Uterine fibroids are common, non-cancerous growths that develop within or on the uterus. Also known as leiomyomas or myomas, these growths are composed of muscle and fibrous tissue and can vary in size, from as small as a pea to as large as a melon. Many individuals with fibroids experience no symptoms and may not even be aware they have them. However, symptoms can include pelvic pain, pressure, and abnormal uterine bleeding.
Understanding Fibroid-Related Bleeding
Uterine fibroids can cause abnormal bleeding through several mechanisms. Submucosal fibroids, located just beneath the uterine lining, can distort the uterine cavity, increasing the surface area of the endometrium that sheds during menstruation, contributing to heavier flow. Fibroids also require a robust blood supply, increasing overall blood flow to the uterus and further contributing to heavy bleeding. The presence of fibroids can disrupt the uterus’s ability to contract effectively, preventing it from adequately constricting blood vessels to stop bleeding, leading to prolonged and heavier periods.
Hormonal imbalances influenced by fibroids may also play a role, as they can elevate certain hormone levels, leading to increased bleeding. Common types of abnormal bleeding include heavy menstrual bleeding (menorrhagia) and prolonged periods lasting longer than seven days.
Factors Influencing Bleeding Duration
The duration of bleeding with uterine fibroids is highly variable, depending on factors like their size, number, and location. Submucosal fibroids, growing directly into or just beneath the uterine lining, are particularly prone to causing heavy, prolonged, or even continuous bleeding. They can interfere with the normal shedding process of the uterine lining, leading to significant blood loss. Larger fibroids require more blood, increasing uterine blood flow and potentially extending bleeding. The presence of multiple fibroids can also exacerbate bleeding. Hormonal profiles also play a role, as fibroids are linked to estrogen; higher levels can promote their growth and associated bleeding. Other medical conditions can also impact bleeding patterns. If unmanaged, fibroid-related bleeding can range from slightly prolonged periods to bleeding lasting weeks or months, significantly affecting daily life.
Recognizing the Signs of Excessive Bleeding
Recognizing excessive fibroid-related bleeding is important for timely medical attention. Heavy menstrual bleeding (menorrhagia) is defined by symptoms such as soaking through one or more sanitary pads or tampons every hour for several consecutive hours. Other indicators include needing to double up on sanitary protection or changing pads/tampons during the night. Bleeding that lasts for more than seven days is also considered prolonged. Passing blood clots larger than a quarter can also signal excessive bleeding. Significant blood loss can lead to iron deficiency anemia. Symptoms include fatigue, weakness, dizziness, and shortness of breath, as the body lacks enough red blood cells to transport oxygen. Pale skin, lightheadedness, and an irregular heartbeat are also signs of anemia that warrant medical evaluation.
Managing Fibroid-Related Bleeding
Various approaches manage and reduce bleeding caused by uterine fibroids, from non-surgical to surgical interventions. Non-surgical treatments include hormonal medications like birth control pills or progestin-releasing intrauterine devices (IUDs), which regulate menstrual cycles and reduce heavy flow. Gonadotropin-releasing hormone (GnRH) agonists can temporarily shrink fibroids by lowering estrogen levels, reducing bleeding. Non-hormonal options like tranexamic acid help with blood clotting, and nonsteroidal anti-inflammatory drugs (NSAIDs) alleviate pain and reduce blood loss.
For persistent or severe bleeding, procedural and surgical options exist. Uterine artery embolization (UAE) is a minimally invasive procedure that blocks the blood vessels supplying the fibroids, causing them to shrink and reduce bleeding. Myomectomy surgically removes fibroids while preserving the uterus, an option for those wishing to maintain fertility. It can be performed through hysteroscopic, laparoscopic, or open abdominal approaches, depending on fibroid size and location. Endometrial ablation destroys the uterine lining to reduce or stop heavy bleeding. While primarily for heavy bleeding, it can also treat small fibroids within the uterine lining. For cases where other treatments are ineffective or undesired, hysterectomy, the surgical removal of the uterus, offers a definitive solution to fibroid-related bleeding and prevents recurrence. Management choice depends on fibroid characteristics, symptom severity, and desire for future pregnancy.