Uterine fibroids are noncancerous growths that develop in or on the muscular walls of the uterus. Many women with fibroids do not have symptoms or complications and may never require treatment. However, some women experience bothersome symptoms including heavy menstrual bleeding, pelvic pain and pressure, and reproductive issues. Passing blood clots during menstruation is one common symptom of uterine fibroids.
What are Uterine Fibroids?
Uterine fibroids, also called leiomyomas or myomas, are benign smooth muscle tumors that grow on the wall of the uterus. They are extremely common, with an estimated 70-80% of women developing them by age 50.
While the exact cause is unknown, fibroids seem to be influenced by estrogen and progesterone levels. This explains why they rarely develop before a woman’s first period and regress after menopause when hormone levels decline.
There are several types of uterine fibroids:
– Intramural fibroids grow within the uterine wall and are the most common.
– Subserosal fibroids grow on the outer uterine wall.
– Submucosal fibroids grow just under the uterine lining and into the uterine cavity.
– Pedunculated fibroids grow on stalks inside or outside the uterus.
Fibroids range greatly in size from microscopic to several inches across. A woman can have just one or multiple fibroids of varying sizes and locations in the uterus.
Fibroid Symptoms
Most small fibroids do not cause any bothersome symptoms. However, larger fibroids or certain locations can lead to:
– Heavy, prolonged menstrual periods
– Pelvic pressure and pain
– Frequent urination
– Constipation
– Backache or leg pain
– Pain during intercourse
– Reproductive issues like infertility and miscarriage
Heavy menstrual bleeding is one of the most common symptoms of uterine fibroids. This includes longer, more frequent periods and passing large blood clots.
Do Fibroids Cause Clot Passing?
Yes, uterine fibroids often lead to passing clots during menstruation. This occurs because fibroids that distort the uterine cavity tend to cause more blood flow and thicker uterine lining buildup.
When this excess uterine tissue sheds each month, it can come away in clumps rather than dissolving smoothly. As a result, stringy clots of blood tissue are expelled from the vagina.
Clots are more likely if the fibroids are located near the uterine lining or grow into the uterine cavity. Submucosal fibroids that bulge into the uterus often cause prolonged, heavy periods with flooding and large clots.
Women describe clots ranging in size from a quarter to a golf ball. Passing clots over an inch wide is considered abnormal. The number of clots lost per period can vary as well. Seeing a few clots may be normal, but continually passing a lot of large clots is excessive.
This severe blood loss can lead to iron deficiency anemia if left untreated. Anemia causes fatigue, shortness of breath, headaches, and other symptoms from inadequate oxygen delivery.
When to See a Doctor
You should make an appointment with your gynecologist or healthcare provider if you:
– Suddenly begin passing large clots during your period
– Have periods longer than 7 days
– Bleed heavily enough to soak more than one pad or tampon per hour
– Feel weak, dizzy, or short of breath from excessive blood loss
– Have severe pelvic pain and cramping
Severe menstrual bleeding can signal fibroids but may also indicate other conditions like endometriosis, adenomyosis, bleeding disorders, or rarely uterine cancer. Your doctor can examine you and order tests like an ultrasound to check for fibroids and investigate other potential causes.
Treating Heavy Periods from Fibroids
If heavy bleeding and clotting is disrupting your life, there are many treatment options available. Your doctor will recommend the best course of action based on your symptoms, plans for pregnancy, other health conditions, and preferences.
Some medication options to reduce heavy bleeding include:
– Hormonal birth control pills, patch, or ring helps lighten periods by thinning the uterine lining.
– Gonadotropin-releasing hormone (GnRH) agonists stops menstruation by blocking estrogen production.
– Tranexamic acid helps blood clot faster to reduce flow.
– Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen reduce prostaglandins and cramping.
If medication fails to relieve symptoms, there are some minimally invasive procedures that can be performed:
– Endometrial ablation destroys the uterine lining to stop heavy bleeding.
– Uterine artery embolization cuts off blood supply to shrink fibroids.
– MRI-guided focused ultrasound uses sound waves to destroy fibroids.
As a last resort, surgery may be recommended to remove problematic fibroids. Options include:
– Myomectomy removes just the fibroids leaving the uterus intact.
– Hysterectomy removes the entire uterus if fibroids are extensive.
– Endometrial resection shaves away the uterine lining.
Making diet and lifestyle changes may help minimize symptoms:
– Eat fruits, vegetables, and whole grains to reduce inflammation.
– Stay hydrated and avoid alcohol and caffeine.
– Exercise regularly to improve blood flow.
– Use heating pads and ibuprofen to ease cramping.
