleeding constant if it occurs:
– Most days of the month
– For prolonged periods of time without stopping
– In between expected menstrual cycles
So essentially, constant bleeding would be any type of vaginal bleeding outside of regular monthly menstrual periods. This could manifest as spotting between periods, bleeding after sex, or long heavy periods without break.
Is continuous bleeding common with endometriosis?
Abnormal uterine bleeding is very common among women with endometriosis. Up to 30-50% of women with endometriosis report heavy, irregular, or prolonged menstrual bleeding.
However, true constant bleeding every day is less common. Only around 15% of women with endometriosis will experience daily spotting or bleeding. So while abnormal bleeding is very common, constant daily bleeding is less so.
What causes the bleeding?
There are a few theories as to what causes abnormal bleeding in women with endometriosis:
Hormonal imbalances – The endometrial-like tissue outside the uterus responds to hormones just like the uterine lining. The tissue builds up and breaks down each month, which can cause bleeding. However, hormones like estrogen that fuel the tissue growth can be out of balance with endometriosis. This leads to irregular tissue build up and shedding.
Inflammation – The endometrial tissue implants cause inflammation in the pelvis. This inflammation has been associated with heavier, prolonged periods in some women.
Scarring – Endometriosis can cause scar tissue to form around uterine tissue. This may prevent proper shedding of the uterine lining during menstruation.
Polyps – Women with endometriosis are at higher risk for uterine polyps. Polyps are overgrowths that can contribute to heavy bleeding during menses.
Can you bleed after menopause with endometriosis?
Once women reach menopause, monthly menstrual periods cease due to dropping estrogen levels. So can endometriosis cause bleeding even after menopause?
The answer is possibly, but it’s uncommon. One study found postmenopausal bleeding to be reported in around 4% of women with endometriosis. The causes were thought to be:
– Remaining patches of endometrial tissue continuing to break down each month
– Development of new endometrial-like implants
– Formation of polyps
So while unusual, some women with endometriosis may experience spotting even after menopause is reached. Any postmenopausal bleeding should be evaluated by a doctor.
Can you bleed during pregnancy with endometriosis?
For women with endometriosis who become pregnant, one question is if they will still experience abnormal bleeding during pregnancy.
The typical pattern is:
– During the first trimester, some spotting may occur as hormones rapidly change
– Bleeding usually ceases by the second trimester once the placenta is fully formed
– Heavy bleeding during pregnancy is not normal and could indicate complications like miscarriage or placental abruption
Many women find their endometriosis symptoms improve during pregnancy thanks to the high progesterone levels. However, some women may still report occasional spotting or light bleeding during the first several months.
How heavy is the bleeding with endometriosis?
The amount of bleeding experienced by women with endometriosis varies. Symptoms may include:
Heavy menstrual bleeding – Also called menorrhagia, this is defined as soaking a pad or tampon every 1-2 hours, needing double protection, and passing large clots. Up to 1/3 of women with endometriosis have heavy monthly periods.
Prolonged periods – Periods lasting longer than 7 days. About 50% of women with endometriosis have periods longer than normal.
Frequent periods – Cycles shorter than 21 days. This causes frequent menstruation.
Spotting between periods – Known as metrorrhagia, this can range from occasional brown discharge to daily light bleeding.
Irregular bleeding – Bleeding that is difficult to predict and comes and goes randomly.
So the amount of bleeding varies significantly based on the individual. It ranges from infrequent spotting to long, heavy periods.
What other symptoms may occur with endometriosis?
Along with abnormal bleeding, other symptoms of endometriosis may include:
– Painful menstrual cramps and pelvic pain
– Pain during or after sexual intercourse
– Painful bowel movements or urination during menstrual periods
– Fatigue and nausea, especially during periods
– Infertility or difficulty getting pregnant
The severity of symptoms ranges widely. Some women have mild symptoms while others are debilitated during their periods.
When should you contact your doctor?
You should let your doctor know if you experience any of the following:
– Bleeding between regular monthly menstrual cycles
– Periods lasting longer than 7 days
– Bleeding or spotting after menopause or during pregnancy
– Heavy periods requiring changing protection hourly
– Severe cramping or pelvic pain with periods
– Dizziness, fatigue or shortness of breath from heavy bleeding
– Infertility or difficulty conceiving
Your doctor can perform exams and testing to determine if endometriosis may be causing abnormal bleeding. They can also prescribe medication or recommend surgical options if needed to treat heavy, irregular periods caused by endometriosis.
How is endometriosis diagnosed?
If abnormal bleeding occurs, doctors will typically start with a pelvic exam to feel for any unusual growths. They may also perform an ultrasound of the pelvis using a wand placed vaginally. This allows visualization of the uterus and ovaries.
If any abnormal tissue or cysts are seen, it raises suspicion for endometriosis. But the only way to confirm diagnosis is through laparoscopic surgery. This allows the surgeon to visualize all the pelvic organs and take biopsies of suspected endometrial tissue.
Sometimes diagnosis is made at the time of surgery for other indicated reasons like pelvic pain. Other times surgery is elected solely for diagnosis if endometriosis is highly suspected.
What dietary changes help with bleeding from endometriosis?
