Heavy Period Fibroids and Fibroids: What to Know

Heavy Period Fibroids and Fibroids: What to Know

Heavy menstrual bleeding can drain your energy, disrupt work and family life, and lead to iron-deficiency anemia. One of the most common causes is uterine fibroids—noncancerous growths in or on the uterus. Fibroids are extremely common: by age 50, as many as 70–80% of women develop them, though not all have symptoms. Black women are more likely to develop fibroids, at younger ages, and with more severe symptoms.1,2

This guide explains why fibroids can cause heavy periods, how they’re diagnosed, your treatment options (from medications to procedures), and when to seek care—using evidence and recommendations from trusted sources like the NIH, ACOG, and the FDA.

What are uterine fibroids?

Uterine fibroids (leiomyomas) are benign muscle-and-fibrous tissue growths that develop in the uterine wall. Their size, number, and location vary widely, which is why symptoms can differ from person to person. Common locations include:

  • Intramural: within the uterine wall
  • Submucosal: bulging into the uterine cavity
  • Subserosal: projecting to the outside of the uterus
  • Pendunculated: attached by a stalk

Submucosal fibroids are most strongly linked to heavy menstrual bleeding because they increase the surface area of the uterine lining and disrupt normal uterine contractions that limit bleeding.1,3

How fibroids cause heavy periods

Fibroids can lead to heavy menstrual bleeding (also called heavy menstrual bleeding, or HMB) through several mechanisms:

  • Increased uterine surface area—especially with submucosal fibroids.
  • Abnormal blood vessels within fibroids that bleed more readily.
  • Impaired uterine contractions that normally compress blood vessels to reduce bleeding.
  • Inflammatory and hormonal effects that alter the endometrium (uterine lining).1,3

Signs your period may be abnormally heavy include soaking through a pad or tampon every 1–2 hours, passing clots larger than a quarter, bleeding more than 7 days, or anemia symptoms (fatigue, dizziness, shortness of breath, pale skin).3

When to seek medical care

  • Your periods are heavy enough to soak protection every 1–2 hours or last more than a week.
  • You pass large clots, feel dizzy, or develop symptoms of anemia.
  • You have bleeding between periods, after sex, or any bleeding after menopause (urgent evaluation needed).
  • You’re trying to conceive and have irregular or heavy bleeding.3,4

Prompt care can prevent complications like iron-deficiency anemia and help you review fertility-sparing options if pregnancy is a goal.

How fibroids are diagnosed

Diagnosis starts with a detailed history and pelvic exam. Tests may include:1,3

  • Pelvic ultrasound: first-line imaging to assess size, number, and location.
  • Saline infusion sonohysterography: outlines the uterine cavity to detect submucosal fibroids.
  • MRI: detailed mapping if surgery is planned or ultrasound is inconclusive.
  • Hysteroscopy: a thin scope to look inside the uterus, often paired with treatment of submucosal fibroids.
  • Lab tests: pregnancy test (when appropriate), complete blood count, and iron studies if anemia is suspected.
  • Endometrial biopsy: for abnormal bleeding based on age and risk factors to rule out other causes.

Treatment options for heavy bleeding from fibroids

Management is individualized based on your symptoms, fibroid characteristics, age, overall health, and whether you want future pregnancies. Many options reduce bleeding and pain; some also shrink fibroids. Discuss benefits, risks, and recovery with your clinician.

Medications

  • NSAIDs (e.g., ibuprofen, naproxen) can lessen cramps and reduce blood loss during menses.3
  • Tranexamic acid (non-hormonal) taken only during bleeding days can significantly reduce menstrual blood loss.3
  • Hormonal contraceptives (combined pill/patch/ring) help regulate cycles and lighten bleeding; progestin-only methods (including the levonorgestrel-releasing intrauterine device) are highly effective for heavy bleeding. The IUD may be difficult to place if the cavity is severely distorted by fibroids.3
  • GnRH agonists (e.g., leuprolide) temporarily induce a low-estrogen state to shrink fibroids and reduce bleeding; typically used short-term or before surgery due to side effects (hot flashes, bone loss).1,3
  • Oral GnRH antagonists with add-back therapy: elagolix + estradiol + norethindrone acetate (Oriahnn) and relugolix + estradiol + norethindrone acetate (Myfembree) are FDA-approved to treat heavy bleeding due to fibroids. They reduce bleeding and pain but are generally limited to up to 24 months because of bone density concerns; monitoring is recommended.5,6
  • Iron supplementation to correct anemia from chronic blood loss (dose and duration guided by your clinician).4

