Uterine fibroids can cause bleeding, a common symptom prompting medical attention. These non-cancerous growths develop within the uterus and are prevalent, affecting many women during their reproductive years. Heavy or prolonged bleeding is a frequent experience for individuals with fibroids, significantly impacting daily life.
What Are Uterine Fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are benign muscular tumors that grow within the walls of the uterus. These growths consist of smooth muscle cells and fibrous connective tissue. Fibroids vary considerably in size, ranging from microscopic to masses large enough to fill the entire abdominal cavity.
Fibroids are classified based on their location within the uterus. Intramural fibroids, the most common type, are embedded within the muscular wall. Submucosal fibroids grow just beneath the inner lining and protrude into the uterine cavity. Subserosal fibroids develop on the outer surface.
Some fibroids, known as pedunculated fibroids, are attached to the uterus by a stalk-like structure. The presence, size, and location of these fibroids influence whether symptoms, particularly bleeding, occur.
The Mechanism Behind Fibroid-Induced Bleeding
Uterine fibroids contribute to abnormal bleeding through several mechanisms. One way fibroids lead to increased bleeding is by enlarging the overall surface area of the uterine lining, or endometrium. A larger endometrial surface means more tissue sheds during menstruation, resulting in heavier blood flow.
Fibroids, especially those close to the uterine lining, can exert pressure on surrounding blood vessels. This pressure hinders the blood vessels’ ability to constrict effectively after menstrual shedding, leading to prolonged or excessive bleeding. Fibroids also disrupt the uterus’s normal hormonal environment. An imbalance or heightened sensitivity to estrogen and progesterone, hormones regulating the menstrual cycle, can cause the uterine lining to thicken excessively, contributing to heavier periods.
Fibroids can also interfere with the uterus’s natural ability to contract. During menstruation, uterine contractions compress blood vessels and stem blood flow. The presence of fibroids impairs these contractions, preventing the uterus from effectively staunching blood flow, resulting in prolonged or heavier bleeding.
Recognizing Bleeding Patterns and Other Symptoms
Uterine fibroids manifest through specific bleeding patterns. Heavy menstrual bleeding, medically termed menorrhagia, is a frequent symptom, characterized by unusually heavy or prolonged periods. This can mean periods lasting longer than seven days or requiring frequent changes of sanitary products, sometimes as often as every one to two hours. Passing large blood clots is a common indicator of heavy bleeding associated with fibroids.
Another bleeding pattern is intermenstrual bleeding, involving spotting between regular periods. This can also include bleeding after sexual intercourse. Chronic heavy bleeding can lead to iron-deficiency anemia, a condition where the body lacks sufficient healthy red blood cells to carry oxygen. Symptoms of anemia include persistent fatigue, weakness, pale skin, headaches, and dizziness.
Fibroids can cause other symptoms due to their size and location. These include pelvic pressure or pain, often described as a feeling of fullness in the lower abdomen. Fibroids can also press on adjacent organs, leading to frequent urination or difficulty emptying the bladder, as well as constipation or rectal pressure. Lower back pain and pain during sexual intercourse are also symptoms individuals with fibroids may experience.
When to Seek Medical Attention and Diagnosis
Consult a healthcare professional if you experience symptoms suggestive of uterine fibroids, particularly changes in bleeding patterns. This includes unusually heavy or prolonged menstrual bleeding, bleeding or spotting between periods, or severe pelvic pain that interferes with daily activities. Symptoms of anemia, such as persistent fatigue, weakness, or dizziness, especially if accompanied by heavy bleeding, also warrant medical evaluation.
The diagnostic process for uterine fibroids begins with a pelvic exam, where a healthcare provider feels for irregular changes or masses in the uterus. Imaging techniques confirm the presence, size, and location of fibroids. An ultrasound, which uses sound waves to create images of the uterus, is a diagnostic tool. This can involve both transabdominal (over the abdomen) and transvaginal (internal) approaches.
A magnetic resonance imaging (MRI) scan provides more detailed images, particularly for larger fibroids or to differentiate them from other conditions. Hysteroscopy, a procedure involving a thin, lighted scope inserted into the uterus, visualizes fibroids inside the uterine cavity.
Approaches to Managing Fibroid-Related Bleeding
The management of fibroid-related bleeding varies based on symptom severity, fibroid characteristics, and individual considerations like age and fertility desires. For individuals with mild or no symptoms, a “watchful waiting” approach monitors fibroids over time without immediate intervention.
Medications are a first line of treatment for managing bleeding. Non-hormonal options include non-steroidal anti-inflammatory drugs (NSAIDs) to reduce blood loss and pain, and tranexamic acid, which helps with blood clotting. Hormonal therapies, such as birth control pills, progestin-releasing intrauterine devices (IUDs), or gonadotropin-releasing hormone (GnRH) agonists, regulate menstrual cycles, reduce bleeding, and sometimes shrink fibroids by influencing hormone levels.
When medications are insufficient, minimally invasive procedures are considered. Uterine artery embolization (UAE) involves blocking the blood supply to the fibroids, causing them to shrink. Hysteroscopy removes submucosal fibroids that protrude into the uterine cavity.
Surgical options offer more definitive solutions. Myomectomy removes fibroids while preserving the uterus, preferred by individuals who wish to maintain fertility. Hysterectomy, the surgical removal of the entire uterus, is a permanent solution that eliminates both fibroids and future bleeding. It is considered for severe cases or when childbearing is no longer a concern.