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Fibroids & Periods - Heavy Bleeding Is Not Normal

Updated: Jul 6, 2019

For many woman, heavy bleeding can be caused by a connection between fibroids and periods. If you are experiencing fibroids bleeding every day, fibroid pain during, between, or after periods, we discuss possible causes and treatment options.



Heavy menstrual bleeding is the most common symptom associated with uterine fibroids. Around 60% of women that are diagnosed with fibroids live with heavy bleeding that is clinically significant,¹ and in many cases, excessive bleeding imposes serious challenges in a woman’s daily life.² Women living with heavy menstrual bleeding should be mindful that uterine fibroids are a very common cause of it, and that noninvasive treatments are available that can significantly reduce or completely eliminate the burden of their condition.³


In this article, we provide an in-depth review on how to tell if your menstrual bleeding is abnormal, how common excessive bleeding is, its causes, and the relationship between uterine fibroids and periods. If you find this article helpful, we encourage you to comment and share your experiences below in our comments sections.



How Do I Know If My Periods Are Excessive?


Normal menstrual periods last 3–6 days and involve blood loss of up to 80 ml. Clinically speaking, menstrual bleeding is considered excessive when your period lasts longer than 6 days or when blood loss exceeds 80 ml throughout the duration of your period.²


A common method to estimate blood loss is to count the number of tampons or pads used throughout your period. A fully soaked feminine product holds about 5 ml of blood, so if you go through 16 or more tampons or pads throughout a typical period it probably warrants at least some suspicion that your periods are clinically excessive.² You should also be suspicious if you regularly bleed through your clothes or on to your bedding, if you need to change your pad or tampon every couple hours, if you require double protection to manage your period, or if you’ve passed large blood clots.⁴


Heavy menstrual bleeding has been shown to negatively impact many aspects of a woman’s quality of life, affecting energy levels, mood, work productivity, social interactions, family life, and sexual functioning. Women with heavy menstrual bleeding experience day-to-day discomfort, social isolation, and loss of productivity as a consequence of managing heavy periods. And anemia caused by chronic bleeding can contribute to fatigue, headaches, dizziness, and weakness.⁵



How Common Is Heavy Bleeding?


Heavy menstrual bleeding is very common. Nearly 30% of adult women live with heavy menstrual bleeding, and anywhere from 25% to 65% of these women have iron-deficiency anemia.³ Because bleeding abnormalities are so common, many women assume that their heavy periods are normal and do not attribute their bleeding to any underlying condition.⁵⁻⁶


The popular assumption that heavy periods are normal helps to explain why so many women do not seek medical care for abnormal bleeding.⁶⁻⁷ The Journal of Women’s Health recently published a study on the perceptions and beliefs of women with heavy menstrual bleeding, and why they delay seeking treatment. A team of researchers interviewed 60 women and found that more than one third did not seek an immediate diagnosis despite debilitating symptoms.⁷ When asked how long she had been experiencing heavy bleeding symptoms, one participant responded,


‘‘Oh dear God probably at least like, I mean it was progressively worse, but I would say probably at least five years that it was just worse and worse.’’

The researchers also found that the most commonly cited reason for women’s delayed diagnosis was the perception that what they were going through was normal. One participant said,


“...my period lasted for 30 days and it was heavy and it was horrible. I was wearing pads like the size that you get in the hospital after you have a baby and I was so used to that happening that at that time I didn’t call anybody because you know it was like this is normal.’’

Other women recognize that their bleeding is abnormal and clinically significant, but they just deal with it. Another study participant was quoted in saying:


‘‘...this is what you go through as a woman and it was like every month you are going to bleed half to death and then the rest of the time you are almost okay. I just went with that, you know it didn’t kill me so I would just be stronger.’’


Causes of Heavy Menstrual Bleeding

One of the most common causes of heavy menstrual bleeding is uterine fibroids (also called ‘leiomyomas’). Uterine fibroids are benign (non-cancerous) smooth muscle tumors that grow in the uterus. A number of other conditions are also known to cause heavy menstrual bleeding.⁸ These include:


  • Uterine polyps

  • Conditions related to hormone imbalances such as polycystic ovary syndrome, obesity, insulin resistance, or thyroid problems

  • Adenomyosis

  • Presence of an intrauterine device (IUD)

  • Pregnancy complications

  • Inherited bleeding disorders

  • Being on certain medications, such as anti-inflammatory medications, hormonal medications like estrogens and progestins, and anticoagulants

  • Uterine cancer


Precise estimates are tough to nail down, but we estimate that fibroids are responsible for heavy bleeding in at least 20% of women with period challenges,¹ and possibly many more. Because fibroids are so common, for the remainder of this article we’ll be discussing the relationship between fibroids and heavy menstrual bleeding. But we encourage our readers to inform themselves on the other causes of abnormal bleeding.



How Do Fibroids Cause Bleeding?

The healthy uterus is made up of three primary layers of tissue: the endometrium (inside layer), the myometrium (middle layer), and the perimetrium (outside layer). Fibroids develop within the myometrium at various locations throughout the uterus, with sizes ranging from small seedlings to massive tumors.



Fibroids that grow against the inner layer are called submucosal fibroids and those that are contained within the middle layer are called intramural fibroids. Fibroids in these locations are thought to contribute the most to heavy menstrual bleeding.⁹ Fibroids can also grow against the outer layer and on small stalks inside or outside of the uterus, but these are thought to be less involved with bleeding abnormalities.