Procedures and surgery

  • Hysteroscopic myomectomy: removes submucosal fibroids via the cervix; often first-line for cavity-distorting fibroids causing heavy bleeding; preserves the uterus.3
  • Myomectomy (laparoscopic/robotic or open): removes fibroids while preserving the uterus. Effective for symptom relief and fertility preservation, though fibroids can recur over time.3
  • Uterine artery embolization (UAE/UFE): interventional radiology procedure that blocks fibroid blood supply to shrink them and reduce bleeding. Many recover quickly; future fertility after UAE is possible but less predictable than after myomectomy.7
  • Radiofrequency ablation of fibroids (laparoscopic or transcervical): uses targeted energy to shrink fibroids; data on future fertility are evolving.3
  • MRI-guided focused ultrasound (MRgFUS): noninvasive thermal ablation for select fibroids; availability varies.2
  • Endometrial ablation: can reduce bleeding but is not suitable if you want future pregnancies and may be less effective when the cavity is distorted by fibroids.8
  • Hysterectomy: definitive treatment that removes the uterus and ends menstruation; not appropriate if pregnancy is desired.3

Safety note: If a minimally invasive surgery may use power morcellation to remove tissue, discuss the FDA’s safety guidance; morcellation can spread unsuspected uterine cancer in rare cases. Surgeons may use containment systems and careful patient selection.9

Fertility, pregnancy, and fibroids

Fibroids can sometimes interfere with conception or raise risks during pregnancy (e.g., miscarriage, preterm birth, malpresentation), especially when they distort the uterine cavity. Submucosal fibroid removal can improve bleeding and may improve fertility in select cases. If you’re planning pregnancy, ask your clinician which options best balance symptom relief and reproductive goals.1,3

Living well with fibroids

  • Track your cycles (flow, clots, pain, missed work/school) to guide decisions.
  • Screen and treat anemia if you’re fatigued, dizzy, or short of breath.
  • Nutrition and lifestyle: an iron-rich diet and vitamin C to aid absorption support anemia recovery. Healthy weight, exercise, and blood pressure control support overall gynecologic health, though no lifestyle change reliably shrinks fibroids.4,2
  • Follow-up to reassess symptoms and adjust treatment as needs change.

Common questions

Do fibroids turn into cancer? No. Fibroids are benign. A rare uterine cancer (leiomyosarcoma) can occur, but it usually does not arise from a preexisting fibroid.3

Do fibroids shrink after menopause? Often yes, because estrogen and progesterone levels decline. Persistent or new bleeding after menopause needs prompt evaluation.1,3

This article is informational and not a substitute for personal medical advice. See your clinician for evaluation and treatment tailored to you.

Sources

  1. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Uterine Fibroids – Condition Information. https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
  2. U.S. Office on Women’s Health (OWH), HHS. Uterine fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  3. American College of Obstetricians and Gynecologists (ACOG). Uterine Fibroids; Heavy Menstrual Bleeding. https://www.acog.org/womens-health/faqs/uterine-fibroids and https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding
  4. MedlinePlus, NIH. Iron deficiency anemia. https://medlineplus.gov/ency/article/000584.htm
  5. U.S. Food and Drug Administration (FDA). Oriahnn (elagolix, estradiol, and norethindrone acetate) – Drug information and safety. https://www.fda.gov/drugs/drug-safety-and-availability/oriahnn-elagolix-estradiol-and-norethindrone-acetate-capsules
  6. U.S. Food and Drug Administration (FDA). Myfembree (relugolix, estradiol, and norethindrone acetate) – Patient and provider information. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/myfembree-relugolix-estradiol-and-norethindrone-acetate-tablets
  7. American College of Obstetricians and Gynecologists (ACOG). Uterine Artery Embolization. https://www.acog.org/womens-health/faqs/uterine-artery-embolization
  8. American College of Obstetricians and Gynecologists (ACOG). Endometrial Ablation. https://www.acog.org/womens-health/faqs/endometrial-ablation
  9. U.S. Food and Drug Administration (FDA). Updated: Laparoscopic Power Morcellators—When Used for Uterine Tissue—May Spread Undiagnosed Cancer. https://www.fda.gov/medical-devices/safety-communications/updated-laparoscopic-power-morcellators-when-used-uterine-tissue-may-spread-undiagnosed-cancer-fda

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