Fibroids and Heavy Bleeding: Your FAQs

Fibroids and Heavy Bleeding: Your FAQs

Uterine fibroids might sound like a concerning condition, but these growths that form from the muscle tissue of the uterus are almost always noncancerous. For many people, they cause mild symptoms.

In fact, it’s not uncommon to be asymptomatic and unaware that you have a uterine fibroid.

That said, when symptoms do occur, they can range from moderate to severe and include:

  • heavy menstrual bleeding
  • pelvic pain and pressure
  • back pain
  • anemia
  • frequent urination if they’re putting pressure on the bladder

Uterine fibroids are most common in your 30s and 40s but can occur at any age. According to the US Office on Women’s Health, about 20 to 80 percent of women develop fibroids by age 50.

A fibroid can be small and singular or grow and multiply into several fibroids of varying sizes. Plus, the location is not always the same.

Some fibroids may grow in the uterine wall or be attached to it by a stem-like structure.

Depending on the size and location of your fibroids, a doctor may be able to feel a fibroid during a regular pelvic exam.

Otherwise, they may decide to do further testing if you’re experiencing heavy bleeding, pain, and changes in menstruation, especially if these symptoms interfere with your daily routine or increase in severity or frequency.

Fibroids tend to go away on their own, but in some cases, like with heavy or painful menstrual periods, you may need treatment to stop the bleeding.

Read on for answers to five frequently asked questions about heavy bleeding and fibroids.

Bleeding from fibroids lasts longer than a typical menstrual period, which generally lasts up to 7 days, according to the American College of Obstetricians Gynecologists.

An average menstrual cycle — which is defined as the time between the first day of your period to when the next period begins — is typically between 21 and 35 days.

If you have uterine fibroids, it’s not uncommon to experience bleeding that lasts longer than 8 or 9 days. In many cases, your doctor will consider it abnormal if you are experiencing longer periods and bleeding between periods for at least 6 months.

Bleeding is a common side effect of uterine fibroids. But too much bleeding can lead to complications like anemia and infertility.

If you experience longer, more frequent periods, have a heavy flow that prevents you from participating in daily activities, or have frequent bleeding between periods, it’s time to take action.

according to the Centers for Disease Control and Prevention (CDC)a longer than usual period is defined as menstrual bleeding that lasts more than 7 days.

A heavy flow often means you’re changing a pad or tampon after fewer than 2 hours, or you pass blood clots that are the size of a quarter or larger.

If you have heavy bleeding from fibroids, your doctor may talk with you about treatments such as medications and surgical procedures that can help stop the flow.

Medications

Medications are often recommended as the first line of treatment for mild symptoms.

Your doctor may suggest a low dose birth control pill to help control heavy bleeding. Other contraceptive methods used for uterine fibroids are progesterone-like injections such as Depo-Provera or a hormone-containing intrauterine device (Mirena).

Your doctor may recommend a gonadotropin-releasing hormone agonist (GnRHa) like Lupron to shrink a fibroid to control bleeding or make it smaller before surgery.

Your period may stop while taking GnRHAs. That said, once you stop taking them, the fibroids will grow back, and heavy bleeding will likely resume.

In 2020, the Food and Drug Administration (FDA) approved Oriahnn, a GnRHa that’s combined with estrogen and progesterone (elagolix, estradiol, and norethindrone), to treat heavy menstrual bleeding associated with fibroids.

If a hormonal treatment option isn’t considered appropriate for you or if that treatment doesn’t seem to be working, there are many surgical options to consider.

Other treatments

  • myomectomy. This outpatient surgical option removes uterine fibroids when they’re diagnosed as the source of abnormal bleeding. While it removes existing fibroids, it doesn’t prevent new ones from developing. There are several ways to perform a myomectomy, including an abdominal, laparoscopic, or hysteroscopic myomectomy. Your doctor will determine the method most appropriate for you.
  • Hysterectomy. Hysterectomy is a major surgical procedure that removes the uterus. There are three different approaches: vaginal, abdominal, and laparoscopic hysterectomy. The method your doctor chooses is based on the size of your uterus, among other factors.
  • Endometrial ablation. This outpatient surgical technique destroys the lining of the uterus. Doctors often use it to treat small fibroids inside the uterus. There are different methods for performing this procedure, so your doctor will discuss which one is best for you.
  • Uterine fibroid embolization (UFE) or uterine artery embolization (UAE). This is a newer procedure your doctor may recommend as an alternative to surgery. UAE blocks the blood flow to the fibroid, which causes them to shrink or die.

Any abnormal bleeding is cause for concern. This may include:

  • a heavier flow
  • longer periods
  • passing clots larger than the size of a quarter
  • bleeding between periods

An increase in blood loss can lead to extreme fatigue and anemia, which need to be addressed and treated by your doctor.

In addition, persistent pelvic pain and pressure or sharp, sudden pain in the abdomen that does not respond to pain medication are signs of fibroids that need immediate medical attention.

While rare, you can pass fibroid tissue during your period. But this typically happens if you’ve been treated for fibroids with UFE. Otherwise, it’s unlikely that you will naturally pass a fibroid during your period.

That said, researchers reported on a unique case in 2020 of a perimenopausal woman who had a complete and spontaneous expulsion of uterine fibroids without medication or a procedure.

Uterine fibroids are a common condition that responds well to treatment. Some people may have a fibroid and not know it, while others will experience moderate to severe symptoms like heavy bleeding, pelvic pain, and pressure.

If heavy menstrual bleeding interferes with your regular activities, seems to be getting worse or more frequent, or you’re experiencing fatigue and anemia, it’s time to see your doctor. They can determine the cause of bleeding and recommend the appropriate treatment.

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