Fibroid Abnormal Bleeding

1. Heavy Menstrual Bleeding (Menorrhagia)

• Description: Fibroids can cause excessive bleeding during menstruation, which can result in soaking through pads or tampons every hour for several hours. The bleeding may last longer than usual, extending beyond the typical 3-7 days of menstruation.
• Cause: The presence of fibroids, especially submucosal fibroids (those that grow into the uterine cavity), can increase the surface area of the uterine lining, leading to heavier blood flow. They can also disrupt normal uterine contractions and increase blood flow to the uterus, contributing to excessive bleeding.

2. Prolonged Menstrual Bleeding

• Description: Some women with fibroids may experience longer-than-normal periods, where the bleeding lasts several days longer than typical menstruation (e.g., 10 or more days).
• Cause: Fibroids may affect the normal shedding of the uterine lining, causing the menstrual cycle to be prolonged.

3. Spotting Between Periods (Intermenstrual Bleeding)

• Description: In some cases, fibroids can cause bleeding between periods, known as spotting. This can occur even if a woman is not on her period.
• Cause: Fibroids that press on the inner lining of the uterus or cervix can irritate the endometrial lining or affect hormone production, leading to irregular bleeding.

4. Clotting

• Description: Some women with fibroids may pass large blood clots during their periods, which can be a sign of abnormal uterine bleeding.
• Cause: The fibroids can disrupt the normal blood flow in the uterus, leading to the formation of blood clots.

Why Fibroids Cause Abnormal Bleeding:

• Increased Blood Supply: Fibroids may have their own blood vessels, which can cause increased blood flow to the uterus and contribute to heavier menstrual bleeding.
• Altered Uterine Function: Fibroids, especially those near or within the uterine lining, can distort the normal structure of the uterus, impairing its ability to contract and shed the endometrial lining efficiently.
• Hormonal Influence: Fibroids are sensitive to hormones, particularly estrogen and progesterone. These hormones can influence the size and growth of fibroids and the lining of the uterus, which may lead to abnormal bleeding.

Diagnosis of Abnormal Bleeding Due to Fibroids:

• Pelvic Exam: A healthcare provider may detect fibroids during a pelvic exam, although they can be small and not detectable this way.
• Ultrasound: A common imaging technique used to confirm the presence, size, and location of fibroids.
• Hysteroscopy: A procedure in which a small camera is inserted into the uterus to examine the interior and detect fibroids.
• MRI: In some cases, a magnetic resonance imaging (MRI) scan may be used for more detailed imaging, especially for larger fibroids.

Treatment Options for Abnormal Bleeding Caused by Fibroids:

1. Medications:
   • Hormonal Therapies: Birth control pills, intrauterine devices (IUDs), or hormone therapy can help regulate menstrual cycles and reduce heavy bleeding.
   • Tranexamic Acid: This medication can help reduce heavy bleeding by preventing blood clots from breaking down too quickly.
   • GnRH Agonists: These drugs can shrink fibroids temporarily by suppressing estrogen production but are typically used only short-term due to potential side effects like bone thinning.
2. Minimally Invasive Procedures:
   • Uterine Artery Embolization (UAE): This procedure blocks the blood vessels feeding the fibroids, causing them to shrink and reducing bleeding.
   • Myomectomy: Surgical removal of fibroids, which can be done via hysteroscopy, laparoscopy, or abdominal surgery, depending on the size and location of the fibroids.
   • Endometrial Ablation: A procedure to destroy the uterine lining, which can help reduce heavy menstrual bleeding.
3. Surgical Removal of the Uterus (Hysterectomy): In severe cases where fibroids cause significant bleeding and other treatments are not effective, a hysterectomy (removal of the uterus) may be recommended. This is considered a permanent solution to fibroid-related bleeding.
4. Lifestyle and Supportive Care:
   • Iron Supplements: Women who experience heavy bleeding may become anemic. Iron supplements can help replenish red blood cell counts and combat anemia.
   • Dietary Changes: Eating a healthy, balanced diet rich in iron, folic acid, and vitamin C can help support overall health during abnormal bleeding episodes.

When to See a Doctor:

If you experience abnormal bleeding such as excessively heavy periods, prolonged menstruation, or spotting between periods, it’s important to consult a healthcare provider. A proper diagnosis can help determine whether fibroids are the cause and the most appropriate course of treatment.

Conclusion:

Fibroids can lead to abnormal bleeding, most commonly in the form of heavy or prolonged periods. Treatment options range from medication and minimally invasive procedures to surgery, depending on the severity of the symptoms and the size of the fibroids. If you suspect that fibroids are causing abnormal bleeding, a healthcare provider can help determine the cause and suggest appropriate treatments.