Uterine fibroids are benign, non-cancerous growths that occur on and inside the walls of the uterus. They are a surprisingly common condition- research shows that between 20% and 80% of all women will develop fibroids during their reproductive years.
Most of the time, women with fibroids have very mild symptoms or no symptoms at all. However, in some cases, fibroid symptoms can be severe. Heavy menstrual bleeding, painful menstrual cramps, and bleeding throughout your menstrual cycle are all commonly reported in women who suffer from uterine fibroids. So, if you’re experiencing these symptoms and suspect you may have fibroids, it’s important to seek treatment as soon as possible.
I’ve worked as an emergency room doctor for decades, and I’ve treated many patients who have presented with pelvic pain and heavy menstrual bleeding due to fibroids. And in recent years, the number of women seeking emergency care for these symptoms has risen.
However, in my experience, many of these visits could have been avoided. If women can spot the signs and symptoms of fibroids, they are more likely to seek care from their doctor in a nonemergency setting. And so, I hope that by spreading awareness of this common condition and educating women on the treatment options available, I can prevent more women from suffering.
I’ve also noticed there’s a lot of misinformation about fibroids on the internet. So, in this post, I intend to combat that. For example, just the other day, I received an email from a reader who was worried about her fibroid symptoms. She was experiencing heavy periods and became concerned that she may even pass fibroid tissue during her menstruation.
So, is this possible? After all, passing blood clots during your period is common. Can you also pass fibroid tissue, too?
Below, I’ll answer this question and several others. Plus, I’ll also cover the signs and symptoms to look out for if you suspect you have fibroids. Then, I’ll discuss the potential treatments that can help.
What are Uterine Fibroids?
Fibroids are non-cancerous growths that can develop inside and on the surface of the uterus. They vary in size, starting very small, around the size of a pea. However, in some cases, they can grow very large, to around the size of a grapefruit or melon.
There are three main types of fibroids: intramural, subserosal, and submucosal.
- Intramural Fibroids: Grow inside the wall of the uterus. These are the most common type, and they often don’t present many symptoms.
- Subserosal Fibroids: Grow outside of the womb. Because they’re not as constricted, they can grow to become very large and cause significant pain.
- Submucosal Fibroids: Grow in the deeper layer of muscle, which sits underneath the uterus lining, otherwise known as the endometrium. Submucosal fibroids can often cause the most significant symptoms of all. Heavy menstrual bleeding during periods is a common complaint with this type of fibroid, and women often pass large clots during their period, too.
What Are the Symptoms of Fibroids?
Fibroids can cause multiple symptoms, including:
- Excessive bleeding during periods
- Passing blood clots during a period
- Pain and cramping throughout your period
- Pain in the lower back or pelvis at any time during your cycle
- A period that lasts longer than 7 days
- A bulging feeling or pressure in the pelvic area
- Needing to urinate frequently
- Difficulty emptying bladder
- Fatigue
- Dizziness
If you suspect that fibroids are causing any of the symptoms above, book an appointment with your doctor as soon as possible.
Can You Pass Fibroids During Menstruation?
If you have fibroids, you may pass large blood clots during your period. Fibroids can cause heavy bleeding during your period, and it’s not abnormal to experience this symptom during this time of the month.
However, it’s extremely rare to pass fibroid tissue unless you have undergone a procedure. One such procedure is called uterine fibroid embolization (UTE). Even after this treatment, research suggests just 2.5% of women will pass fibroid tissue. Usually, this will happen in the first year after the procedure takes place; however, in some circumstances, it can happen later.
It’s also possible to pass some destroyed fibroid tissue during menstruation after a treatment known as focused ultrasound. This procedure breaks down fibroids using ultrasound waves, which create enough heat to destroy the tissue.
There is only one recorded case of someone naturally passing a fibroid during a period. The patient was a perimenopausal woman who had not undergone any procedure, nor was she taking any medication at the time.
How Are Fibroids Diagnosed?
Depending on the size and position of the fibroids, it is sometimes possible to detect them during a manual pelvic exam.
However, most of the time, an ultrasound scan is necessary to confirm the presence of fibroids. An ultrasound uses sound waves to create an image of the surface and the inside of your uterus.
Other tests that may be needed include:
- Blood Tests: To rule out other conditions, such as an infection. You may also require a full blood count to check for anaemia, a condition that can be caused by excess blood loss during your period.
- An MRI, or Magnetic Resonance Imaging Scan: Can provide a clearer picture of uterine fibroids, including their size and location.
