“Can endometriosis cause abnormal bleeding?” is a question patients often ask us at our OB-GYN clinic for good cause. Abnormal bleeding, especially from the vagina, is a symptom of various reproductive concerns, leading many to wonder if endometriosis is among them.
The short answer to that question is: yes, endometriosis can cause abnormal bleeding. Although it’s less commonly experienced than pelvic pain, disruptive abnormal bleeding is among the primary reasons why women get hysterectomies or endometrial ablation.
But don’t fret: there are many methods to manage abnormal bleeding from endometriosis that you can try before you explore those options. In this article, we’ll explore how endometriosis causes abnormal bleeding.
How Endometriosis Impacts Your Body
For one in ten women globally, endometriosis causes a slew of symptoms that they experience at varying degrees. For some women, carrying on with daily activities while experiencing these symptoms can be difficult but not impossible. However, for others, these symptoms can be debilitating.
What Happens When You Have Endometriosis
Endometriosis develops when tissue similar to the lining inside your uterus (the endometrium) starts growing outside the uterus. It can grow on your ovaries, fallopian tubes, or other pelvic organs, causing the symptoms discussed in the next section.
Like your uterine lining, this tissue responds to hormonal changes during your menstrual cycle, thickening and breaking down. However, because it’s trapped in the body, it can cause inflammation, irritation, and, eventually, scar tissue formation (adhesions). These adhesions can cause organs in the pelvic region to stick together, leading to discomfort and pain, and even affect fertility, making it harder for some women to conceive.
Common Symptoms of Endometriosis
The adhesions that result from endometriosis cause discomfort in and around the pelvic region. Some of the most common symptoms related to this are:
- Pelvic pain: Many women experience chronic or cyclical pelvic pain that worsens around menstruation.
- Severely painful periods (dysmenorrhea): Periods may be excessively painful, with cramps that can be more intense than typical menstrual cramps.
- Discomfort during intercourse: Some women report pain during or after sexual intercourse, particularly in deeper penetrations.
- Digestive issues: In some cases, endometriosis can lead to gastrointestinal symptoms such as bloating, constipation, or diarrhea, especially during menstruation.
Types of Abnormal Bleeding Associated with Endometriosis
While abnormal bleeding—such as heavy periods, spotting, or postmenopausal bleeding—seldom presents as a symptom, it can point to endometriosis. You must immediately consult your OB-GYN regarding any unusual bleeding to determine the cause.
As a guide, you can watch out for the different ways bleeding in endometriosis can manifest:
- Spotting Between Periods: Many women with endometriosis experience light bleeding or spotting outside of their normal menstrual cycle. This can occur randomly throughout the month and can be both frustrating and concerning.
- Heavy or Prolonged Menstrual Bleeding (Menorrhagia): Endometriosis may cause excessively heavy periods or periods that last longer than average. This type of bleeding can be debilitating, leading to anemia, fatigue, and a lower quality of life.
- Postmenopausal Bleeding: Although endometriosis is typically diagnosed in reproductive-aged women, it can persist beyond menopause. Some women may experience postmenopausal bleeding due to existing endometrial implants, which can still respond to hormonal fluctuations, even after the cessation of regular periods.
Why Does Endometriosis Cause Abnormal Bleeding?
The abnormal bleeding associated with endometriosis is primarily due to the hormonal sensitivity of the endometrial-like tissue that grows outside the uterus. This tissue responds to the hormonal changes during the menstrual cycle, especially estrogen, by thickening and breaking down, much like the uterine lining. However, unlike the uterine lining, this tissue has no exit route, leading to internal bleeding, inflammation, and the development of scar tissue.
The ongoing inflammation and scar tissue formation can also contribute to irregular bleeding patterns. Adhesions—bands of scar tissue that form between organs—may distort the pelvic anatomy, affecting the uterus and its normal ability to shed its lining. This disruption can result in irregular, heavy, or prolonged bleeding.
Managing Endometriosis and Abnormal Bleeding
Managing endometriosis and abnormal bleeding often requires a multifaceted approach that often starts with lifestyle modifications like:
- Shifting to an anti-inflammatory diet. Introducing more whole foods, including fruits, vegetables, and lean proteins, can help reduce inflammation. Some women find relief by limiting dairy, gluten, or processed foods, although individual responses to dietary changes can vary.
- Make exercise a regular part of your routine. Regular physical activity has been shown to reduce pain and improve mood in women with endometriosis. Low-impact exercises like yoga, swimming, or walking are enough to support overall health without exacerbating symptoms.
- Manage your stress levels. Chronic stress can worsen symptoms of endometriosis, including abnormal bleeding. Stress-reducing techniques such as mindfulness, meditation, or therapy can be beneficial in managing the emotional and physical toll of the condition.
- Have a reliable support system. This emotional and mental support system is crucial if you have endometriosis. As the condition can often lead to feelings of insecurity, having this support system is an integral part of coping with the challenges it poses.
Plans to conceive a child and fertility also make treatment for endometriosis a critical matter. As its symptoms interfere with reproductive health and may cause infertility when treatment is delayed, prompt diagnosis and intervention are pertinent to ideal health outcomes.
Long-Term Outlook and Medical-Surgical Interventions
Endometriosis is a chronic condition. Hence, it often requires continuing care and management. You’ll need to monitor symptoms and maintain regular communication with your OB-GYN so you can actively manage any abnormal bleeding or disruptive symptoms.
When lifestyle modifications don’t suffice for management, your doctor will explore medical or surgical options that can give you lasting and even permanent relief. Among these options are:
- Hormone Replacement Therapy (HRT). These medications help regulate or reduce the hormonal fluctuations that facilitate endometrial growth outside the uterus. By controlling your estrogen levels, these can lessen or stop the tissue from thickening and breaking down. Although it won’t reverse endometriosis, it can relieve symptoms like pain and heavy bleeding.
- Pelvic Pain Management. This management course aims to relieve chronic pain. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain relievers, and physical therapy are the most common approaches for this. Medication and physical therapy techniques help muscle tension and improve mobility and daily functioning.
- Endometrial Ablation. This procedure involves removing or destroying the excess uterine lining to reduce bleeding. This option is usually considered if you don’t have plans on getting pregnant, as it can impact fertility.
- Hysterectomy. Surgical removal of the uterus via hysterectomy is considered your last resort for severe endometriosis that does not respond to other treatments. In some cases, the ovaries may also be removed to reduce estrogen production. This procedure can provide lasting relief, but it also means the end of fertility.
Final Thoughts
Endometriosis can indeed cause abnormal bleeding, from heavy periods to spotting and even postmenopausal bleeding. These irregularities are often linked to the hormonal sensitivity of the endometrial-like tissue outside the uterus and the inflammation and scarring resulting from this condition.
Early diagnosis and proper treatment are essential for managing endometriosis and its related symptoms, including abnormal bleeding. If you are experiencing unusual menstrual patterns or other signs of endometriosis, consulting with a healthcare provider is crucial.
At Atlanta Obstetrics & Gynecology Specialists, we offer expert care and personalized treatment options to help manage endometriosis and improve your quality of life. Don’t hesitate to reach out for support and guidance as you navigate this condition.
