Fibroids and How Long Does Endometriosis Bleeding Last: Why It Happens and What Helps

Fibroids and How Long Does Endometriosis Bleeding Last: Why It Happens and What Helps

Heavy, irregular, or prolonged bleeding is one of the most frustrating symptoms people face with uterine fibroids and endometriosis. Although these two conditions are different, both are fueled in part by estrogen and can disrupt normal menstrual patterns. This guide explains why bleeding happens, how long endometriosis-related bleeding can last, ways fibroids change your period, and evidence-based options that help.

Quick refresher: Fibroids vs. Endometriosis

  • Uterine fibroids are noncancerous growths in or on the uterus. They can cause heavy menstrual bleeding (HMB), pelvic pressure, and anemia. Many people have fibroids without symptoms. (Sources: MedlinePlus/NIH; Office on Women's Health)
  • Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus (e.g., on ovaries, pelvic peritoneum). It commonly causes pelvic pain, painful periods, and sometimes irregular or heavy bleeding. (Sources: MedlinePlus/NIH; NICHD/NIH)

How long does endometriosis bleeding last?

There is no single “typical” duration, because endometriosis affects people differently. A normal period commonly lasts about 2–7 days. With endometriosis, bleeding patterns can include:

  • Prolonged periods (>7 days). Inflammation and hormone sensitivity can lengthen menstrual flow.
  • Pre- and post-period spotting. Some people notice brown or pink spotting for days before and after a period.
  • Intermenstrual bleeding. Bleeding can occur between periods, especially with hormonal fluctuations or when starting/stopping treatments.
  • Breakthrough bleeding on therapy. When initiating hormonal treatments (e.g., progestins, GnRH medications), irregular bleeding may occur for several weeks before stabilizing.

If you are bleeding more than 7 days, soaking through a pad/tampon every 1–2 hours, passing large clots, or developing symptoms of anemia (fatigue, dizziness, shortness of breath), seek medical care. Abnormal uterine bleeding warrants evaluation to rule out other causes as well. (Source: ACOG; Office on Women's Health)

Why bleeding happens in endometriosis and fibroids

Endometriosis

  • Inflammation and prostaglandins. Endometriotic lesions are hormonally responsive and inflamed, which can intensify uterine contractions and bleeding.
  • Hormonal sensitivity. Endometriosis is estrogen-dependent; cyclical hormonal changes can trigger spotting and prolonged menses.
  • Coexisting conditions. Adenomyosis (endometrial-like tissue within the uterine muscle) often coexists with endometriosis and is strongly linked to heavy, painful, and prolonged periods. (Source: NICHD/NIH)

Fibroids

  • Increased surface area and blood flow. Fibroids—especially those inside the cavity (submucosal)—distort the endometrium, increasing the area that bleeds.
  • Impaired uterine contractility. The uterus may not clamp down efficiently, leading to heavier, longer bleeding.
  • Vascular changes. Fibroids can create fragile blood vessels that bleed more easily. (Sources: MedlinePlus/NIH; Office on Women's Health)

When to call a clinician

  • Bleeding >7 days per cycle or between periods.
  • Soaking through a pad/tampon every 1–2 hours, large clots, or “flooding.”
  • Severe pain, fever, or foul discharge.
  • Signs of anemia: fatigue, pale skin, dizziness, shortness of breath. (Source: NHLBI/NIH)
  • Bleeding after sex, after menopause, or during pregnancy.

How clinicians evaluate abnormal bleeding

  • History and exam. Cycle tracking, pain patterns, and family history guide next steps.
  • Labs. Pregnancy test, blood count (to check for anemia), sometimes thyroid or bleeding-disorder tests.
  • Imaging. Pelvic ultrasound is first-line for fibroids; MRI may clarify complex anatomy.
  • Endometrial sampling. In certain cases (e.g., over age 45, or risk factors) to rule out endometrial pathology.
  • Laparoscopy. The definitive way to diagnose and stage endometriosis, though many are treated based on clinical suspicion. (Sources: MedlinePlus/NIH; ACOG)

What helps now: Self-care steps

  • Track your bleeding. Note start/stop dates, clots, pain, and overflow. Bring this log to appointments.
  • NSAIDs (e.g., ibuprofen, naproxen). Can reduce prostaglandins, lessen cramps, and may modestly reduce bleeding when started at period onset. Ask your clinician about dosing and safety. (Source: Office on Women's Health)
  • Iron-rich diet and supplements. If anemic or at risk, your clinician may recommend iron; don’t self-treat significant anemia without testing. (Source: NHLBI/NIH)
  • Heat, rest, and gentle movement. Heat packs and low-impact exercise can ease cramps.

Medical treatments that reduce bleeding

Choice depends on your symptoms, desire for pregnancy, other health conditions, and whether the bleeding is driven primarily by endometriosis, fibroids, or both.

  • Hormonal contraceptives. Combined pills/patch/ring or progestin-only methods can regulate or suppress periods and reduce bleeding. The levonorgestrel intrauterine system (IUD) is highly effective for heavy bleeding and can help with pain; very large or cavity-distorting fibroids may limit IUD use. (Sources: Office on Women's Health; ACOG)
  • Tranexamic acid. A non-hormonal medication taken during menses to reduce heavy bleeding. Discuss risks (e.g., clot history) with your clinician. (Source: MedlinePlus/NIH)
  • GnRH agonists/antagonists. These lower estrogen to reduce bleeding and pain.
    • Endometriosis pain: Elagolix (brand: ORILISSA) is FDA-approved for moderate to severe endometriosis pain. (Source: FDA label)
    • Fibroid bleeding: Elagolix with add-back therapy (brand: ORIAHNN) and relugolix combination therapy (brand: MYFEMBREE) are FDA-approved to reduce heavy menstrual bleeding due to fibroids. Myfembree is also approved for endometriosis-associated pain. (Sources: FDA; FDA)
  • Other progestins. Oral or injectable progestins can lighten or stop periods and may help with pain.

Procedures and surgery

  • Endometriosis excision/ablation (laparoscopy). Removes or destroys lesions to reduce pain and may improve bleeding patterns. Fertility-sparing.
  • Myomectomy. Surgical removal of fibroids; preserves the uterus and fertility potential.
  • Uterine artery embolization (UAE). Minimally invasive procedure to shrink fibroids and reduce bleeding; generally not used when actively planning pregnancy.
  • Endometrial ablation. Destroys the uterine lining to reduce bleeding; not for those desiring future pregnancy and not a treatment for endometriosis outside the uterus.
  • Hysterectomy. Definitive option when other treatments fail and childbearing is complete.

Fertility considerations

Endometriosis and fibroids can affect fertility depending on lesion location and severity. Early discussion with a gynecologist or reproductive endocrinologist can align symptom control with family-building goals. (Sources: NICHD/NIH; Office on Women's Health)

Bottom line

Endometriosis-related bleeding can be prolonged, occur between periods, or include days of spotting; fibroids most often cause heavy and sometimes longer periods. Both conditions are treatable. If your bleeding lasts more than a week, is very heavy, or is disrupting your life, talk with a clinician about evaluation and tailored options—from NSAIDs and hormonal methods to FDA-approved therapies and, when needed, procedures that preserve fertility or provide definitive relief.

Sources

This article is for educational purposes and does not replace personalized medical advice. If you have concerning bleeding or pain, seek care promptly.

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