Table of ContentsView AllTable of ContentsPainful PeriodsPeriod LengthSpotting in-Between PeriodsWhen to See a Healthcare ProviderPain Without MenstruationCopingOther CausesFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Painful Periods
Period Length
Spotting in-Between Periods
When to See a Healthcare Provider
Pain Without Menstruation
Coping
Other Causes
Frequently Asked Questions
People withendometriosis(endo) often have menstrual periods that are heavier, more painful (dysmenorrhea), and occur more frequently than those without endometriosis.
This article will explain the effects of endometriosis on people who menstruate and those who no longer have a period.
Alicia Fdez / Getty Images
Painful Periods, One Symptom of Endometriosis
Each month the lining of the uterus thickens in preparation for pregnancy. When implantation of an egg doesn’t occur, the endometrium is shed and exits the body through the vagina.
In endometriosis, the tissue similar to the lining of the uterus (endometrium) invades surrounding tissue and organs like the ovaries, bladder, and colon.
Endometrial tissue found in surrounding tissues also thickens and becomes inflamed during menstruation; however, it does not exit the body. As a result, scar tissue and adhesions develop, worseningpain during menstruation.
In addition, some endometrial lesions have nerves that are more sensitive to pain. Although worse during monthlyperiods, endometriosis pain often persists between menstrual cycles.
How Endo Periods FeelWith endometriosis, you may feel these symptoms during your period:Pelvic heaviness and fullnessIntense crampingAbdominal bloatingLower backacheBladder pain/difficulty urinatingPainful bowel movements and constipationPain with sexWorsening depression, anxiety, or irritability
How Endo Periods Feel
With endometriosis, you may feel these symptoms during your period:Pelvic heaviness and fullnessIntense crampingAbdominal bloatingLower backacheBladder pain/difficulty urinatingPainful bowel movements and constipationPain with sexWorsening depression, anxiety, or irritability
With endometriosis, you may feel these symptoms during your period:
The Endometriosis Advice I Give to My Daughters
Length of Menstruation With Endometriosis
Endometriosis periods may be longer, lasting seven days or more.Interestingly, endometriosis occurs more often in people with shorter menstrual cycle (less than 27 days) or longer menstrual period (lasting more than seven days).
Flow Characteristics
Certain immune system cells help break down endometrial fragments in the uterus. However, chronic inflammation, dysfunction of the immune system, and hormonal imbalances reduce the body’s ability to break down the endometrial tissue properly. Many people with endometriosis report having largeblood clotsand a heavy menstrual flow.
Spotting between periodsis a frustrating side effect of endometriosis.Estrogencontrols the growth of endometrial tissue, and increased levels of this hormone have been linked to endometriosis. Therefore, spotting in between periods is often due to the hormonal imbalance of estrogen andprogesterone.
When to Talk to an OB-GYN or Specialist
You should schedule an appointment with a healthcare provider orgynecologistfor the following symptoms:
Endometriosis Pain Without Menstruation
People who do not menstruate can also experience endometriosis pain. However, since reduced estrogen levels improve the symptoms of endometriosis, natural or medically induced menopause may decrease the pain associated with the condition.
Menopause
Naturalmenopauseusually occurs in a person’s 40s or 50s, with an average age of 52 in the United States.When the ovaries stop producing estrogen, menstruation also ceases. Therefore, postmenopausal development of endometriosis is not common.
Since a lack of menstruation often alleviates endometrial pain, postmenopausal people report less pain with endometriosis than premenopausal people.
Medically-Induced Menopause
Although some therapies like chemotherapy and radiation inadvertently cause menopause, premenopausal people with endometriosis pain may be placed on medications that purposefully result inmedically induced menopause.These medications include:
Surgical Menopause
The ovaries are a primary source of estrogen. Surgical menopause happens when the ovaries are removed (oophorectomy). This reduces estrogen levels and removes endometriosis lesions that have invaded the ovaries. Endometriosis pain is diminished when the ovaries and the endometriosis lesions are gone.
How to Cope Through Endometriosis Periods
Fortunately, there are ways to improve the physical and psychological pain of endometriosis periods.
Seek Mental Health HelpBe sure to seek mental health support if you have painful endometriosis periods. Resources can be found through theEndometriosis Association.
Seek Mental Health Help
Be sure to seek mental health support if you have painful endometriosis periods. Resources can be found through theEndometriosis Association.
Lifestyle
The following lifestyle changes have been shown to reduce painful endometriosis periods:
Holistic
Incorporating the followingholistic interventionsinto your routine can improve physical comfort and mental health:
Medication
The following over-the-counter (OTC) therapies have been shown to alleviate painful endometriosis periods:
Speak to a healthcare provider before taking any new medications, herbs, or vitamins.
Prescription medications to reduce endometriosis pain include:
Surgery
Less commonly, laparotomy (open surgery with a larger incision) may be performed. Hysterectomy (removal of the uterus) with removal of both ovaries in a person close to menopause is sometimes a final option for pain resolution.
Other Causes of Painful Periods
It’s important to speak to a healthcare provider about dysmenorrhea rather than assume you have endometriosis. Other reasons you could be experiencing painful periods include:
Endometriosis vs. Adenomyosis
Summary
In endometriosis, tissues similar to the uterine lining proliferate outside of the uterus. These tissues respond to the hormones of the menstrual cycle, swelling and bleeding like the endometrial lining. This can cause chronic pelvic pain, heavy menstrual flow, spotting between periods, and other complications.