– Track your cycles and avoid strenuous activity during your period.
– Reduce stress through yoga, meditation, or therapy.
When Fibroids Warrant Surgery
Most women with fibroids can manage their symptoms medically without surgery. However, your doctor may recommend surgical treatment if:
– Medications have not improved heavy bleeding and anemia.
– Fibroids are causing severe pelvic pain and pressure.
– Large fibroids are compressing or blocking nearby pelvic organs.
– Fibroids are interfering with fertility and pregnancy.
– An ovarian cyst or cancer is suspected.
– You have posterior fibroids with severe rectal pressure.
– An abnormal Pap test signals cervical cancer risk.
– Menopausal symptoms like hot flashes develop.
If one or more large fibroids are present, surgery often provides the most complete relief of symptoms. Which surgery is recommended depends on location, size, and number of fibroids; desire for future pregnancy; and other factors.
Surgical Options for Fibroids
– Myomectomy removes fibroids while leaving the uterus intact. This preserves fertility for women still wishing to have children.
– Hysterectomy removes the entire uterus along with fibroids. This permanently ends menstruation and fertility. The ovaries may or may not be removed as well.
– Endometrial ablation destroys the uterine lining to control heavy bleeding but does not remove fibroids. This causes permanent infertility.
– MRI-guided focused ultrasound uses sound waves to break down fibroids non-invasively. It may not eliminate all fibroids and symptoms could return.
– Uterine artery embolization cuts off blood supply to shrink fibroids while leaving the uterus in place. Not all fibroids may be reduced.
– Laparoscopic or robotic myomectomy utilizes minimally invasive techniques to remove fibroids through small incisions. It allows quicker recovery than open surgery but has a longer learning curve.
Discuss all treatment options thoroughly with your gynecologist to choose the surgery that best fits your individual situation. Most women experience significant improvement in fibroid symptoms and quality of life after surgery.
Recovery after Fibroid Surgery
Recovering after fibroid removal surgery will vary based on the procedure performed. With any surgery, you can expect:
– Light vaginal bleeding and discharge for 1-2 weeks
– Soreness, cramping, and fatigue for a few days
– Back to work in 4-7 days typically
Myomectomy recovery typically takes 4-6 weeks, with restrictions on heavy activity for 2-3 weeks to allow the uterine incision to heal. Most women feel much better within 2 weeks. Your periods may be lighter and shorter after fibroids are removed.
Hysterectomy recovery takes about 6 weeks. You may need help with household chores while restrictions are in place for about 2 weeks. Sexual intercourse can usually resume in 4-6 weeks. Hormone changes may cause menopause-like symptoms that subside over time.
Endometrial ablation has a relatively quick recovery of about 1 week until you can resume normal activities. Ablation often makes periods much lighter but does not completely stop them in some women.
No matter the surgical procedure, call your doctor if you experience fever, nausea, vomiting, heavy bleeding, difficulty urinating, or other concerning symptoms during recovery. Some temporary side effects are normal, but excess pain, bleeding, or infection requires prompt medical care.
Long-term Outlook after Fibroid Treatment
The long-term outlook is generally good after treatment for bothersome uterine fibroids. Symptoms often improve dramatically, allowing you to enjoy daily life again without severe bleeding and discomfort.
However, fibroids do have a recurrence rate after treatment of 15-50% within 5 years. This means regrowth of the same fibroid or development of new fibroids is common. Certain factors that increase recurrence risk include:
– Being under age 45 at time of treatment
– Having multiple fibroids
– Very large or rapidly growing fibroids
– Family history of fibroids
– Hormone imbalances like polycystic ovary syndrome
– Obesity
Women who had fibroid embolization or non-surgical treatments are more likely to experience recurrence than those treated surgically. Myomectomy to remove only fibroids has a higher recurrence rate than hysterectomy. But hysterectomy is only recommended when childbearing is complete given its impact on fertility.
Staying alert to new fibroid symptoms and maintaining annual pelvic exams can help detect recurrence early. Further treatment may be warranted if heavy bleeding, pain, or other bothersome symptoms develop again.
Conclusion
Passing large blood clots during menstruation is a common symptom of uterine fibroids. Fibroids that bulge into the uterine cavity tend to cause excess buildup and shedding of the uterine lining each month. This leads to heavy, prolonged periods with flooding, significant blood loss, and passing clots.
If you begin experiencing heavy bleeding with clots, see your doctor to investigate potential fibroids and other causes. There are many medication and surgical options available to treat heavy periods from fibroids. Most women can find substantial relief from symptoms and enjoy improved quality of life. Stay mindful of possible recurrence through routine follow-up care.