Do Fibroids Hurt During Period and Fibroids: What to Know

September 13, 2025

Do Fibroids Hurt During Your Period? What to Know

Uterine fibroids are common, noncancerous growths that can affect how your periods feel and how heavy they are. If your cramps seem to be worsening, periods are heavier or longer, or you’re passing large clots, fibroids may be part of the reason. Here’s what to know about why fibroids can hurt during your period, how to tell if they’re involved, and the treatment options that can help.

What are uterine fibroids?

Uterine fibroids (leiomyomas) are benign tumors of the uterus. They vary in size and number and can grow within the uterine wall (intramural), bulge into the cavity (submucosal), or project to the outside surface (subserosal). Fibroids are very common—by age 50, an estimated 20% to 80% of women will have them. They are more likely to occur, occur earlier, and be more symptomatic in Black women. Many fibroids cause no symptoms; others lead to heavy bleeding, pelvic pressure, and pain.

Do fibroids cause period pain? Why it happens

Yes, fibroids can make periods more painful. Several mechanisms are involved:

Stronger uterine contractions: Fibroids can distort the uterus and increase prostaglandin production, leading to more intense cramps (dysmenorrhea).
Heavy bleeding and clots: Submucosal and large intramural fibroids increase the surface area of the uterine lining, which can cause heavy flow and clots. Passing clots can trigger painful cramping.
Pressure and ischemia: Bulky fibroids can compress nearby tissues and cause a deep, achy pelvic pain that may worsen during menses.
Inflammation and degeneration: When a fibroid outgrows its blood supply (degeneration), it can cause acute, localized pain—sometimes severe—often coinciding with hormonal shifts around the period.

Signs your period pain may be related to fibroids

Typical period cramps vary from person to person, but fibroid-related symptoms often include:

Heavy menstrual bleeding (soaking through a pad or tampon every 1–2 hours)
Periods lasting longer than 7 days
Passing large clots
Pelvic pressure or fullness; low back or thigh pain
Frequent urination or constipation from pressure on the bladder or bowel
Pain with sex (dyspareunia)
Fatigue or shortness of breath related to iron-deficiency anemia

When to seek medical care

If bleeding is heavy enough to soak a pad or tampon every 1–2 hours for more than a day
If pain is severe, sudden, worsening, or not relieved by over-the-counter (OTC) pain relievers
If you have signs of anemia: fatigue, dizziness, pale skin, shortness of breath
If you’re trying to conceive or are pregnant and have symptoms
If you notice a rapidly enlarging abdomen or new pressure symptoms

How fibroids are diagnosed

Your clinician will review your symptoms and perform a pelvic exam. Imaging confirms the diagnosis and helps plan treatment:

Pelvic ultrasound: First-line, widely available test to detect and measure fibroids.
MRI: Useful for surgical planning, mapping number/location, and choosing procedures like uterine artery embolization.
Hysteroscopy or saline infusion sonography: To evaluate fibroids that protrude into the uterine cavity (submucosal), especially when heavy bleeding or fertility issues are present.
Blood tests: A complete blood count (CBC) checks for anemia from heavy bleeding.

Treatments that can ease period pain from fibroids

The best approach depends on your symptoms, fibroid size/location, overall health, and fertility goals. Options range from watchful waiting to medications and procedures.

Medications

NSAIDs (e.g., ibuprofen, naproxen): Reduce prostaglandins to relieve cramps and can modestly reduce bleeding. Most effective when started at the onset of bleeding or cramping. Not suitable for everyone—ask your clinician if you have stomach, kidney, or bleeding risks.
Hormonal contraception: Combined pills, patches, or rings, and progestin-only methods (including the levonorgestrel-releasing IUD) can reduce menstrual bleeding and cramps. The levonorgestrel IUD is FDA-approved for heavy menstrual bleeding and often helps even when fibroids are present, though very large or cavity-distorting fibroids may limit placement.
Tranexamic acid: A non-hormonal, FDA-approved option taken only during menses to reduce heavy menstrual bleeding. It doesn’t treat pain directly but can reduce bleeding-related cramps. Not for use if you have certain clotting risks—review with your clinician.
GnRH agonists (e.g., leuprolide): Temporarily induce a low-estrogen state to shrink fibroids and reduce bleeding/pain, often used preoperatively. Side effects include hot flashes and bone loss; typically limited to a few months.
Oral GnRH antagonists with add-back therapy: FDA-approved combinations—elagolix/estradiol/norethindrone acetate (Oriahnn) and relugolix/estradiol/norethindrone acetate (Myfembree)—reduce heavy menstrual bleeding from fibroids while protecting bone with low-dose hormones. Usually limited to 24 months of use.

