Heavy Periods and Fibroids: What to Know
Heavy menstrual bleeding can drain your energy, disrupt work and home life, and lead to iron-deficiency anemia. One of the most common causes is uterine fibroids—benign (noncancerous) growths of the uterine muscle. Up to 70–80% of women develop fibroids by age 50, but not everyone has symptoms. If you’re dealing with prolonged or very heavy periods, understanding how fibroids contribute—and what you can do about it—can help you take back control of your health.
What are fibroids?
Also called leiomyomas or myomas, fibroids are growths of smooth muscle in the uterus. They vary in size from tiny seedlings to masses that enlarge the uterus. Location matters:
- Submucosal (just under the lining) often cause the heaviest bleeding.
- Intramural (within the wall) can enlarge or distort the uterine cavity and increase bleeding and cramping.
- Subserosal (on the outer surface) tend to cause bulk symptoms (pressure, urinary frequency) more than bleeding.
Estrogen and progesterone influence fibroid growth, so symptoms often peak during the reproductive years and may improve after menopause. Learn more from the National Institutes of Health (NIH): NIH: Uterine Fibroids and MedlinePlus: Uterine Fibroids.
How fibroids cause heavy periods
Fibroids contribute to heavy or prolonged bleeding by:
- Increasing the surface area of the uterine lining (more tissue to shed each cycle)
- Distorting the uterine cavity, which disrupts normal contraction and clotting
- Promoting local inflammation and abnormal blood vessel growth
Typical clues include soaking pads or tampons every hour for several hours, passing clots larger than a quarter, periods lasting longer than seven days, and cycles that are close together. The American College of Obstetricians and Gynecologists (ACOG) provides a helpful overview of abnormal bleeding: ACOG: Abnormal Uterine Bleeding.
Who is at higher risk?
- Age 30–50
- Black race (higher prevalence and earlier onset)
- Family history of fibroids
- Early first period, obesity, and certain lifestyle factors
See the U.S. Office on Women’s Health for more on risk and symptoms: OWH: Uterine Fibroids.
When to see a clinician—and signs of anemia
Seek care if you have heavy bleeding that:
- Soaks through a pad or tampon every hour for more than two hours
- Includes clots larger than a quarter
- Lasts longer than seven days, or occurs between periods
Symptoms of iron-deficiency anemia include fatigue, shortness of breath, dizziness, headaches, brittle nails, and cravings to chew ice (pica). The NIH Office of Dietary Supplements explains iron needs and sources: NIH ODS: Iron. If you feel lightheaded, faint, or your bleeding is soaking through one pad per hour for several hours, seek urgent care.
How fibroids are diagnosed
Diagnosis starts with your history and a pelvic exam. Your clinician may order:
- Lab tests: pregnancy test, complete blood count (CBC) to check for anemia, and sometimes thyroid tests or iron studies.
- Imaging: transvaginal ultrasound (first-line), saline infusion sonohysterography (to map submucosal fibroids), or MRI (for complex cases or surgical planning).
- Endometrial sampling: if you’re 45 or older or have risk factors for endometrial disease.
Other causes of heavy bleeding—polyps, adenomyosis, bleeding disorders, thyroid disease, pregnancy-related conditions, or medication effects (e.g., anticoagulants)—are also considered.
Treatment options for heavy bleeding from fibroids
The best plan depends on your symptoms, fibroid size and location, overall health, and pregnancy goals. Treatments range from medications to targeted procedures and surgery.
Medications
- NSAIDs (e.g., ibuprofen, naproxen) can reduce menstrual blood loss and cramps by lowering prostaglandins. Take with food, and avoid if you have certain stomach, kidney, or bleeding conditions.
- Tranexamic acid is a non-hormonal option taken only during the heaviest days of your period to reduce bleeding. Discuss risks if you have a history of blood clots. See MedlinePlus: Tranexamic Acid.
