Fibroids and Heavy Periods
Why This Matters
Heavy periods can affect every part of your life.
You may find yourself planning your day around toilet breaks, carrying spare clothes "just in case," waking during the night to change sanitary protection or avoiding social events altogether. Some women become so used to heavy bleeding that they begin to believe it's simply something they have to live with.
It isn't.
Fibroids are one of the most common causes of heavy menstrual bleeding, but effective treatments are available. Understanding why fibroids cause heavy periods can help you recognise when it's time to seek medical advice and explore your treatment options.
Quick Summary
Heavy menstrual bleeding is one of the most common symptoms of fibroids.
Not every woman with fibroids experiences heavy periods.
Fibroids that grow close to or into the lining of the uterus are most likely to cause heavy bleeding.
Heavy bleeding can lead to iron deficiency anaemia.
Several treatments are available to reduce bleeding and improve quality of life.
You do not have to simply "put up with" heavy periods.
How Do Fibroids Cause Heavy Periods?
Researchers don't believe there's just one reason why fibroids cause heavy bleeding.
Instead, several factors may contribute.
Fibroids may:
increase the surface area of the uterine lining that is shed during your period
interfere with the normal contractions of the uterus, making it harder to stop bleeding
affect the blood vessels supplying the uterus
alter the normal structure of the uterine cavity
contribute to inflammation within the uterus
The result can be periods that are heavier, longer or both.
Which Fibroids Are Most Likely to Cause Heavy Bleeding?
The position of a fibroid is often more important than its size.
Submucosal Fibroids
These grow just beneath the lining of the uterus and bulge into the uterine cavity.
They are the type most likely to cause heavy menstrual bleeding because they directly affect the lining that is shed during each period.
Intramural Fibroids
Fibroids growing within the muscular wall of the uterus can also cause heavy bleeding, particularly if they become large or distort the uterine cavity.
Subserosal Fibroids
Fibroids growing on the outside of the uterus are less likely to cause heavy periods.
Instead, they are more likely to cause pressure symptoms, such as bladder or bowel problems.
What Counts as a Heavy Period?
Many women aren't sure whether their periods are considered heavy.
Heavy menstrual bleeding may include:
bleeding for more than seven days
soaking through a pad or tampon every hour for several hours
needing to use two forms of protection at the same time
passing blood clots larger than a £2 coin
needing to wake during the night to change protection
bleeding through clothes or bedding
avoiding work, school or social activities because of your period
If your periods regularly interfere with your daily life, it's worth speaking to your healthcare provider.
Can Heavy Periods Cause Anaemia?
Yes.
Losing large amounts of blood every month can reduce your body's iron stores.
Over time, this may lead to iron deficiency anaemia.
Symptoms include:
constant tiredness
weakness
dizziness
headaches
shortness of breath
pale skin
poor concentration
feeling cold more often than usual
If your periods are very heavy, your doctor may recommend a blood test to check your haemoglobin and iron levels.
How Are Heavy Periods Diagnosed?
Your healthcare provider will usually ask about:
how long your periods last
how often you change sanitary protection
whether you pass clots
whether bleeding affects your daily life
any pain or pressure symptoms
whether you're trying for a baby
They may also recommend:
a pelvic examination
blood tests
an ultrasound scan
occasionally an MRI scan or hysteroscopy
These tests help determine whether fibroids are causing your symptoms.
Treatment Options
Treatment depends on:
how heavy your bleeding is
whether you have anaemia
the size and location of your fibroids
your age
whether you hope to have children
Possible treatments include:
Medication
Tranexamic acid to reduce bleeding.
Anti-inflammatory medicines (NSAIDs), such as ibuprofen, which may reduce pain and bleeding.
Hormonal contraception.
The hormonal intrauterine system (Mirena®), if appropriate.
Hormone treatments that temporarily shrink fibroids.
Procedures
If medication doesn't help, your doctor may discuss:
uterine artery embolisation (UAE)
MRI-guided focused ultrasound (where available)
myomectomy
hysterectomy
The most suitable treatment depends on your individual circumstances.
