Endometriosis can cause extremely painful periods with heavy bleeding and other symptoms. Our resident endometriosis expert has answers to your questions.

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Endometriosis is a condition that can cause extremely painful menstrual periods. It’s also one of the most common causes of chronic pelvic pain. Endometriosis affects about 1 in 10 women of reproductive age. But it also affects people of other genders.

This chronic (long lasting) condition can cause mild to severe pain at any time of the month, but most people find it gets worse right before or during their periods.

Endometriosis can cause many other symptoms, such as significant bleeding, painful bowel movements, and infertility. But there are treatment options that can help ease your pain during menstrual periods.

Healthline turned to our resident endometriosis expert, Dr. Sanaz Ghazal, to answer your most frequently asked questions about endometriosis and periods.

Ghazal, a graduate of Harvard University and the Yale School of Medicine, is a double board certified OB-GYN, reproductive endocrinologist, and fertility specialist practicing in Southern California.

“Endometriosis is a painful condition where cells similar to the cells that line the inside of your uterus end up outside of your uterus,” says Ghazal. “These cells respond to your hormones and can grow and bleed.”

“When this happens inside your uterus, the blood and tissue come out of the vagina. But when it happens outside your uterus, there’s no way for that blood and tissue to escape.

“This endometriotic blood and tissue can build up and grow over time, causing pain, inflammation, scarring, distortions of anatomy, and even infertility.”

“Abnormal bleeding is a common symptom of endometriosis,” says Ghazal. “Endometriosis can affect the duration and severity of your bleeding, and it can even cause irregular bleeding or bleeding in between periods.”

The typical menstrual cycle is 28 days long — measured from the first day of your period to the first day of your next period. Your periods are usually irregular if your cycle lasts less than 21 days or more than 35 days.

If your period is coming more frequently than that, or you’re bleeding between periods, your periods may be atypical. But this doesn’t necessarily mean you have endometriosis. There are many possible causes of irregular periods.

“The initial presentation of endometriosis can vary pretty widely, and abnormal bleeding is just one sign,” Ghazal points out.

“Endometriosis can increase the duration of your periods and make your periods heavier, with a faster flow and more blood clots,” says Ghazal.

This means that your period may last longer than 7 days. And it may be so heavy that you soak through your tampon or pad in as little as 1 hour.

While blood clots are common during menstrual periods, these pieces of fleshy tissue are usually smaller than the size of a quarter. With the type of heavy bleeding that can occur during endometriosis periods, these blood clots can be larger than a quarter and appear more frequently.

Blood clots passed during your period can vary in appearance and consistency. They may look like pieces of fleshy tissue, thick clumps of blood, or stringy, gel-like lumps. The color can also vary from bright red to very dark red or brown.

“Pelvic pain due to endometriosis tends to be more severe during or around the time of your period, but it can occur at other times as well,” says Ghazal.

“Some people experience chronic pelvic pain or pain throughout their cycle, even when they are not having menstrual bleeding.”

Chronic endometriosis pain can appear anywhere in the pelvic region or the lower back. It may feel like period cramps or a general achiness, and it may get worse over time.

“[People with endometriosis] can also experience pain at other times, including with intercourse, bowel movements, and urination,” Ghazal explains.

Endometriosis pain can occur during any type of vaginal penetration. People often describe it as a deep pain, different from the pain you may experience when something passes through the vaginal opening. Endometriosis pain can occur during or after sexual activity.

Endometriosis can also cause intestinal pain or other digestive issues, like diarrhea, constipation, and bloating.

“The main strategies for treating painful or abnormal periods due to endometriosis are medical management or surgical management,” says Ghazal.

“Medical management typically involves hormonal therapy, such as oral contraceptive pills or an intrauterine device (IUD) to suppress your hormones,” she says. “[This can help] manage your bleeding and prevent endometriosis from spreading.”

Extended-cycle hormonal birth control options can help reduce or eliminate the number of menstrual periods you get each year. This can help provide significant pain relief. You might consider an extended-cycle birth control pill, a long lasting birth control shot, or a hormonal IUD that can work for up to 7 years.

Hormonal birth control only works for as long as you take it. You’ll have to stop taking or remove your birth control if you want to become pregnant.

“Surgical management is typically reserved for more severe cases of endometriosis,” says Ghazal. “Surgery may be performed to remove endometriotic implants or scar tissue to help improve severe or chronic pelvic pain.”

A laparoscopy procedure to remove patches of endometriosis is a minimally invasive surgery that can help reduce pain and improve your chances of getting pregnant. But the effects of this surgery are often temporary, and endometrial patches can continue to grow.

According to Ghazal, more significant surgical options are available. “This may include removal of the uterus with or without removal of the ovaries.”

This type of surgery may provide the most relief, but it’s not an option if you want to get pregnant in the future.

“If you are experiencing painful periods or abnormal bleeding, especially if it’s so severe that you can’t go to school or work, it’s important to be evaluated by a doctor,” says Ghazal.

“Endometriosis can sometimes take years to diagnose because people downplay or ignore their symptoms or they think their symptoms are normal.”

What’s the one thing Ghazal wants everyone to know?

“It’s not normal for your periods to negatively impact your quality of life or limit your ability to function.”

  • Endometriosis can cause severe period pain and other symptoms, like heavy bleeding.
  • Endometriosis can affect the appearance and length of your periods.
  • If your period pain is severe and affecting your daily activities, tell a doctor and get some help.