Constipation with Endometriosis or Adenomyosis
Constipation that worsens before or during your period can be a sign of endometriosis or adenomyosis. Inflammation, scar tissue and tight pelvic floor muscles can make it harder to go, even when endometriosis isn't on the bowel.
- How common
- Common
- When
- Before and during your period
- Often with
- Bloating, pelvic or bowel pain
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Oct 2026
When it flares
It often builds in the days before your period and peaks during bleeding, and some people notice it around ovulation. Constipation that doesn't follow your cycle still deserves a check.
Does this sound like you?
Tap any that fit. We'll turn them into a note you can bring to your visit.
None of these? If your constipation worries you, it's still worth a conversation. Speak with us
When to get help
Constipation that comes back with your period, or holds on despite fiber and fluids, is reason enough to see an endometriosis specialist.
Keep track
For two or three cycles, note the cycle day, how often you go, what your stools are like, any pain or straining, and what you've tried. It's the most useful thing to bring to your first visit.
Speak with Us
Book a visit if it:
- Comes back with your period
- Keeps coming back despite fiber, fluids and other basics
- Comes with painful bowel movements, bloating or pelvic pain
- Comes with heavy or painful periods, or painful sex
- Comes with rectal bleeding around your period
Your first visit
We go through your history and your notes, then map out next steps together, whether that's tests, imaging or treatment.
When it needs a specialist: Bowel endometriosis surgery
What it feels like
How patients often describe it
- It's like I'm blocked and nothing will move.
- I strain even when I don't want to.
- I never feel like I've fully emptied.
- There's deep pressure in my rectum during my period.
Some people notice thin stools or need to change position to go. Others swing between constipation and diarrhea, or have a lot of pain with only small changes in how often they go. It can also worsen bloating and nausea, disrupt sleep and change how you eat.
Why it happens
Inflammation around your period
Endometriosis is inflammatory. Around your period, chemicals called prostaglandins surge, which can increase pain and make nearby muscles tighten, slowing the bowel. Irritated pelvic nerves can make you feel blocked even when the bowel isn't fully blocked.
Endometriosis on or near the bowel
Endometriosis can grow on the bowel, often the rectum and sigmoid colon, or behind the uterus. It can narrow the bowel or leave scar tissue (adhesions) that tethers it, making bowel movements harder and more painful. But constipation doesn't always mean endometriosis is in the bowel wall, and how bad it is doesn't reliably show how deep the disease goes.
A tight pelvic floor
Pain can make the pelvic floor muscles guard. When they don't relax, stool reaches the rectum but is hard to pass, and straining adds pain. That's one reason diet changes alone may not help. Pelvic floor pain can also flare when you sit.
Adenomyosis
Adenomyosis can contribute too. It makes the uterus inflamed and often enlarged. Around your period, that tender, swollen uterus adds pressure in the pelvis and can make the pelvic floor guard, so bowel movements feel harder. Many people have both conditions.
Learn moreEndometriosisAdenomyosis
“Constipation that comes back with every period deserves more than another round of fiber. We look at the whole pelvis, the bowel, the uterus and the pelvic floor, because a normal colonoscopy doesn't rule out endometriosis.”
Why it's often missed
Constipation is common, so it's easy to dismiss or put down to IBS-C, diet, dehydration, an underactive thyroid or medicines such as iron. These can sit alongside endometriosis or adenomyosis, so finding one doesn't rule them out. The clue is timing: constipation that comes back with your period, often alongside pelvic pain or painful bowel movements.
Tests can miss it too. A colonoscopy checks the bowel's inner lining, while endometriosis usually sits outside or deeper in the wall.
How it's diagnosed
Track two or three cycles
Note the cycle day, how often you go, your stools and any straining. Constipation that lines up with your period is a key clue.
Rule out other causes
Thyroid problems, medicines, IBS and inflammatory bowel disease can look alike. Bleeding, anemia or a big change in bowel habits may call for a colonoscopy.
An exam and focused imaging
A pelvic exam and an ultrasound or MRI aimed at deep endometriosis can find disease near the bowel. A normal scan doesn't rule it out.
See an endometriosis specialist
A specialist puts your timeline, exam and imaging together, and can confirm and remove endometriosis with surgery. Bring your notes.
Treatment options
Treatment depends on what's driving your constipation, and often combines several approaches.
- Medical
Hormonal therapy
Quiets the cycle, which may make period-linked constipation less intense for some people. It doesn't remove endometriosis or scar tissue.
Hormonal Therapy - Surgical
Excision surgery
Removes endometriosis and adhesions at the root, which can improve constipation when they tether or narrow the bowel. Results vary.
Surgery overview - Support
Pelvic floor therapy
Teaches tight muscles to relax and work together, which can make going less of a strain.
Pelvic Floor Therapy - Support
Everyday bowel care
Fluids, fiber added slowly, a stool softener if your clinician approves, a footstool, heat and gentle movement.
Integrative Medicine
Constipation that follows your cycle?
We look for what's behind it, from endometriosis and adenomyosis to your pelvic floor.
Schedule a ConsultationPrefer to talk it through? Call or text us.
Questions people ask
Can endometriosis cause period-related constipation?
Yes, endometriosis can cause constipation that worsens around your period, even without endometriosis on the bowel. Inflammation, pelvic swelling and adhesions can disrupt bowel function, but other conditions can mimic the same symptoms.
Can adenomyosis cause constipation?
Yes, adenomyosis can contribute to constipation even without bowel endometriosis. An enlarged, tender uterus, period-related inflammation, and pelvic floor muscle guarding may make bowel movements harder, but other causes can overlap.
Can constipation be a sign of bowel endometriosis?
Yes, constipation can be a sign of bowel endometriosis, especially when it predictably flares before or during your period. It can result from effects on the bowel, adhesions or pelvic floor muscle spasm, but symptoms don’t reliably show how deep endometriosis is.
IBS-C vs endometriosis constipation: how can I tell the difference?
Endometriosis-related constipation often worsens before or during your period and improves afterward, while IBS-C can cause constipation, bloating, and stool changes. Pelvic pain or painful periods can point toward endometriosis, but IBS and endometriosis can coexist.
Can hormonal therapy help cyclical constipation?
Sometimes, hormonal therapy may make period-linked constipation less intense by reducing or suppressing menstrual cycling. Hormones don’t remove endometriosis lesions or adhesions, so constipation may continue with bowel tethering, scarring, or pelvic floor dysfunction.
When is period-related constipation an emergency?
Period-related constipation is an emergency with severe, worsening belly pain and a swollen belly, repeated vomiting, or prolonged inability to pass gas or stool. Significant rectal bleeding, black/tarry stools, fainting, or signs of dehydration are also emergency signs.
Often happens with
Sources & medical review
Reviewed by Dr. Steven Vasilev, MD, Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute. Last reviewed Oct 2026; next review Oct 2027.
- Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women's Health. Am J Obstet Gynecol. 2023;229(5):536.e1–536.e20.
- Raimondo D, Cocchi L, Raffone A, et al. Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis. Int J Gynaecol Obstet. 2022;159(2):505–512.
- Habib N, Centini G, Lazzeri L, et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int J Womens Health. 2020;12:35–47.