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 need treatment. But for some women, fibroids can cause heavy menstrual bleeding, pelvic pain and pressure, and other symptoms. Fibroid bleeding usually does not indicate an emergency. But in some cases, very heavy bleeding or bleeding that does not stop can signal a medical emergency requiring prompt treatment.
What are fibroids?
Fibroids are benign (noncancerous) tumors that grow from the muscle layers of the uterus. They are made up of dense bundles of fibrous tissue and smooth muscle fibers. Fibroids can range in size from microscopic to the size of a grapefruit or larger. The exact cause of fibroids is unknown, but hormones and genetics likely play a role.
Fibroids are very common, affecting about 70% to 80% of women by age 50. However, not all fibroids cause symptoms. When fibroids do cause symptoms, the most common signs and symptoms include:
- Heavy, prolonged menstrual periods
- Pelvic pressure or pain
- Frequent urination
- Pain during intercourse
- Lower back pain
- Reproductive problems, such as infertility, miscarriages, or early labor
Fibroid bleeding can range from light spotting between periods to very heavy bleeding during menstrual periods. The amount of bleeding depends on the size, location, and number of fibroids present.
What is considered heavy menstrual bleeding?
Normal menstrual bleeding lasts about 4-5 days and the amount of blood lost ranges from 2 to 3 tablespoons per cycle. Heavier bleeding is considered “heavy menstrual bleeding”, also called menorrhagia. With heavy bleeding:
- Periods last more than 7 days
- Bleeding is so heavy that you have to change pads or tampons often (more than every 1-2 hours)
- Blood clots larger than a quarter are passed
- You soak through pads or tampons overnight
The Centers for Disease Control and Prevention defines heavy menstrual bleeding as exceeding 80ml of blood loss per cycle. For comparison, a normal period sheds about 30ml on average.
When is fibroid bleeding considered an emergency?
Most of the time, even heavy bleeding caused by fibroids is not an emergency. However, prompt medical treatment is needed if:
- You are soaking more than 1 pad or tampon per hour for more than a few hours in a row
- Bleeding lasts longer than 12 days
- You pass blood clots larger than the size of a lemon
- Bleeding interferes with your daily activities
- You experience dizziness, lightheadedness, chest pain, shortness of breath, or fainting
Extremely heavy bleeding can sometimes lead to iron deficiency anemia as the body struggles to replace the blood loss. Symptoms of anemia include fatigue, dizziness, rapid heartbeat, shortness of breath, and chest pain.
When to seek emergency care
Seek emergency medical care right away if you experience any of the following:
- Soaking more than 1 pad or tampon per hour for several hours
- Feeling faint, dizzy, or short of breath
- Chest pain or rapid heart rate
- Severe pain in the pelvis or lower back
- Vaginal bleeding that is still very heavy after 12 days
Any of these symptoms could indicate a fibroid complication that needs rapid treatment. Possible complications include:
- Hemorrhagic shock – Extreme blood loss can lead to a dangerous drop in blood pressure and vital organ failure. Emergency surgery may be needed to stop the bleeding.
- Disseminated intravascular coagulation (DIC) – A disorder in which small blood clots form throughout the circulatory system, using up clotting factors. This can cause heavy bleeding or serious organ damage.
- Infection – Pieces of fibroid tissue can sometimes die and become infected, requiring IV antibiotics and urgent surgical removal.
Any signs of these conditions require emergency fibroid treatment. Call 911 or go to the nearest emergency room right away if you have severe or prolonged fibroid bleeding.
What causes heavy fibroid bleeding?
Fibroids themselves do not actually cause heavy periods. The bleeding happens because fibroids distort and stretch the uterine cavity. Signs that fibroids may be causing heavy bleeding include:
- Prolonged periods (more than 7 days)
- Passing large blood clots
- Anemia from blood loss
Specific factors that can lead to heavy bleeding include:
- Fibroid location – Submucosal fibroids grow into the uterine cavity. These are more likely to cause heavy bleeding.
