Dr. Eric DePopas, MD
PainTheory Chief Medical Officer
Vascular & Interventional Radiologist
If your doctor has just diagnosed you with uterine fibroids, you’re probably wondering or worried about your prognosis and what to expect going forward. You may also be asking about your immediate or future treatment options and to expect in terms of day-to-day symptoms or quality of life—including how your fibroids will affect your menstrual cycle or periods.
We see some women who experience little or no fibroid-caused disruption to their periods. However, others have heavy or longer periods or suffer painful cramping. In fact, a peer-reviewed study published in BMC Women’s Health found that 54% of women aged 40-49 with fibroids reported more extreme or irregular periods. The study, which interviewed 21,479 women across eight countries, showed that fibroid-induced menstrual changes had a negative impact on various aspects of the subjects’ daily lives.
Wherever you are in terms of symptoms, screening, diagnosis, or treatments, you need to know how best you can protect and manage your health over the long term. Here’s everything you need to know about fibroids and periods.
Table of Contents
What Impact Do Fibroids Have On Periods?
There are a number of ways fibroids impact periods, starting with how likely you are to develop them in the first place. In their lists of fibroid risk factors, the Fibroid Foundation, a nationwide patient education and advocacy non-profit, cites the early onset of menstruation—or getting your period at a young age—among the potential determinants for developing fibroids. On the clinical-provider side, the Mayo and Cleveland Clinics also include early menstruation in their list of possible fibroid risk factors.
On the symptom end, one of the most common “red flag” signs of fibroids is a change in your menstruation, including heavier bleeding, longer, more frequent periods, abdominal cramps, and bleeding (spotting) in between your periods. A secondary complication of these menstrual changes is the possibility of developing anemia, or iron deficiency, due to blood loss-induced decreased red blood cells in your bloodstream.
PHYSICIAN INSIGHT
In past articles, we have also often referenced studies that show women of African and Caribbean descent are more likely to develop fibroids. It turns out that this group are also more likely to have heavy, longer periods due to fibroids and to experience cramps and pass blood clots during their period.
Fibroids and Heavy Periods
Many women’s health researchers point to the relatively limited amount of research on uterine fibroids—including the underlying causes. However, we do know that fibroids are under hormonal control—namely estrogen and progesterone. Estrogen is the primary sex hormone in women and, as such, it can fluctuate during various stages of women’s reproductive cycles, including during monthly menstrual cycles, pregnancy, and menopause.
According to a 2017 study published in Reproductive Sciences, high estrogen levels can increase your chances of developing fibroids and make your symptoms worse. No surprise, then, that, as hormone levels rise significantly during periods, fibroid symptoms also grow more severe as you menstruate.
What’s Considered a Heavy Period?
Here, it’s good to start with a baseline normal or what, at least in terms of frequency, we consider to be a “regular” period. According to The Center for Uterine Fibroids, menstrual bleeding lasts between four and five days. Other experts set that baseline normal at seven days.
Here’s the bottom line for you: If your periods last for seven or eight days (or longer), you should consult your doctor.
Another way to gauge and track the impact of your fibroids is by measuring the volume of bleeding or how often you have to change your sanitary protection.
Do any (or more than one) of these describe your experience?
- I have to change my sanitary pad or tampon every hour for several hours
- Sometimes I have to wear more than one pad at a time
- I sometimes have to change my tampon or pad during the night
- I often pass clots in my menstrual blood
If your periods last more than a week and/ or one of the above applies to you, then you are experiencing abnormal menstruation. Abnormal periods don’t always signal fibroids. But they always require making an appointment with your doctor.
So why do fibroids lead to abnormal periods? We actually don’t know the definitive or clinically proven reasons, but there are a few theories.
Fibroids can grow as large as a single nodule (one growth) or in a cluster that can range in size from 1 mm to more than 20 cm (8 inches) in diameter or even larger. Also, single fibroids can be as small as a seedling or can grow as large as a potato or watermelon.
Intramural fibroids, which grow within the muscular walls of the uterus, are the most common type of fibroids. If they grow larger, they can press against the lining of the uterine wall, which stimulates more bleeding during your period. Other clinicians believe that fibroids stimulate blood vessel growth or that elevated hormone levels (which cause fibroids) also contribute to heavier bleeding. Alternatively, because fibroids increase the surface area of the uterine lining, women may experience more intense cramps and bleeding.
Although we don’t always know the cause, based on symptomatology and the BMC-published international study (cited above) of the self-reported experiences of 21,479 women across eight countries, there is a verified connection between fibroids and heavy or prolonged menstrual bleeding.
How Long Does Bleeding Last with Fibroids?
In addition to prolonged periods or bleeding, some women report spotting in between their periods. Also, during bouts of particularly heavy menstrual bleeding, some women pass blood clots.
Whether or not you have been diagnosed with fibroids, this article in The National Institute for Child Health and Human Development (NICHD) advocates for “menstrual tracking.” In the article, Dr. Candace Tingen, Ph.D. program officer in NICHD’s Gynecologic Health and Disease Branch, states: “Think of menstruation as another vital sign. Menstruation, as a health metric like heart rate or blood pressure, is something women could track in the comfort of their own homes …”
If you have or suspect you have fibroids, use a cell phone app or a notebook to take daily notes on how long you bleed for, how heavy the flow is, and if there is between-periods spotting or blood clots. You should then share this information with your doctor. Based on your carefully tracked patterns and symptoms, they can advise you on the best treatments for you. the best course of treatment.
Fibroids Bleeding Between Periods
In addition to being at risk for heavier bleeding, some women with fibroids bleed or experience “spotting” between their periods. This is known as intermenstrual bleeding or, to use the clinical term, metrorrhagia. Spotting between periods doesn’t automatically signal that you have developed fibroids. If you experience “spotting,” you should be evaluated by a doctor immediately. In extreme cases, interperiods can be a sign of endometrial cancer.
Why Do Fibroids Hurt During Periods?
Fibroids not only change the length and frequency of periods, but they can also intensify your pain—particularly when heavy periods result in your passing blood clots.
Likewise, if the physical size of a fibroid is large enough to press on pelvic nerves, it causes pressure that extends through the abdomen, lower back, and legs, and creates cramping.
Fibroids and Irregular Periods
The length of the menstrual cycle can vary for individual women. But generally speaking, most women see a normal or predictable pattern develop and a consistent number of days between the first day of one period and the onset of their next period.
By contrast, irregular periods tend to have no predictable pattern or are extremely heavy or painful. Again, while fibroids can trigger irregular periods, irregular menstruation does not necessarily signal fibroids, and there are a number of other potential causes such as stress, eating disorders, other gynecological conditions, and excessive exercise.
Any disruption to your menstrual patterns should be assessed by a doctor. It’s important to determine why the period has become irregular in order to stop the bleeding, and prevent long-term damage and any potential restrictions to your fertility.
A popular treatment for abnormal bleeding is Uterine Fibroid Embolization (UFE), which is a non-invasive procedure that blocks the blood flow to fibroids causing them to shrink. UFE has a success rate of 85%, and the majority of women experience a return to normal periods after the treatment.
Conclusion
Before and after your diagnosis, fibroids can have a substantial impact on your periods and you should get any changes to your menstruation patterns checked by your doctor. There are plenty of ways to alleviate the pain and distress of fibroid-induced periods. We recommend speaking with a medical professional to find the right path for you.
If you’re interested in Uterine Fibroid Embolization as an option to stabilize your periods, book a free care consultation with a PainTheory Care Coordinator, or schedule an appointment with one of our partners.
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