Fibroids and Bleeding 3 Days After Endometrial Biopsy: Why It Happens and What Helps

September 13, 2025

Fibroids and Bleeding 3 Days After Endometrial Biopsy: Why It Happens and What Helps

If you’re three days out from an endometrial biopsy and still seeing bleeding, you’re not alone—and if you also have uterine fibroids, it can be a bit heavier or last slightly longer than expected. Most post-biopsy bleeding is mild and temporary, but it’s important to know what’s normal, why fibroids can amplify spotting, and when to seek care.

Key takeaways

Light bleeding or spotting for a few days after an endometrial biopsy is common.
Fibroids—especially submucosal fibroids that distort the uterine cavity—can increase the amount and duration of bleeding.
Heavy bleeding (soaking a pad an hour for more than two hours), fever, foul discharge, or severe pain are not typical and warrant a call to your clinician.
Simple measures like rest, pads (not tampons) for 48 hours, and NSAIDs can help; longer-term options exist to manage fibroid-related heavy menstrual bleeding.

Why bleeding happens after an endometrial biopsy

An endometrial biopsy uses a thin instrument (often a Pipelle) to gently sample the lining of the uterus for diagnostic testing. The procedure briefly disrupts small blood vessels in the endometrium, causing light bleeding or spotting afterward. According to MedlinePlus (NIH) and the American College of Obstetricians and Gynecologists (ACOG), it’s normal to have mild cramping and light bleeding or spotting for a day or a few days after the biopsy.

Most people can resume normal activities the same day, but clinicians commonly recommend avoiding vaginal intercourse, tampons, and douching for about 48 hours to lower infection risk and reduce irritation that could prolong bleeding.

How fibroids change the picture

Uterine fibroids are noncancerous muscle growths in or on the uterus. They can increase blood flow to the uterine lining and make the cavity more irregular—especially when fibroids are submucosal (just beneath the lining) or intramural with cavity distortion. The biopsy instrument may graze more fragile, vascular surfaces in these cases, leading to:

Heavier initial spotting or bleeding than average
Bleeding that lasts a bit longer (e.g., several days rather than one to two)
More cramping due to increased uterine sensitivity

Fibroids are a well-known cause of heavy or prolonged menstrual bleeding in general, and that tendency can also be seen in the short recovery window after a biopsy.

What’s normal vs. not at three days

Normal at day three:

Light spotting that’s pink, brown, or small amounts of bright red blood
Mild, improving cramping responsive to over-the-counter pain relievers
Gradually decreasing need for pads

Concerning signs (call your clinician):

Soaking through a pad or more per hour for two consecutive hours
Passing large clots (e.g., larger than a quarter) or continuous bright red bleeding that isn’t slowing down
Fever of 100.4°F (38°C) or higher, chills
Foul-smelling vaginal discharge
Severe or worsening pelvic pain not relieved with NSAIDs
Dizziness, fainting, or symptoms of anemia (marked fatigue, shortness of breath)

If you take blood thinners, have a bleeding disorder, or use certain supplements with anticoagulant effects, contact your clinician sooner for guidance.

What you can do today

Use pads, not tampons, for at least 48 hours after the biopsy (some clinicians advise up to a few days). Avoid intercourse until spotting has subsided or as directed by your clinician.
Rest and hydration. Brief periods with your feet elevated can help if you feel lightheaded. Gentle heat (a heating pad) may ease cramps.
Pain relief. Over-the-counter NSAIDs like ibuprofen or naproxen, if safe for you, can reduce cramping and bleeding by inhibiting prostaglandins. Follow label directions and your clinician’s advice.
Track your bleeding. Note pad counts, clot size, and symptoms. A brief bleeding diary helps your clinician assess whether the course is typical.

Planning ahead if you have fibroids

If biopsy-related bleeding was heavier because of fibroids—or if heavy periods are a recurring problem—evidence-based options can help. Discuss these with your clinician:

Nonprocedural treatments

Levonorgestrel-releasing intrauterine device (LNG-IUD): Often reduces heavy menstrual bleeding and cramping. It’s a common first-line option for fibroid-related bleeding when the uterine cavity can accommodate it.
Tranexamic acid (oral): An antifibrinolytic taken only on heavy bleeding days. The FDA has approved tranexamic acid tablets for heavy menstrual bleeding; it does not shrink fibroids but can meaningfully reduce flow. Not typically used specifically for post-biopsy bleeding, but useful for cycles going forward.
Hormonal therapies: Combined oral contraceptives or progestin-only options can regulate and lighten periods.
GnRH agonists/antagonists with add-back therapy: Short-term options that reduce bleeding and shrink fibroids. FDA-approved combinations include elagolix with estradiol/norethindrone acetate and relugolix with estradiol/norethindrone acetate for heavy menstrual bleeding due to fibroids. These are generally limited in duration because of side effects like bone density loss without add-back.

Procedural options

Uterine artery embolization (UAE): Minimally invasive procedure that shrinks fibroids by blocking their blood supply.
Myomectomy: Surgical removal of fibroids, preserving the uterus. Can be hysteroscopic, laparoscopic, or open depending on size and location.
Other options: MRI-guided focused ultrasound or, for those who are finished with childbearing and have severe symptoms, hysterectomy.

Your best choice depends on your symptoms, fibroid size/location, fertility goals, and medical history.

When to follow up

Most people won’t need a special visit after an endometrial biopsy. However, if bleeding remains more than light spotting after a week, if you have any of the red flags above, or if fibroid-related heavy periods are disrupting your life, schedule a check-in. Ask about your biopsy results, iron status (a ferritin test can screen for iron deficiency), and a plan to prevent future heavy bleeding.

FAQ

How long should bleeding last after an endometrial biopsy? Typically one to a few days of light spotting. Some people, particularly those with fibroids, may notice minor spotting for up to a week. Heavy or worsening bleeding is not typical.

Can I use tampons after the biopsy? Most clinicians recommend using pads for at least 48 hours and avoiding vaginal intercourse for a couple of days to reduce infection risk and irritation.

Do fibroids make complications more likely? Serious complications are rare, but fibroids can increase the chance of heavier or longer spotting. Infection and significant bleeding are uncommon—seek care if you have concerning symptoms.

Bottom line

Three days of light bleeding after an endometrial biopsy is usually normal. Fibroids can make that bleeding a bit heavier or longer, but you should not be soaking pads, passing large clots, or feeling unwell. Use conservative self-care now, and talk with your clinician about proven treatments to prevent heavy bleeding if fibroids are an ongoing issue.

Sources and resources

MedlinePlus (NIH): Endometrial Biopsy – what to expect, risks, and aftercare: https://medlineplus.gov/lab-tests/endometrial-biopsy/
American College of Obstetricians and Gynecologists (ACOG): Endometrial Biopsy (Patient FAQ): https://www.acog.org/womens-health/faqs/endometrial-biopsy
NIH/NICHD: Uterine Fibroids – symptoms and treatment options: https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
ACOG: Uterine Fibroids (Patient FAQ): https://www.acog.org/womens-health/faqs/uterine-fibroids
FDA: Tranexamic acid tablets (Lysteda) prescribing information for heavy menstrual bleeding: FDA label
FDA: Oriahnn (elagolix/estradiol/norethindrone acetate) for heavy menstrual bleeding due to fibroids – prescribing information: FDA label
FDA: Myfembree (relugolix/estradiol/norethindrone acetate) for heavy menstrual bleeding due to fibroids – prescribing information: FDA label