Endometriosis No Heavy Periods and Fibroids: What to Know

September 13, 2025

Endometriosis No Heavy Periods and Fibroids: What to Know

Pelvic pain, fatigue, and changes in your cycle can be confusing—especially when you don’t have heavy periods. Many people assume heavy bleeding must be present for conditions like endometriosis or uterine fibroids, but that’s not always true. This guide explains how endometriosis can occur without heavy periods, how fibroids behave, key differences between the two, and what to discuss with your clinician. The information below is grounded in guidance from trusted sources such as the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists (ACOG), and the U.S. Food and Drug Administration (FDA).

Quick definitions

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus—on the ovaries, fallopian tubes, bowel, bladder, or pelvic lining. These lesions can cause inflammation, scarring, and pain. Common symptoms include painful periods (dysmenorrhea), pelvic pain between periods, pain with sex, pain with bowel movements or urination, spotting, and sometimes infertility. Heavy bleeding can occur but is not required for diagnosis.

Uterine fibroids (leiomyomas)

Fibroids are benign (noncancerous) tumors of the uterine muscle. They vary in size and location: inside the cavity (submucosal), within the wall (intramural), or on the outer surface (subserosal). Heavy menstrual bleeding is common—especially with submucosal fibroids—but some fibroids cause little or no bleeding and instead create pressure symptoms like urinary frequency, constipation, or pelvic fullness.

Can you have endometriosis without heavy periods?

Yes. Heavy bleeding is not necessary for endometriosis. In fact, many people with endometriosis have normal or light flow but still experience significant pain. That’s because endometriosis involves inflammation and nerve sensitization outside the uterus, not just the amount of uterine bleeding.

Common endometriosis features even when periods aren’t heavy include:

Severe cramping that starts before bleeding and lasts beyond the period
Pelvic or low back pain between periods
Pain during sex (particularly with deep penetration)
Pain with bowel movements or urination, especially around menses
Fatigue, bloating, or nausea around periods
Infertility or difficulty conceiving

Endometriomas (ovarian cysts caused by endometriosis) can occur regardless of period flow. Imaging may detect these cysts, but superficial lesions often don’t show on ultrasound or MRI, which is why definitive diagnosis still relies on laparoscopy in some cases (per NIH and ACOG guidance).

Can you have fibroids without heavy periods?

Also yes. Whether fibroids cause heavy bleeding depends largely on their location and size. Submucosal fibroids are more likely to cause heavy or prolonged bleeding. Subserosal fibroids, which grow on the outside of the uterus, often cause little menstrual change but may produce bulk symptoms:

Pelvic pressure or fullness
Urinary frequency or urgency (pressure on the bladder)
Constipation (pressure on the rectum)
Low back pain or pain with intercourse
Visible abdominal enlargement with large fibroids

Endometriosis vs. fibroids: how to tell them apart

Bleeding pattern: Heavy or prolonged periods are more characteristic of fibroids, particularly submucosal types. Endometriosis can involve normal flow with severe pain.
Pain pattern: Endometriosis often causes cyclic pain that may begin before bleeding and include pain with sex, bowel movements, or urination. Fibroid pain is more often pressure-related, though cramping and pain can occur.
Bowel/bladder symptoms: Both can affect these organs. Bladder or bowel pain around menses leans toward endometriosis; constant frequency/pressure can suggest fibroids.
Fertility: Both conditions can affect fertility. Endometriosis may impact egg quality, tubal function, and pelvic anatomy; fibroids—especially those distorting the uterine cavity—can interfere with implantation and pregnancy.

It’s also possible to have both conditions at the same time.

How clinicians diagnose these conditions

History and exam: Your clinician will ask about bleeding, pain timing, bowel and urinary symptoms, pregnancy plans, and prior surgery.
Imaging: Pelvic ultrasound is first-line for fibroids and can detect endometriomas. MRI may help map fibroids or complex disease.
Blood tests: To assess anemia if bleeding is heavy; there’s no single blood test that diagnoses endometriosis or fibroids.
Diagnostic laparoscopy: The gold standard to confirm endometriosis and treat it during the same procedure when appropriate.

