Heavy Periods Every Month? Here’s What Your Doctor Might Not Tell You About Fibroids

September 10, 2025

This article is for informational purposes and does not replace professional medical advice. If you’re experiencing severe bleeding or symptoms of anemia, seek medical care promptly.

Heavy Periods Every Month? It Might Be Fibroids—But There’s More to the Story

If you’re soaking through pads or tampons every hour, passing clots larger than a quarter, or bleeding longer than seven days, you may have heavy menstrual bleeding (HMB). Uterine fibroids—noncancerous growths of the uterus—are a common cause. By age 50, the majority of women develop fibroids, with higher prevalence and more severe symptoms among Black women. Yet many people aren’t told about the full range of tests and treatments available, or the nuances that could change their care plan.

First, What Counts as “Heavy”?

Heavy menstrual bleeding is typically defined as bleeding that interferes with your physical, social, or emotional quality of life, blood loss greater than about 80 mL per cycle, or any of the following:

Soaking through a pad or tampon every 1–2 hours
Passing large clots
Bleeding longer than seven days
Symptoms of anemia: fatigue, dizziness, shortness of breath, pale skin

Don’t normalize heavy bleeding. Untreated, it can lead to iron-deficiency anemia that affects your heart, brain, and daily functioning.

Fibroids 101: Common, But Not One-Size-Fits-All

Fibroids (leiomyomas) can grow in different locations: inside the uterine cavity (submucosal), within the muscle wall (intramural), or on the outer surface (subserosal). Location often drives symptoms more than size. Submucosal fibroids are most associated with heavy bleeding. Risk factors include age in the reproductive years, family history, early menstruation, obesity, and being of African ancestry.

What Your Doctor Might Not Emphasize

1) Not all heavy periods are caused by fibroids

Other causes include thyroid disorders, bleeding disorders (like von Willebrand disease), endometrial polyps, adenomyosis, medications (anticoagulants), and endometrial hyperplasia. A thorough evaluation may include pregnancy testing, a complete blood count and ferritin for anemia, thyroid testing, and sometimes an endometrial biopsy (especially if you’re 45+ or have risk factors).

2) Imaging matters—and so does the type

A transvaginal ultrasound is the first-line imaging test. If bleeding is heavy or the ultrasound is inconclusive, a saline-infusion sonohysterogram (adds saline to outline the cavity) or MRI can better show submucosal fibroids and adenomyosis. The best treatment depends on accurate mapping of fibroid number, size, and location.

3) You may have effective non-surgical options

NSAIDs (e.g., ibuprofen) can reduce bleeding and cramps for some.
Tranexamic acid is a non-hormonal option taken only during menses; it can significantly cut blood loss.
Hormonal therapies: combined birth control pills, progestin-only pills, depot medroxyprogesterone, or the levonorgestrel IUD can reduce bleeding (the IUD may be less effective if the cavity is severely distorted by fibroids).
GnRH agonists (e.g., leuprolide) and oral GnRH antagonists with add-back therapy are FDA-approved for heavy bleeding from fibroids. Elagolix with estradiol/norethindrone (brand: Oriahnn) and relugolix with estradiol/norethindrone (brand: Myfembree) can control bleeding and shrink fibroids. They’re typically limited to up to 24 months because of potential bone density loss; not suitable for everyone.

Medical therapy can be a bridge to surgery, a long-term strategy, or a way to stabilize anemia before any procedure.

4) Fertility goals change the plan

If you wish to get pregnant, ask which options best preserve fertility. Hysteroscopic myomectomy removes submucosal fibroids from inside the uterus and often improves bleeding and fertility. Intramural fibroids that deform the cavity may also be removed via laparoscopic or open myomectomy. Fibroids can recur; reintervention rates after myomectomy can be 15–30% over five years depending on number and size. After deep myometrial incisions, some clinicians recommend cesarean delivery in future pregnancies—confirm this with your surgeon.

5) Uterine Fibroid Embolization (UFE) is a well-studied, uterus-sparing option

UFE, performed by interventional radiologists, blocks blood flow to fibroids, shrinking them and reducing bleeding. Most women have substantial symptom relief, with shorter recovery than surgery. Some may need future procedures; pregnancy after UFE is possible but data are mixed—discuss fertility plans beforehand.

6) Other minimally invasive options exist

MRI‑guided focused ultrasound uses thermal energy to ablate fibroids without incisions; availability and insurance coverage vary.
Radiofrequency ablation (laparoscopic Acessa or transcervical Sonata) targets fibroids with heat while sparing uterine tissue; recovery is typically fast. Fertility data are growing but remain more limited than for myomectomy.

7) Hysterectomy is definitive—but not the only answer

Hysterectomy eliminates fibroid recurrence, but it’s major surgery and removes the uterus permanently. Ovaries don’t have to be removed at the same time; removing them before natural menopause can increase risks like heart disease and bone loss. Ask about vaginal or laparoscopic approaches that may reduce recovery time when appropriate.

8) Power morcellation has FDA warnings

During some minimally invasive surgeries, fibroids or the uterus are cut into smaller pieces (morcellation). The FDA advises against the use of certain power morcellators in most women because of the rare risk of spreading an undiagnosed uterine cancer. If morcellation is discussed, ask about alternatives or the use of an FDA-cleared containment system and your individual risk profile.

9) Treating anemia is part of treating fibroids

Ask for iron studies (including ferritin). Oral iron helps many; if levels are very low or you can’t tolerate pills, intravenous iron can restore iron more rapidly. Severe anemia may require transfusion.

10) Shared decision-making beats one-size-fits-all

Symptom trackers (like a period diary or a pictorial blood loss chart) can guide decisions and insurance approvals. A second opinion—especially with a minimally invasive gynecologic surgeon or interventional radiologist—can broaden your options. Be aware of disparities: Black women are more likely to have severe fibroids and receive hysterectomy; advocate for your preferences and ask about all eligible treatments.

How Fibroids Are Diagnosed

History and exam: bleeding patterns, pain, fertility goals
Labs: pregnancy test, CBC, ferritin, thyroid tests; bleeding disorder workup when indicated
Imaging: transvaginal ultrasound first; saline sonohysterography or MRI for detailed mapping
Endometrial sampling: for persistent abnormal bleeding, age 45+, or risk factors

When to Seek Urgent Care

Soaking through a pad or tampon every hour for more than two hours
Lightheadedness, chest pain, shortness of breath, or fainting
Positive pregnancy test with heavy bleeding

Smart Questions to Ask Your Doctor

Which fibroid locations are causing my symptoms?
What are my non-surgical options, and how effective are they for my situation?
How will this treatment affect my fertility or future pregnancy?
What are the chances I’ll need another procedure later?
Do you offer hysteroscopic myomectomy, laparoscopic myomectomy, UFE, or radiofrequency ablation—or can you refer me?
If surgery is recommended, will morcellation be used, and how will you minimize risk?

Bottom Line

Heavy periods every month aren’t “just part of being a woman.” Fibroids are common, but your treatment should be tailored to your symptoms, anatomy, and goals. With the right evaluation and a full view of available therapies—from medications and IUDs to UFE, myomectomy, ablation, or hysterectomy—you can choose a plan that controls bleeding, treats anemia, and respects your preferences.

Trusted Resources

Back to blog