Fortunately, there are pharmacologic, lifestyle, holistic, and surgical therapies that can improve painful endometriosis periods. Call a healthcare provider for painful periods lasting more than seven days, expelling blood clots bigger than a quarter, or if you are soaking a pad or tampon within two hours.
It’s essential to incorporate healthy mental and physical lifestyle changes when diagnosed with endometriosis. Joining a support group or talking to a counselor can also help manage the psychological effects of this condition.
Frequently Asked QuestionsAlthough pain is subjective, people with endometriosis report having heavier and more painful periods than those without endometriosis. Cramping, pelvic heaviness, constipation, and pain with urination can occur with endometriosis periods.Learn MoreEndometriosis PainWhen endometrial tissue invades surrounding organs, it swells and bleeds like it did in the uterus. This process results in worsening inflammation and pain during menstruation.Learn MoreAbout the Endometrial LiningCall a healthcare provider if you are experiencing periods that last seven days or longer, soaking a pad or tampon within two hours, experiencing infertility, or have chronic pelvic pain.Learn MoreHow Endometriosis Is DiagnosedBoth endometriosis and polycystic ovary syndrome (PCOS) cause infertility and irregular periods; however, endometriosis is more likely to result in chronic pelvic pain than PCOS.Learn MoreEndometriosis vs. PCOS
Although pain is subjective, people with endometriosis report having heavier and more painful periods than those without endometriosis. Cramping, pelvic heaviness, constipation, and pain with urination can occur with endometriosis periods.Learn MoreEndometriosis Pain
Although pain is subjective, people with endometriosis report having heavier and more painful periods than those without endometriosis. Cramping, pelvic heaviness, constipation, and pain with urination can occur with endometriosis periods.
Learn MoreEndometriosis Pain
When endometrial tissue invades surrounding organs, it swells and bleeds like it did in the uterus. This process results in worsening inflammation and pain during menstruation.Learn MoreAbout the Endometrial Lining
When endometrial tissue invades surrounding organs, it swells and bleeds like it did in the uterus. This process results in worsening inflammation and pain during menstruation.
Learn MoreAbout the Endometrial Lining
Call a healthcare provider if you are experiencing periods that last seven days or longer, soaking a pad or tampon within two hours, experiencing infertility, or have chronic pelvic pain.Learn MoreHow Endometriosis Is Diagnosed
Call a healthcare provider if you are experiencing periods that last seven days or longer, soaking a pad or tampon within two hours, experiencing infertility, or have chronic pelvic pain.
Learn MoreHow Endometriosis Is Diagnosed
Both endometriosis and polycystic ovary syndrome (PCOS) cause infertility and irregular periods; however, endometriosis is more likely to result in chronic pelvic pain than PCOS.Learn MoreEndometriosis vs. PCOS
Both endometriosis and polycystic ovary syndrome (PCOS) cause infertility and irregular periods; however, endometriosis is more likely to result in chronic pelvic pain than PCOS.
Learn MoreEndometriosis vs. PCOS
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institutes of Health.What are the symptoms of endometriosis?
Maddern J, Grundy L, Castro J, Brierley SM.Pain in endometriosis.Front Cell Neurosci. 2020;14:590823. doi:10.3389/fncel.2020.590823
Endometriosis Foundation of America.Endometriosis symptoms.
Office on Women’s Health.Endometriosis.
Chantalat E, Valera MC, Vaysse C, et al.Estrogen receptors and endometriosis.Int J Mol Sci. 2020;21(8):2815. doi:10.3390/ijms21082815
Shifren J, Gass M.The North American Menopause Society recommendations for clinical care of midlife women.Menopause. 2014;21(10):1038-1062. doi:10.1097/gme.0000000000000319
Pirtea P, Dorin G, Pirtea L.Endometriosis in menopause-renewed attention on a controversial disease.Diagnostics (Basel). 2020;10(3):134. doi:10.3390/diagnostics10030134
Gambadauro P, Carli V, Hadlaczky G.Depressive symptoms among women with endometriosis: a systematic review and meta-analysis.American Journal of Obstetrics & Gynecology. 2019;220(3):230-241. doi:10.1016/j.ajog.2018.11.123
Ball E, Khan KS.Recent advances in understanding and managing chronic pelvic pain in women with special consideration to endometriosis.F1000Res. 2020;9(F1000 Faculty Rev):83. doi:10.12688/f1000research.20750.1
Sinclair J, Collett L, Abbott J, Pate DW, Sarris J, Armour M.Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms.PLoS One. 2021;16(10):e0258940. doi:10.1371/journal.pone.0258940
Kamal DAM, Salamt N, Zaid SSM, Mokhtar MH.Beneficial effects of green tea catechins on female reproductive disorders: a review.Molecules. 2021;26(9):2675. doi:10.3390/molecules26092675
Daily JW, Zhang X, Kim DS, Park S.Efficacy of ginger for alleviating the symptoms of primary dysmenorrhea: a systematic review and meta-analysis of randomized clinical trials.Pain Med. 2015;16(12):2243-55. doi:10.1111/pme.12853
Brown J, Crawford TJ, Datta S, Prentice A.Oral contraceptives for pain associated with endometriosis.Cochrane Database Syst Rev. 2018;5(5):CD001019. doi:10.1002/14651858.CD001019.pub3
Lamb YN.Elagolix (Orilissa): first global approval.Drugs. 2018;78(14):1501-1508. doi:10.1007/s40265-018-0977-4
Food and Drug Administration.Myfembree prescribing information.
Duffy JM, Arambage K, Correa FJ, et al.Laparoscopic surgery for endometriosis.Cochrane Database Syst Rev.2014;(4):CD011031. doi:10.1002/14651858.CD011031.pub2
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