Evidence-based treatment options

Endometriosis

NSAIDs and heat therapy for pain relief.
Hormonal options to suppress ovulation and reduce lesion activity: combined oral contraceptives, progestin-only pills, depot medroxyprogesterone, or the levonorgestrel-releasing IUD (LNG-IUD). Note: The LNG-IUD is FDA-approved for contraception and heavy menstrual bleeding, and commonly used off-label to help with endometriosis-related pain.
GnRH analogs: FDA-approved medications like elagolix (Orilissa) for moderate to severe endometriosis pain, and leuprolide acetate (Lupron Depot). These can reduce pain but may cause side effects such as hot flashes and bone mineral density loss; treatment duration and add-back therapy are considered to protect bone health.
GnRH antagonist combination therapy: Relugolix/estradiol/norethindrone acetate (Myfembree) is FDA-approved for moderate to severe endometriosis pain. Your clinician will review benefits, risks, and duration limits.
Surgery: Laparoscopic excision or ablation of lesions can improve pain and fertility in selected patients. Advanced disease may require a multidisciplinary approach.
Supportive care: Pelvic floor physical therapy, addressing sleep, stress, and nutrition patterns may help symptoms for some individuals, although evidence varies.

Fibroids

Watchful waiting for small, asymptomatic fibroids.
Medical therapy for bleeding and anemia: NSAIDs, tranexamic acid, combined hormonal contraceptives, progestins, and LNG-IUD (FDA-approved for heavy menstrual bleeding).
GnRH analogs to shrink fibroids temporarily or reduce bleeding: elagolix/estradiol/norethindrone (Oriahnn) and relugolix/estradiol/norethindrone (Myfembree) are FDA-approved for heavy menstrual bleeding associated with fibroids. Treatment courses are time-limited because of bone health considerations.
Uterine-sparing procedures: Myomectomy (surgical fibroid removal), uterine fibroid embolization (UFE), and radiofrequency ablation. Choice depends on size, number, and location of fibroids, and future fertility goals.
Hysterectomy: A definitive option for those who do not desire future pregnancy and whose symptoms are not controlled by other measures.

When to seek care

Severe period pain that disrupts work, school, or daily life—especially if over-the-counter pain relievers don’t help.
Pelvic pain between periods, pain with sex, or pain with bowel movements/urination.
Heavy bleeding (soaking a pad/tampon every 1–2 hours), passing clots, or bleeding that lasts more than 7 days.
Symptoms of anemia: fatigue, dizziness, shortness of breath, or palpitations.
Difficulty conceiving after 6–12 months of trying (depending on age and other factors).

Only a clinician can evaluate your individual situation, rule out other causes of pelvic pain or bleeding, and tailor a plan to your goals, including fertility considerations.

Bottom line

You can have endometriosis without heavy periods, and you can have fibroids without heavy bleeding. The pattern of pain, pressure symptoms, and imaging findings often helps distinguish the two—yet they may coexist. Evidence-based options range from medications to minimally invasive procedures and surgery. Partner with a gynecologist to confirm the diagnosis and choose treatments aligned with your symptoms and life plans.

Trusted sources and further reading

NIH MedlinePlus: Endometriosis – https://medlineplus.gov/endometriosis.html
NIH MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
NICHD (NIH): Endometriosis Overview – https://www.nichd.nih.gov/health/topics/endometri
NICHD (NIH): Uterine Fibroids – https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
ACOG: Endometriosis FAQ – https://www.acog.org/womens-health/faqs/endometriosis
ACOG: Uterine Fibroids FAQ – https://www.acog.org/womens-health/faqs/uterine-fibroids
FDA: Information on approved drugs (Orilissa, Lupron Depot, Oriahnn, Myfembree) – https://www.fda.gov/drugs