Uterine fibroids are common non-cancerous growths, also known as leiomyomas, that develop in the muscular wall of the uterus. They are strongly linked to abnormal uterine bleeding and frequently cause significant reproductive health issues. The presence of fibroids can dramatically alter the menstrual cycle, leading to heavier and longer periods. Understanding these growths is the first step toward effective management and treatment.
Understanding Uterine Fibroids
Uterine fibroids are composed of smooth muscle cells and fibrous connective tissue that form a dense, rubbery mass within the uterus. They can range in size from microscopic seedlings to large masses that significantly distort the uterine structure. Fibroids are classified based on where they are located in the uterine wall, which affects the type and severity of symptoms experienced.
Intramural fibroids are the most common type, developing entirely within the muscular wall of the uterus. Subserosal fibroids grow on the outer surface of the uterus, often projecting outward into the pelvic cavity. The type most commonly associated with bleeding issues is the submucosal fibroid, which grows just beneath the inner lining of the uterus and bulges into the uterine cavity.
How Fibroids Cause Abnormal Bleeding
The presence of fibroids initiates several biological changes that lead directly to excessive blood loss. Submucosal fibroids are particularly disruptive because they protrude into the space where the uterine lining (endometrium) sheds each month. This distortion and enlargement of the uterine cavity increases the total surface area of the lining, resulting in a larger volume of tissue to be shed during menstruation.
Fibroids also directly interfere with the vascular and muscular functions necessary for menstrual control. They create irregular and enlarged blood vessels within the uterus, increasing overall blood flow to the region. Furthermore, the growths can impair the uterus’s ability to contract properly, which is required to compress blood vessels and stop the flow of blood once the lining has shed.
The tumors also affect local signaling molecules that regulate bleeding. The tissue surrounding the fibroids may produce fewer vasoconstrictors, compounds needed to constrict blood vessels and control hemorrhage. Simultaneously, fibroids can increase the production of angiogenic factors, which stimulate the growth of additional blood vessels.
Recognizing Bleeding Patterns and Severity
The most common symptom of fibroid-related bleeding is menorrhagia, characterized by heavy and prolonged menstrual periods. A period lasting longer than seven days or requiring changing protection every hour for several consecutive hours is considered abnormally heavy. This excessive flow often includes the passage of large blood clots.
Bleeding may also occur outside of the normal menstrual cycle, known as intermenstrual bleeding or spotting. Chronic and heavy blood loss can quickly deplete the body’s iron stores, leading to iron-deficiency anemia. Symptoms of anemia include persistent fatigue, weakness, paleness, dizziness, and shortness of breath. These symptoms necessitate medical evaluation to prevent further health complications.
Addressing Bleeding and Treatment Options
A medical consultation is necessary to accurately diagnose fibroids and rule out other causes of abnormal bleeding. Treatment decisions depend on the severity of the bleeding, the size and location of the fibroids, and the patient’s desire for future fertility. Initial medical options often focus on controlling the blood loss and managing symptoms.
Non-hormonal medications like tranexamic acid can be taken during the menstrual cycle to help the blood clot and reduce flow. Hormonal treatments, such as progestin-releasing intrauterine devices (IUDs) or oral contraceptives, can effectively thin the uterine lining to reduce the volume of blood shed. Other hormonal therapies, including GnRH agonists or antagonists, can temporarily shrink the fibroids by lowering estrogen levels.
When medical management is insufficient, minimally invasive procedures or surgery may be required to address the fibroids directly. Procedures like Uterine Fibroid Embolization (UFE) block the blood supply to the tumors, causing them to shrink. Myomectomy is a surgical option to remove the fibroids while preserving the uterus, performed through hysteroscopy, laparoscopy, or an open abdominal incision. For individuals with completed families and severe, persistent symptoms, a hysterectomy (removal of the entire uterus) offers a definitive cure for fibroid-related bleeding.