- Hormonal options can lighten periods: the levonorgestrel-releasing intrauterine device (IUD), combined oral contraceptives, or progestin-only regimens. The levonorgestrel IUD is particularly effective for heavy bleeding; candidacy depends on uterine shape and cavity distortion.
- GnRH agonists (e.g., leuprolide) temporarily shrink fibroids and reduce bleeding but can cause menopausal-like side effects; typically used short-term (e.g., pre-surgery) due to bone density concerns.
- Oral GnRH antagonists with add-back therapy are FDA-approved for heavy menstrual bleeding due to fibroids and can be used for up to 24 months in appropriate patients: These reduce bleeding by lowering hormones that drive fibroid activity; the add-back hormones help protect bone and reduce hot flashes.
- Iron therapy (dietary and/or supplements) treats anemia while you address the underlying cause.
Minimally invasive procedures
- Hysteroscopic myomectomy: Removal of submucosal fibroids via the vagina and cervix, often a first choice when bleeding is the main symptom and fertility is desired.
- Uterine fibroid embolization (UFE): An interventional radiology procedure that blocks the blood supply to fibroids, shrinking them and reducing bleeding. Many people have significant symptom relief and quick recovery. Fertility after UFE is possible but less predictable; discuss your goals. See MedlinePlus: UFE.
- Radiofrequency ablation (RFA): Laparoscopic (e.g., Acessa) or transcervical (e.g., Sonata) techniques use heat to shrink fibroids. Recovery is rapid; fertility data are emerging, so ask about evidence relative to your goals.
- MRI-guided focused ultrasound (MRgFUS): Noninvasive ultrasound energy targets fibroids under MRI guidance. Availability and candidacy vary.
Surgery
- Myomectomy: Surgical removal of fibroids while preserving the uterus (hysteroscopic, laparoscopic/robotic, or open). It can improve bleeding and fertility in selected cases, especially for submucosal or cavity-distorting fibroids. Fibroids can recur over time.
- Hysterectomy: Removal of the uterus is the only definitive cure for bleeding due to fibroids. It is appropriate for people who are done with childbearing and want a permanent solution.
ACOG’s patient guidance summarizes these options and what to expect: ACOG: Uterine Fibroids.
Preserving fertility and planning pregnancy
If you want to conceive now or in the future, tell your clinician early. Hysteroscopic myomectomy for submucosal fibroids often improves bleeding and may enhance fertility. Myomectomy for certain intramural fibroids can also be helpful depending on size and location. Discuss timing of conception after surgery, cesarean delivery considerations, and your individual risks. UFE, RFA, and MRgFUS have evolving data regarding fertility; decisions should be individualized.
Living with fibroids: practical steps
- Track cycles and symptoms to guide evaluation and treatment response.
- Prioritize iron-rich foods (lean red meat, beans, lentils, leafy greens) plus vitamin C to enhance absorption; consider supplements under clinician guidance.
- Use NSAIDs as directed at period start to reduce bleeding and cramps, unless contraindicated.
- Heat therapy, rest, hydration, and regular exercise can ease cramps and fatigue.
- Be cautious with unproven “natural cures.” Some supplements interact with medicines or affect bleeding and are not regulated like prescriptions.
Questions to ask your clinician
- Which fibroids are causing my heavy bleeding—where are they, and how big?
- What are my medical options versus procedures, and how will they affect fertility?
- What outcomes can I expect for bleeding, pain, and quality of life?
- What are the risks, recovery time, and chances of recurrence?
- Will I need iron treatment or monitoring for anemia?
Trusted resources
- NIH: Uterine Fibroids
- MedlinePlus: Uterine Fibroids | UFE
- ACOG: Uterine Fibroids (FAQ) | Abnormal Uterine Bleeding
- FDA drug labels: Oriahnn | Myfembree
- NIH ODS: Iron Fact Sheet
This article is for educational purposes and does not replace personalized medical advice. If heavy bleeding is affecting your life, a gynecologist can help you choose a plan that aligns with your goals and values.