Uterus-sparing procedures

Uterine artery embolization (UAE/UFE): A minimally invasive radiology procedure that cuts off blood supply to fibroids, shrinking them and improving bleeding and pain. Recovery is typically quicker than surgery. Future fertility is possible but not guaranteed—discuss if pregnancy is a goal.
Myomectomy: Surgical removal of fibroids (hysteroscopic for submucosal, laparoscopic or open for others) preserves the uterus and is often preferred if you wish to conceive. Fibroids can recur.
Radiofrequency ablation (RFA): Uses targeted heat to shrink fibroids (laparoscopic or transcervical approaches). Many patients experience reduced bleeding and pain with shorter recovery.
MRI-guided focused ultrasound (MRgFUS): Noninvasive, image-guided thermal ablation for select patients.

Definitive treatment

Hysterectomy: Removal of the uterus eliminates fibroids and related bleeding and pain. It’s definitive but not appropriate if future pregnancy is desired.

Self-care strategies

Apply a heating pad or warm bath during cramps.
Consider regular physical activity and stress-reduction techniques, which can help pain perception.
Start NSAIDs at the first sign of your period if approved by your clinician.
Address iron deficiency with diet (iron-rich foods plus vitamin C) or supplements if recommended.

Fertility and pregnancy considerations

Fibroids don’t always affect fertility, but their impact depends on size and location. Submucosal fibroids—those that protrude into the uterine cavity—are most strongly linked to heavy bleeding, miscarriage risk, and reduced fertility. Many people conceive and carry healthy pregnancies with fibroids, but pain from fibroid degeneration can flare during pregnancy. If you’re planning pregnancy or are pregnant, ask your OB-GYN which treatments are compatible with your goals and timing.

Key takeaways

Fibroids can intensify period pain and bleeding by distorting the uterus and increasing contractions.
Heavy, prolonged periods; large clots; pelvic pressure; and anemia are common fibroid clues.
Effective treatments exist—from NSAIDs and hormonal options to uterine-sparing procedures and definitive surgery.
Seek care for heavy bleeding, severe pain, anemia symptoms, or if you’re pregnant or trying to conceive.

Sources and further reading

U.S. Department of Health and Human Services, Office on Women’s Health. Uterine fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids
National Institutes of Health, NICHD. Uterine fibroids: Overview and symptoms. https://www.nichd.nih.gov/health/topics/uterine/conditioninfo
MedlinePlus (NIH/NLM). Uterine fibroids. https://medlineplus.gov/uterinefibroids.html
American College of Obstetricians and Gynecologists (ACOG). Uterine fibroids FAQ. https://www.acog.org/womens-health/faqs/uterine-fibroids
U.S. Food and Drug Administration (FDA). FDA approves first oral drug combination to treat heavy menstrual bleeding due to fibroids (Oriahnn). https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-drug-combination-treat-heavy-menstrual-bleeding-fibroids
U.S. Food and Drug Administration (FDA). FDA approval of relugolix combination therapy (Myfembree) for heavy menstrual bleeding associated with uterine fibroids. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-relugolix-combination-therapy-management-heavy-menstrual-bleeding-associated-uterine-fibroids

If period pain or heavy bleeding is disrupting your life, you don’t have to tough it out. A conversation with a clinician can clarify whether fibroids are involved and help tailor a plan that fits your symptoms and goals.