When Should You Seek Urgent Medical Advice?
Seek urgent medical attention if:
you're soaking through sanitary protection every hour for several hours
you feel faint or collapse
you have severe dizziness or chest pain
you become extremely short of breath
the bleeding is much heavier than usual and you feel unwell
Although these situations are uncommon, very heavy bleeding sometimes requires urgent assessment.
What Does This Mean for You?
Heavy periods are not simply something you have to accept because you're a woman or because you've been told you have fibroids.
If your periods are affecting your work, family life, sleep or emotional wellbeing, it's important to seek medical advice.
Even if your fibroids don't need to be removed, there are often treatments that can significantly reduce bleeding and improve your quality of life.
You Are Not Alone
Many women quietly organise their lives around heavy periods.
You may know exactly where every public toilet is, avoid wearing light-coloured clothes or feel anxious about travelling during your period.
You might even have been told that heavy periods are "normal" because other women in your family experience them too.
They aren't something you should have to suffer through.
Help is available, and you deserve to have your symptoms taken seriously.
Questions to Ask Your Doctor
Are my heavy periods likely to be caused by fibroids?
Do I need a blood test to check for anaemia?
Which fibroids are causing the bleeding?
What treatment options are available for me?
Will treatment affect my fertility?
What are the benefits and risks of each treatment?
When should I seek urgent medical advice about my bleeding?
Myth vs Fact
Myth
Fact
Heavy periods are just part of being a woman.
Heavy menstrual bleeding is not normal if it's affecting your daily life or causing anaemia.
Only large fibroids cause heavy bleeding.
Even relatively small fibroids inside the uterine cavity can cause significant bleeding.
If I have heavy periods, I'll definitely need surgery.
Many women are successfully treated with medication or minimally invasive procedures.
Passing large clots is always normal.
Large clots can be a sign of heavy menstrual bleeding and should be discussed with your healthcare provider.
Your Next Step
Before your next appointment, consider keeping a period diary for two or three months.
Record:
when your periods start and finish
how often you change pads or tampons
whether you pass clots
any pain you experience
how tired you feel
whether bleeding affects work, school or social activities
This information can help your healthcare provider understand how much your symptoms are affecting your life and guide the most appropriate treatment.
Key Takeaways
Heavy periods are one of the most common symptoms of fibroids.
The location of a fibroid often determines whether it causes heavy bleeding.
Heavy menstrual bleeding can lead to iron deficiency anaemia.
Several effective treatments are available.
You should not feel that heavy periods are simply something you have to live with.
If your bleeding is affecting your quality of life, speak to your healthcare provider.
Frequently Asked Questions
Do all fibroids cause heavy periods?
No. Many fibroids cause no symptoms at all, while others mainly cause pressure or pain rather than heavy bleeding.
Can heavy periods make me anaemic?
Yes. Heavy blood loss over time can lead to iron deficiency anaemia, causing tiredness, weakness and other symptoms.
Can medication help with heavy bleeding?
Yes. Several medications can reduce menstrual blood loss, although they don't usually remove the fibroids themselves.
Will removing my fibroids stop the heavy bleeding?
In many cases, treating or removing the fibroids significantly improves heavy menstrual bleeding, although the outcome depends on the size, number and location of the fibroids.
When should I seek urgent help?
If you're bleeding so heavily that you're soaking through protection every hour for several hours, feeling faint, or experiencing severe dizziness, shortness of breath or chest pain, seek urgent medical assessment.
References
National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management (NG88).
Royal College of Obstetricians and Gynaecologists (RCOG). Fibroids: Information for You.
American College of Obstetricians and Gynecologists (ACOG). Management of Symptomatic Uterine Leiomyomas.
Stewart EA, et al. Uterine Fibroids. Nature Reviews Disease Primers.
Bulun SE. Uterine Fibroids. New England Journal of Medicine.
World Health Organization (WHO). Women's reproductive health resources.