- Number of fibroids – Having multiple fibroids increases the chance of heavy bleeding.
- Fibroid size – Larger fibroids more readily distort the uterine cavity.
As women approach menopause, fibroids tend to shrink, which often lessens heavy bleeding as well. But after menopause, fibroids usually don’t completely go away.
Risk factors
Certain factors can increase your risk of developing fibroids and accompanying heavy bleeding:
- Genetics – Women with a family history of fibroids are 2-3 times more likely to develop them.
- Ethnicity – Fibroids are more common in African American women.
- Obesity – Higher body mass index (BMI) is associated with increased fibroid risk.
- Early menarche – Women who had their first period before age 10 are at increased risk.
- Pregnancy – Pregnancy elevates fibroid risk due to increased estrogen.
While fibroids tend to shrink after menopause, women who started menstruating early, had late menopause, or never gave birth also seem to have increased lifetime risk.
Diagnosis
If you have heavy bleeding associated with fibroids, your doctor will perform a pelvic exam to check for enlargement of the uterus. They may be able to feel larger fibroids during the internal exam.
Other diagnostic tests used to evaluate heavy fibroid bleeding include:
- Ultrasound – Allows visualization of the size and location of uterine fibroids.
- Sonohysterography – Saline solution is injected into the uterus during ultrasound to enhance visualization.
- MRI – Provides detailed images of the uterus and fibroids without radiation.
- Hysteroscopy – A slender scope with a camera is inserted into the uterus to directly view fibroids.
- Endometrial biopsy – Takes a small sample of the uterine lining to check for abnormal cells.
Your doctor will also check for signs of anemia with a complete blood count (CBC) test. This can help determine if the bleeding is significant enough to cause low hemoglobin or red blood cells.
Treatments for heavy fibroid bleeding
If fibroids are causing severe bleeding, treatment is usually recommended to prevent complications like anemia. Treatment options include:
- Medications – Hormonal birth control pills or IUDs help lighten bleeding. Other drugs like tranexamic acid or NSAIDs can help slow or reduce flow.
- Uterine artery embolization – Tiny particles are injected into the blood vessels feeding the fibroids, blocking their blood supply so they shrink.
- MRI-guided ultrasound surgery – Focused ultrasound waves are used to destroy fibroids without any incisions.
- Endometrial ablation – The uterine lining is destroyed to control heavy bleeding.
- Myomectomy – Fibroids are surgically removed while leaving the uterus intact.
- Hysterectomy – Removal of the entire uterus. This is a last resort for severe cases.
The best treatment depends on your age, symptoms, desire for future pregnancies, and other factors. Your gynecologist can help determine the optimal treatment approach for your individual case.
Self-care tips for heavy fibroid bleeding
In addition to medical treatments, you can help manage heavy fibroid bleeding at home with these self-care measures:
- Use extra sanitary pads, menstrual cups, period underwear, or adult diapers as needed.
- Avoid using tampons, which can increase risk of Toxic Shock Syndrome (TSS).
- Take ibuprofen or naproxen to reduce flow.
- Apply a heated pad to the abdomen for comfort.
- Get plenty of iron-rich foods like spinach, beans, and red meat.
- Try an iron supplement if approved by your doctor.
- Drink lots of water to stay hydrated.
- Limit strenuous activity and get extra rest.
- Track bleeding on a calendar to identify patterns.
- Wear dark clothing during your period to hide leaks and stains.
Let your doctor know if these self-care tips do not provide adequate relief from fibroid bleeding. Other treatment options may be recommended.
Conclusion
Heavy bleeding is a common symptom of uterine fibroids. Most fibroid bleeding is not an emergency, but extremely heavy, prolonged, or uncontrolled bleeding requires prompt medical care. Seek emergency treatment for dizziness, shortness of breath, severe pain, fainting, or soaking more than 1 pad per hour. To prevent complications from blood loss, fibroid treatment is often needed for severe cases. Self-care measures can help reduce nuisance bleeding between periods. With proper management, symptoms from even large fibroids can often be controlled.