The endometrium of the uterus thickens during the menstrual cycle and sheds during your period. This is the source of normal, healthy menstrual bleeding. When submucosal or intramural fibroids develop, they increase the amount of tissue in the endometrium and make it more vascular so more blood is available to feed the fibroids.¹⁰ Because of these changes, when the endometrium sheds, it releases an excessive amount of blood and bleeds for longer in women with fibroids.



Fibroid Symptoms During Your Period


Fibroids may cause other alterations in your cycle that are atypical,² including:

  • Fibroids pain during period

  • Fibroids pain after period

  • Unpredictable bleeding between periods

  • Fibroids bleeding everyday

  • Frequent periods that occur more often than every 24 days.

  • Spotting

  • Clots

  • Fibroid bleeding after menopause


Other Fibroid Symptoms


In addition to bleeding abnormalities, number of other symptoms may also suggest that you have fibroids. Women with fibroids may experience:

  • Pelvic pain or pressure

  • Backache or leg pain

  • Painful or uncomfortable intercourse

  • Frequent urination

  • Constipation

  • Unexplainable weight gain.

In many cases, heavy bleeding is the only outward sign of uterine fibroids.⁵



Living With Fibroids & Heavy Bleeding

Experiences of women with fibroids and heavy bleeding vary widely. Some women describe minimal impact on their daily lives and find their symptoms completely tolerable, while others deal with far more extreme consequences of heavy bleeding. Women & Health published a study in 2003 that interviewed 29 women about their decision to seek care for their fibroids.⁵ Some women described how heavy bleeding interfered with their home, social activities, and work.


“My heavy bleeding kept me home all the time. If I had to leave home, I had to make sure that I was close to a bathroom because I had to change my tampon every single hour.”

Participants also described the inconveniences of unpredictable bleeding and their lack of control over it.


“You don’t have a life basically. You never know when it is going to come. It is very unpredictable. I used to have it one day, then two days nothing, and then again and so on.”

The symptoms of fibroids can also cause lower self-esteem, impaired sense of well-being, nervousness, irritability, feelings of helplessness and depression.


“I was getting suicidal. I couldn’t live like that anymore. I had too many unpleasant days. I was in constant trouble and constant discomfort.”


Stop Fibroid Bleeding

There are a handful of established treatments for fibroids that, by eliminating fibroids, address heavy menstrual bleeding as well. Medications such as progestogens (birth control) can help suppress bleeding symptoms and reduce fibroids size to some extent, but in many cases they do not completely eliminate symptoms and they’re certainly not curative.¹¹


Major surgery is the most common and most invasive approach to fibroid management and symptom alleviation. Surgical approaches include complete removal of the uterus (called hysterectomy), and and selective removal of the fibroids themselves while keeping the uterus intact (called myomectomy). Uterine fibroid embolization (UFE) is a far less invasive but equally effective treatment options to alleviate symptoms of uterine fibroids, including heavy bleeding.³


The only way to know for sure if you’re living with fibroids is to see a Fibroid Specialist and undergo imaging tests. Typically an ultrasound test is sufficient to determine whether or not clinically significant fibroids are present. Women living with heavy menstrual bleeding should be mindful that uterine fibroids are a very common cause of it, and that noninvasive treatments are available that can significantly reduce or completely eliminate the burden of their condition. The first step is seeking a diagnosis.



About the Author


Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. In addition to patient care, Dr. Lalezarian teaches and supervises medical students, residents, and fellows as a full time teaching Professor in the Department of Radiology at UCLA. He is regarded as an expert in uterine fibroid embolization. You can view Dr. Lalezarian's full bio here.


This blog post was written with research and editorial assistance from OnChart™.



References


[1] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.

[2] Marret, H., Fauconnier, A., Chabbert-Buffet, N., Cravello, L., Golfier, F., Gondry, J., … Fernandez, H. (2010). Clinical practice guidelines on menorrhagia: Management of abnormal uterine bleeding before menopause. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 133–137.

[3] [1] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).

[4] Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski-Wende, J., & Schisterman, E. F. (2012). Menstrual bleeding patterns among regularly menstruating women. American Journal of Epidemiology, 175(6), 536–545.

[5] Uskul AK1, Ahmad F, Leyland NA, S. D., Mid, G., & Nsg, M. (2008). Women’s Hysterectomy Experiences and Decision-Making. Women and Health, 38(1), 53–67.

[6] Fraser, I. S., Mansour, D., Breymann, C., Hoffman, C., Mezzacasa, A., & Petraglia, F. (2015). Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. International Journal of Gynecology and Obstetrics, 128(3), 196–200.

[7] Ghant, M. S., Sengoba, K. S., Vogelzang, R., Lawson, A. K., & Marsh, E. E. (2016). An Altered Perception of Normal: Understanding Causes for Treatment Delay in Women with Symptomatic Uterine Fibroids. Journal of Women’s Health, 25(8), 846–852.

[8] Munro, M. G., Critchley, H. O. D., & Fraser, I. S. (2011). The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Seminars in Reproductive Medicine, 29(5), 391–399.

[9] Stewart, E. A. (2001). Uterine fibroids. Lancet, 357(9252), 293–298.

[10] Gupta, S., Jose, J., & Manyonda, I. (2008). Clinical presentation of fibroids. Best Practice and Research: Clinical Obstetrics and Gynaecology, 22(4), 615–626.

[11] Faustino, F., Martinho, M., Reis, J., & Águas, F. (2017). Update on medical treatment of uterine fibroids. European Journal of Obstetrics Gynecology and Reproductive Biology, 216, 61–68.



Medical disclaimer


The Materials available on the FibroidSpecialists.org blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.

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