- Hysterosonography: (Sometimes Called sonohysterography) uses sound waves and saline to capture images of the inside of the uterus. This test is more invasive than a regular ultrasound. However, the images are much clearer and allow doctors to get a better idea of the size, shape, and location of fibroids. This test is often preferred in the case of symptoms such as heavy bleeding.
How Are Fibroids Treated?
Fibroids are generally left alone unless they cause problems. If you are diagnosed with fibroids, several interventions can help to ease or eradicate the symptoms.
A fibroid specialist will analyze your condition using one or more of the diagnostic methods above. They will then determine the type of fibroids you have, where they are, and how big they are. This will help inform you of the best treatment option for you.
Here are the most commonly used procedures and treatments for fibroids:
1. Uterine fibroid embolization (UFE)
One of the most commonly used treatments for fibroids today is uterine fibroid embolization (UFE). This minimally invasive treatment is the current gold standard for non-complex cases of fibroids. Sometimes, this procedure is referred to as uterine artery embolization (UAE). However, the UAE can also apply to non-fibroid-related surgeries.
During a UFE procedure, tiny embolic agents are introduced into an artery to essentially block blood that nourishes the fibroid. Without this steady blood flow, fibroids can no longer grow bigger. Instead, they shrink to a fraction of their previous size and eventually die.
2. Radiofrequency ablation (RFA)
This is another minimally invasive treatment that uses heat created by radiofrequency to destroy the fibroid tissue. Also known as “Acessa procedure” and “Lap-RFAIt”, the procedure can be performed using small incisions (laparoscopy). In some cases, it can also be performed non-surgically via the vagina or cervix.
3. Myomectomy
Also known as a fibroidectomy, a myomectomy is the surgical removal of fibroids while preserving the uterus. In some cases, this allows a woman to still become pregnant after the procedure. The most commonly used forms of this type of surgery are laparoscopic, robotic, and hysteroscopic myomectomies. These procedures use only very small incisions and involve a shorter recovery time. However, in some instances, your surgeon may perform an abdominal myomectomy, a traditional open surgery that requires a bigger incision in the abdomen. This is typically done for large, deep, or multiple fibroids.
4. Hysterectomy
A hysterectomy is the surgical removal of the uterus. Removing the uterus means that you will no longer be able to get pregnant or carry children.
In some, but not all, cases, the ovaries are also removed. This results in surgical menopause, a sudden onset of menopause, which can be managed by interventions such as hormone replacement therapy.
The less invasive treatments and procedures listed above can be highly effective for many patients. However, as long as the uterus remains in place, there is always the risk that fibroids may return. A hysterectomy removes this risk and ensures a permanent solution.
FAQ’s
Yes. Fibroids and heavy periods go hand in hand. The most commonly reported symptom of uterine fibroids is excessive uterine bleeding, abnormal bleeding, and menstrual bleeding that lasts more than a week.
Occasional blood clots are normal during periods; however, if the clots you pass during menstruation are larger than a quarter (around 1 inch), it could be one of the signs of fibroids.
Living with fibroids isn’t always easy. When fibroids cause heavy menstrual bleeding, it can be uncomfortable and interfere with your daily life. But if you’re experiencing heavy bleeding during your periods, there are other factors to consider.
Heavy bleeding during periods can lead to iron deficiency anaemia. This can cause symptoms such as fatigue, weakness, pale skin, and shortness of breath. If left untreated, it can lead to severe health complications.
So, if you’re concerned about fibroid bleeding, it’s important to speak to your doctor as soon as possible.
Yes. Most women with symptomatic fibroid will experience pain, pressure, and discomfort in the pelvic and lower back region during their periods. However, fibroids can also cause pain when you are not on your period.
The risk of developing fibroids after menopause is relatively low. Most women who do suffer with them after this phase of life have already developed them during their fertile years.
However, it is possible, yet rare, to develop new fibroids after menopause too. For more information, read our dedicated blog post about fibroids after menopause here.
Conclusion
I’ve met many women in my personal and professional life who have suffered from fibroids. While fibroids are not cancerous, they can cause severe pain and discomfort and disrupt your daily life. And in some cases, this pain can be so great that it warrants a trip to the emergency room.
If left untreated, fibroids can also lead to other complications such as infections and iron deficiency anemia. So, if you’re experiencing excess menstrual blood during your period or you have other symptoms that cause you to suspect you have fibroids, seek medical advice as soon as possible.