Some women find making certain dietary changes can help ease period symptoms from endometriosis:
Boost iron intake – Heavy bleeding leads to iron deficiency. Getting adequate iron from foods like red meat, eggs, spinach and supplements can help reduce this risk.
Increase omega-3 fatty acids – Found in fish, walnuts, and supplements, omega-3s reduce inflammation which may lessen bleeding.
Eliminate alcohol and caffeine – These can make cramps and bleeding worse for some women. Avoiding them may help.
Reduce sugar – Some find refined sugars worsen inflammation. Limiting sugar may help.
Eat more fiber – Fiber from fruits, veggies and whole grains can ensure regularity and help remove excess hormones through waste.
Making dietary modifications may potentially help reduce the amount of bleeding experienced by some women with endometriosis.
What medications are used to treat heavy bleeding from endometriosis?
If bleeding becomes heavy or disruptive, medications may be used to regulate menstruation. Options include:
Hormonal birth control – Birth control pills, patch, ring, or shot can help stabilize hormones and control bleeding.
NSAIDs- Anti-inflammatories like ibuprofen or naproxen can help decrease heavy flow when taken right before and during periods.
Tranexamic acid – This is an anti-fibrinolytic that helps blood clot. It leads to reduced blood loss during menses.
Progestin therapy – Progestin helps stabilize the endometrium. Taken as a pill, injection, or IUD, it lightens periods.
Gonadotropin-releasing hormone (GnRH) agonists – These drugs switch off hormone production, inducing a temporary menopause-like state to stop periods.
Aromatase inhibitors – These estrogen-reducing drugs are sometimes prescribed off-label to control heavy menstrual bleeding.
If bleeding is severe enough to cause anemia, iron supplements will also be prescribed to boost iron levels.
Can endometrial ablation help heavy bleeding from endometriosis?
Endometrial ablation is a procedure that removes the lining of the uterus. It reduces or stops heavy bleeding.
Ablation is sometimes used to control heavy bleeding in women with endometriosis. However, results are mixed. One study found 74% of women with endometriosis who had ablation reported resolution of excessive bleeding. But other studies show less positive results.
Since endometriosis occurs outside the uterus, removing the uterine lining may not address all bleeding sources. Many experts feel ablation should not be relied upon alone to treat endometriosis-related bleeding. Instead, medications or surgery to excise endometrial tissue may be recommended along with or instead of ablation.
Does getting a hysterectomy stop endometriosis bleeding?
A hysterectomy removes the uterus and sometimes the ovaries and fallopian tubes. Because this removes the source of menstrual bleeding, a hysterectomy will resolve endometriosis-related menstrual bleeding.
However, a hysterectomy alone is not usually a cure for endometriosis. Tissue outside the uterus is left behind and can still bleed in some cases. Pain may also persist.
To effectively treat endometriosis via hysterectomy, the surgeon must also excise all endometrial lesions throughout the pelvis at the time of hysterectomy. Care must be taken to remove all disease to stop pain and bleeding.
Can endometriosis bleeding stop without surgery?
In some cases, bleeding symptoms may resolve without surgical treatment:
– After menopause is reached, bleeding naturally ceases
– During pregnancy, symptoms often improve
– Some women respond well to hormonal medications alone
– Conservative therapies like diet changes, supplements, and NSAIDs may help
However, for many women endometriosis requires surgery to fully treat abnormal bleeding patterns. Commonly performed surgeries include:
– Laparoscopic excision – endometrial lesions are cut out. This has the highest success rate.
– Laparoscopic ablation – lesions are destroyed by laser or heat. Less effective than excision.
– Hysterectomy with removal of endometrial tissue – definitive treatment but most invasive option.
While not every woman needs surgery, many find it is the only reliable way to completely stop endometriosis-related bleeding. The decision depends on the individual’s symptoms and treatment goals.
Coping tips for constant bleeding from endometriosis
Dealing with bleeding daily or for prolonged periods can be challenging. Here are some tips for coping:
– Use a period tracking app to record symptoms. This helps identify patterns.
– Take iron supplements to prevent anemia from blood loss.
– Try double sanitary protection methods during heavy flow.
– Carry extra menstrual supplies so you’re never caught off guard.
– Wear dark clothing that won’t show stains during heavy flow days.
– Use heating pads, rest, avoid exercise during heavy bleeding days.
– Communicate with your support system when you’re having a hard day.
– Ask your employer for accommodations like work from home options or a modified schedule if needed.
– See a therapist who specializes in chronic illness if emotions become overwhelming.
Constant bleeding from endometriosis is challenging but support and proper treatment can help women manage symptoms.
Conclusion
Endometriosis frequently causes heavy, irregular, or prolonged menstrual bleeding. However, true constant daily bleeding is rarer, occurring in 15% or less of women with endometriosis. The amount of bleeding varies from light spotting to passing large clots for over a week each cycle. Diet changes, medications, hormonal treatments, surgery, and coping techniques can help manage troublesome bleeding from endometriosis. Seeking treatment is important, as constant bleeding can cause complications over time like anemia. With proper care, bleeding symptoms can often be reduced to more tolerable levels.