If your heavy periods are disrupting your life, fibroids may be the reason, and you deserve to know. Heavy menstrual bleeding is one of the most common symptoms among those with uterine fibroids.
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Uterine fibroids are non-cancerous growths that develop in or on the uterus. Also known as leiomyomas or myomas, they are extraordinarily common. By age 50, nearly two-thirds of all women will experience them. Among Black women, that number is even higher: more than 80% develop fibroids by age 50, often experiencing them earlier, more severely, and with a greater impact on daily life.
Fibroids vary widely in size, from barely detectable to as large as a melon, and they can appear on the outer surface, within the wall, or on the inner lining of the uterus. Their location matters enormously, especially when it comes to bleeding. Fibroids that grow on or near the inner lining of the uterus, called submucosal fibroids, are the most likely to cause significant heavy menstrual bleeding.
Approximately 26 million women in the United States have been diagnosed with uterine fibroids, but many more remain undiagnosed, quietly managing symptoms without knowing what is causing them.
Heavy menstrual bleeding (HMB) is the most common symptom of uterine fibroids. But why do fibroids cause such significant bleeding?
The exact mechanisms are not fully understood, but research points to several contributing factors. Fibroids can cause abnormal development of the endometrium, the inner lining of the uterus that sheds each month during menstruation, and can alter the clotting mechanisms that normally help regulate blood flow during your period. Fibroids also increase the surface area of the uterine lining, meaning there is simply more tissue shedding each cycle. Together, these changes can result in blood loss that is far beyond what is considered typical.
It is also important to understand that “heavy” means different things to different women, and exact blood loss is rarely measurable in real life. The signs that your period may be crossing into medically significant territory include:
If any of these sound familiar, you are not alone, and what you are experiencing is not something you simply have to live with.
Passing blood clots is another very common and distressing symptom for people with fibroids. The clotting is directly related to how fibroids affect the blood vessels and clotting mechanisms within the uterus during menstruation. Larger and more numerous fibroids tend to produce more pronounced clotting. While occasional small clots during a period are not unusual, consistently passing clots, particularly those larger than a quarter, warrants a conversation with your healthcare provider.
Many women don’t know they have fibroids until a provider notices an irregularity during a routine pelvic exam. But if you are experiencing heavy menstrual bleeding, blood clots, pelvic pain, pressure, or other symptoms, it’s important to advocate for a thorough evaluation.
Fibroids can be confirmed and assessed using several diagnostic tools:
Ultrasound is typically the first imaging test used. It is widely available and can detect the presence of fibroids, though it does not always capture the full picture.
MRI (Magnetic Resonance Imaging) provides a more detailed and comprehensive view of fibroid size, number, and location, as well as blood supply, which is critical for surgical planning. The Fibroid Foundation recommends MRI as the gold-standard imaging tool for fibroids.
Hysteroscopy uses a thin scope inserted through the cervix to directly visualize fibroids inside the uterine cavity, particularly helpful for submucosal fibroids that may be driving heavy bleeding.
Lab Tests, including a complete blood count (CBC), help determine whether anemia has developed as a result of blood loss, and can rule out other causes such as bleeding disorders or thyroid problems.
Don’t wait for symptoms to worsen before seeking a diagnosis. Earlier detection means more options, and better outcomes.
The most important thing to understand is that fibroid-related heavy menstrual bleeding is treatable, and you have more options than you may realize. Treatment is not one-size-fits-all. The right approach depends on the size, location, and number of your fibroids, your symptoms, your desire for future pregnancy, and your personal goals.
Therapies focused on managing symptoms include birth control pills, progesterone-only hormones, hormone-releasing IUDs, tranexamic acid (which regulates clotting to reduce blood loss), and endometrial ablation (which may not suitable for those who wish to become pregnant). These approaches can reduce bleeding but do not treat the fibroids themselves, so symptoms may return or worsen over time.
Therapies that directly treat fibroids include GnRH agonists and antagonists. These are medications that block the hormones that feed fibroid growth, potentially reducing fibroid size and bleeding. These are often used to shrink fibroids before surgery or as a longer-term management option.
Minimally invasive and surgical procedures range from uterine artery embolization (UAE), which cuts off blood supply to fibroids causing them to shrink, to radiofrequency ablation, MRI-guided focused ultrasound, and myomectomy, a procedure that removes fibroids while preserving the uterus. Hysterectomy, the complete surgical removal of the uterus, is considered a last resort after other options have been explored, and while it eliminates fibroids permanently, it also ends the possibility of future pregnancies.
The Fibroid Foundation strongly encourages shared decision-making, an approach in which you and your healthcare provider work together to evaluate your options based on your unique situation and goals. You should never feel rushed into a treatment decision, and getting a second opinion is always your right.
