Fibroids Cause Blood In Urine and Fibroids: What to Know

September 13, 2025

Blood in Urine and Fibroids: What to Know

Uterine fibroids are common benign tumors that can cause heavy menstrual bleeding, pelvic pressure, and urinary symptoms like frequency or urgency. But what if you notice pink, red, or tea-colored urine? Is blood in the urine caused by fibroids? Here’s what to know, how to tell where the bleeding is coming from, and when to seek care—based on guidance from trusted sources.

Quick facts about fibroids

Fibroids (leiomyomas) are noncancerous growths of the uterus that affect many people during their reproductive years. Common symptoms include heavy or prolonged periods, pelvic pain or pressure, difficulty with fertility, and “bulk” symptoms such as urinary frequency or constipation from pressure on nearby organs. Not everyone with fibroids has symptoms; management depends on your goals and severity of symptoms. Learn more from the National Institutes of Health (NIH) and NICHD: NIH/NICHD overview of uterine fibroids and ACOG’s patient guidance: ACOG: Uterine Fibroids.

What does blood in urine mean?

Blood in urine (hematuria) can be visible (gross hematuria) or microscopic (seen only on urinalysis). It is a sign that deserves medical evaluation. The U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that causes range from infections and kidney stones to kidney or bladder disorders, and sometimes cancer—especially in adults with risk factors such as smoking or age over 35–40. See NIDDK’s overview: NIDDK: Hematuria.

Can fibroids cause blood in urine?

Short answer: not usually. Fibroids most commonly cause bleeding from the uterus (vaginal bleeding), not the urinary tract. They can press on the bladder and cause urinary frequency, urgency, or rarely retention, but visible blood in urine is uncommon.

Important distinctions:

Vaginal bleeding (from the uterus or cervix) can contaminate a urine sample or toilet bowl and look like hematuria. A clean-catch or catheterized urine sample helps clarify the source.
Fibroids can indirectly contribute to urinary problems. For example, significant bladder compression or urinary retention can raise the risk of urinary tract infections (UTIs), which can cause hematuria. See NIDDK on UTIs: NIDDK: UTIs.

Because hematuria has important non-gynecologic causes, do not assume fibroids are the source. If you notice blood in your urine, seek evaluation.

Other common causes of blood in urine

Urinary tract infection (UTI): Often accompanied by burning, frequency, urgency, or foul-smelling urine. (NIDDK)
Kidney or ureteral stones: Can cause severe flank pain, nausea, or microscopic/gross hematuria. (MedlinePlus: Kidney Stones)
Exercise-induced hematuria: Typically after vigorous activity; usually resolves within 24–72 hours.
Menstrual or vaginal bleeding: Especially common in people with heavy periods from fibroids; can appear as “blood in urine” unless samples are collected carefully.
Medications: Blood thinners (e.g., warfarin), antiplatelets, or cyclophosphamide can contribute to hematuria.
Kidney or bladder disorders, including cancers: More likely with age, smoking history, or persistent/recurrent hematuria. (NIDDK)

How clinicians figure it out

Your clinician will aim to answer two questions: Is this blood truly coming from the urinary tract? And if so, why?

Typical steps (based on NIDDK guidance):

History and exam: Timing of bleeding (during urination vs independent), urinary symptoms, menstrual history, sexual activity, medications, and risk factors (smoking, occupational exposures).
Urinalysis and urine culture: Confirms red blood cells; looks for infection. A catheterized urine sample may be used if vaginal bleeding is present to avoid contamination.
Pregnancy test when appropriate: Pregnancy-related issues can also cause bleeding and influence imaging choices.
Imaging: Ultrasound, CT urography, or MRI to evaluate kidneys and ureters, chosen based on risk and clinical context. (NIDDK)
Cystoscopy: A small camera examines the bladder and urethra, especially if hematuria persists or risk factors are present. (NIDDK: Cystoscopy)
Gynecologic evaluation for fibroids: Pelvic exam and ultrasound or MRI if fibroids are known or suspected. (NIH/NICHD; ACOG)

When to seek urgent care

Visible blood in urine, especially with clots
Severe pain in the side, back, or lower abdomen
Fever, chills, or signs of infection
Inability to urinate or severe urinary retention
Pregnancy with any bleeding
Lightheadedness, dizziness, or symptoms of anemia

Managing fibroid-related urinary symptoms

If fibroids are causing bladder pressure or urinary frequency (but not hematuria), treatment can target fibroids themselves. Options include:

Watchful waiting: Appropriate if symptoms are mild and stable. (ACOG)
Medications to control bleeding and shrink fibroids: Hormonal contraceptives, levonorgestrel intrauterine system, tranexamic acid (FDA-approved for heavy menstrual bleeding), and GnRH agonists or antagonists with add-back therapy to reduce fibroid size and bleeding. (FDA on tranexamic acid; ACOG)
Minimally invasive procedures: Uterine artery embolization (UAE/UFE), hysteroscopic myomectomy for submucosal fibroids, laparoscopic or transcervical radiofrequency ablation (some systems are FDA-cleared), and MRI-guided focused ultrasound in select cases. (FDA Medical Devices safety communications; ACOG)
Surgery: Myomectomy (fibroid removal) preserves the uterus; hysterectomy (uterus removal) is definitive. Choice depends on symptoms, size/location of fibroids, and fertility plans. (NIH/NICHD: Treatment Options)

Your gynecologist can tailor options to your goals (symptom control, fertility, recovery time). If urinary issues are prominent, a collaborative approach with a urologist may be helpful.

Key takeaways

Fibroids commonly cause heavy periods and pelvic pressure; they can cause urinary frequency from bladder compression. They rarely cause true blood in the urine.
Visible or persistent blood in urine should be evaluated to rule out infections, stones, and—especially in higher-risk adults—kidney or bladder conditions.
If you have fibroids and notice blood when you pee, ask your clinician to confirm whether the source is urinary or vaginal and consider both gynecologic and urologic evaluations.
Effective, evidence-based treatments exist for fibroid symptoms, including medications and minimally invasive procedures.

Helpful resources

NIH/NICHD: Uterine Fibroids — https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
ACOG Patient FAQ: Uterine Fibroids — https://www.acog.org/womens-health/faqs/uterine-fibroids
NIDDK: Hematuria (Blood in the Urine) — https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine
NIDDK: Cystoscopy — https://www.niddk.nih.gov/health-information/diagnostic-tests/cystoscopy
FDA: Information on tranexamic acid for heavy menstrual bleeding — https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tranexamic-acid-information

This article is informational and not a substitute for professional medical advice. If you have blood in your urine or worrisome symptoms, seek care promptly.