Uterine fibroids are common, non-cancerous growths that develop in the muscular wall of the uterus. Anemia is a condition where the body lacks enough healthy red blood cells to transport adequate oxygen to tissues, often measured by low hemoglobin or hematocrit levels. Fibroids are one of the leading gynecological causes of anemia. Their presence can lead to chronic blood loss, which depletes the body’s iron stores and results in iron-deficiency anemia.
The Direct Connection: Heavy Uterine Bleeding
The primary mechanism linking uterine fibroids to anemia is the excessive or prolonged menstrual bleeding, known medically as menorrhagia, that they frequently cause. Fibroids, especially those located just beneath the uterine lining, called submucosal fibroids, can distort the inner cavity of the uterus. This distortion increases the surface area of the endometrium, which is the tissue shed during menstruation, leading to heavier and longer periods.
Fibroids also promote the growth of enlarged blood vessels within and around the uterus, essentially acting as reservoirs for blood. During the menstrual cycle, these disrupted vessels release an excessive amount of blood into the uterine cavity. This chronic loss of blood means the body is losing red blood cells and the iron-rich protein hemoglobin faster than it can naturally replenish them.
Over time, this continuous blood loss depletes the body’s reserve of iron, which is essential for producing new hemoglobin and healthy red blood cells. When iron stores are exhausted, the body develops iron-deficiency anemia because it cannot manufacture enough functional red blood cells to carry oxygen throughout the body.
Recognizing the Signs of Iron Deficiency
The symptoms of anemia often develop slowly, making them easy to dismiss as general tiredness or stress in the initial stages. As the condition progresses, a person may experience persistent fatigue and weakness, which are the most common indicators that oxygen delivery to the body’s tissues is compromised. This lack of oxygen can also manifest as shortness of breath, particularly when performing physical activity, and frequent headaches.
Anemia can affect physical appearance and sensation, leading to noticeably pale skin because of the reduced number of red blood cells circulating beneath the surface. Individuals may also feel dizzy or lightheaded, especially upon standing up quickly, and experience cold hands and feet. Iron deficiency can also cause physical changes, including brittle nails, and the heart may beat unusually fast or irregularly as it attempts to compensate for reduced oxygen-carrying capacity.
A more unusual, yet specific, symptom of severe iron deficiency is pica, which is an unusual craving for non-food items such as ice, dirt, or paper. Recognizing these specific signs is an important first step toward seeking medical evaluation and diagnosis.
Confirming the Diagnosis and Treating the Anemia
Diagnosing anemia associated with fibroids typically begins with blood tests, most commonly a complete blood count (CBC). The CBC measures the levels of hemoglobin and hematocrit, which are direct indicators of the blood’s oxygen-carrying capacity. If these levels are low, further tests, known as iron studies, are usually performed to confirm iron deficiency.
A key part of the iron studies is checking the serum ferritin level, which indicates the body’s stored iron reserves. Patients with fibroid-related anemia often show significantly lower ferritin levels compared to those without anemia. Once the iron deficiency is confirmed, treatment focuses on restoring these reserves and alleviating the immediate symptoms.
The initial treatment for iron-deficiency anemia involves dietary modifications and the use of oral iron supplements. For individuals with severe deficiency or those who cannot absorb oral supplements effectively, intravenous (IV) iron therapy may be necessary to rapidly replenish iron stores. In rare, severe cases, such as when the patient is experiencing chest pain or extreme shortness of breath, a blood transfusion may be required to quickly stabilize them. These treatments address the anemia but are often temporary solutions if the underlying cause—the persistent bleeding from the fibroids—is not also managed.
Addressing the Root Cause: Fibroid Management Options
Long-term resolution of fibroid-related anemia requires addressing the source of the excessive bleeding, which means managing the fibroids themselves. A range of medical and interventional options are available, with the choice depending on the fibroid size, location, symptoms, and the patient’s desire for future pregnancy. Non-surgical medical management often involves hormonal therapies designed to control bleeding.
Low-dose birth control pills or progestin-releasing intrauterine devices (IUDs) can help regulate the menstrual cycle and reduce bleeding volume. Gonadotropin-releasing hormone (GnRH) agonists and antagonists temporarily induce a menopause-like state, which halts menstruation, shrinks the fibroids, and allows the body to rebuild blood counts. GnRH agonists are typically used for a short duration, often before surgery, because long-term use can lead to side effects like bone density loss.
For definitive treatment, minimally invasive procedures or surgery are often recommended. Uterine Fibroid Embolization (UFE) is a non-surgical procedure where small particles are injected into the arteries supplying the fibroids, blocking blood flow and causing the growths to shrink. A myomectomy is a surgical procedure that removes the fibroids while preserving the uterus, making it an option for those who wish to maintain fertility.
A myomectomy can be performed through an open abdominal incision, laparoscopically, or hysteroscopically for submucosal fibroids. The most definitive solution is a hysterectomy, which involves the complete surgical removal of the uterus, eliminating all existing fibroids and preventing recurrence. Choosing the appropriate management path based on individual circumstances is the final step in permanently resolving fibroid-induced anemia.