Fibroid Bleeding

Uterine fibroids are noncancerous tumors that can grow in the uterus and can cause a host of painful and often life-impacting symptoms. Statistics show that 80% of all women will experience fibroids before the age of 50, but only 30% of these women will seek treatment for fibroid symptoms.

The most common symptom due to fibroids is heavy menstrual bleeding. The medical term for this condition is menorrhagia. The National Institute for Health and Clinical Excellence defined it as:

Menorrhagia is excessive menstrual blood loss, which interferes with a woman’s physical, social, emotional, and/or material quality of life.

A normal menstrual cycle occurs every 25-31 days and lasts from 3-7 days. Periods are considered heavy if a woman:

• Soaks through one or more sanitary pads or tampons every hour for several consecutive hours;
• Needs to use double sanitary protection to control menstrual flow;
• Needs to wake up to change sanitary protection during the night;
• Bleeds for longer than a week;
• Passes blood clots;
• Experiences signs of anemia like fatigue, brain fog, migraine-like headaches, and chewing/craving ice.

Women can experience breakthrough bleeding in between their periods, i.e. metrorrhagia, or periods that occur closer together than normal, i.e. polymenorrhea.

Menorrhagia affects around 10 million women in the United States every month and the most common reason is fibroids.

Often women with heavy periods don’t recognize this as being heavy, typically because they have been bleeding this way for some time. This can lead to delays in treatment.

How Do Fibroids Cause Heavy Or Prolonged Bleeding?

Each month, the lining of a woman’s uterus builds up and thickens, and later, if there is no fertilized egg to implant, the lining is discarded. The uterus naturally contracts to assist in removing the lining and this is why some women experience cramping and discomfort. The shedding lining presents itself as a menstrual period with bleeding that lasts between 3-7 days.

When a woman has fibroids growing on or within the lining of her uterus, they can interfere with the natural functions of the uterus. They can distort the shape of the uterus and cause heavy bleeding because:

• Abnormal pressure exerted on the lining of the uterus causes it to bleed more than normal;
• The ability of the uterus to contract may be interrupted rendering it unable to stop the bleeding;
• The growing fibroids can spur the growth of blood vessels, which can result in heavy menstrual bleeding, intermittent periods, or breakthrough bleeding;
• Elevated hormone levels can cause abnormally heavy bleeding during menstruation.

In addition to heavy bleeding, fibroids can also cause a host of other unpleasant symptoms, such as pelvic pain and pressure, back and leg pain, nausea, constipation, bloating, enlargement of the uterus and abdomen, and pain during sex. If fibroids are not treated, they will continue to grow larger, new ones may form, and heavy bleeding often becomes worse.

Anemia: A Dangerous Side Effect Of Heavy Bleeding

Three types of blood cells are continually created by your bone marrow: white blood cells, red blood cells, and platelet blood cells. The red blood cells are the ones that carry oxygen throughout your body and contain hemoglobin. Hemoglobin is a protein that contains iron and is vital as it transports oxygen from the lungs to every part of the body and also assists in expelling carbon dioxide.

With heavy periods, the amount of iron and hemoglobin lost in the blood is too much to be able to be replaced by a normal diet or even supplementation. This leads to iron deficiency anemia.

Fibroids are the most common cause of prolonged heavy bleeding that can lead to anemia. The continual loss of blood decreases the level of hemoglobin carrying red blood cells and causes fatigue, headaches, “brain fog”, dizziness, sallow skin, insomnia, hair loss, brittle nails, irregular heartbeat, as well as a condition called “pica” where you experience abnormal cravings for things like ice, corn starch, dirt/clay (kaolin), or chalk.

These symptoms of anemia can often affect a woman’s quality of life and in severe cases can become very serious, even life-threatening.

Video: Why Do I Chew Ice? Anemia Due to Fibroid Heavy Bleeding

Treatments For Fibroid Bleeding

Approximately 1 in every 3 women that are diagnosed with fibroids will eventually seek treatment to alleviate their symptoms. Besides heavy bleeding, fibroids can cause pain and pressure in the pelvic area, back and leg pain, bloating, protruding abdomen, constipation, urinary incontinence or frequent urination, pain during intercourse, fertility issues, and more.

Fibroid symptoms can sometimes be so debilitating that they can destroy a woman’s quality of life and adversely impact relationships. For these women, finding a solution becomes imperative. There are non-surgical and surgical treatments available to alleviate the symptoms and heavy bleeding caused by fibroids. Some of these treatments merely lessen the symptoms caused by fibroids but do not address the fibroids directly.

Over The Counter Solutions

Over-the-counter medications can help alleviate the pain, bloating, and discomfort that fibroids can cause. Medications like Naproxen and Ibuprofen are pain relievers and anti-inflammatories that can be used. A medication that is helpful for heavy bleeding is a relative of ibuprofen and acts directly at the uterine lining to lighten flow. This medication is only available as a prescription and is called tranexamic acid.

Hormone Therapies To Treat Heavy Bleeding

Many doctors will prescribe hormone therapy before recommending surgery for the relief of fibroid symptoms. Some of these may be:

Birth control pills or IUDs are sometimes prescribed with the intention of regulating hormones and controlling bleeding. However, hormones (particularly estrogen) will cause the fibroids to grow, and, eventually, this type of therapy will cease to work because of this.

SPRMs – Selective Progesterone Receptor Modulators block progesterone receptors which result in decreased thickness of the uterine lining and were first used as an emergency contraceptive. Studies to treat uterine fibroids were performed but a number of women experienced liver damage, resulting in liver failure; and for some required liver transplant. This medication lost its license and was removed for use in fibroids in March of 2020.

GnRH agonist – gonadotropin-releasing hormone agonists suppress ovulation by blocking the production of estrogen and progesterone. The most common of this class is Leuprolide acetate or Lupron. Women receive Lupron as an injection monthly for 3-6 months or a larger dose every 3 months for up to 6 months. The most common indication is used in patients who are too anemic to operate safely on.

Lupron typically puts a woman into immediate menopause and this will buy time for the surgeon to build up the patient’s iron and hemoglobin to be able to undergo surgery. There will be about a 30% reduction in the size of the fibroids while on this medication. It can make myomectomy surgery more difficult in women on Lupron due to a change in the interface between the fibroids and the rest of the uterus while on this drug. Once this medication is stopped, the fibroids will grow and return to their original size. There are significant side effects for women taking Lupron, most notably significant are hot flashes.

GnRH antagonists are hormone therapies that are only used for a short-term solution to inhibit the growth of fibroids. In addition to bringing on early menopause, they have other known negative side effects, and when the patient stops using GnRH therapy, the fibroids begin to grow again. These medications were developed to try to address the negative side effects of Lupron, most notably the severe hot flashes, significant bone loss, and injection-only formulation.

Elagolix and Oriahnn (Elagolix plus birth control pill) are examples of this class of medicines. There are Lupron-like side effects and with Oriahnn there is the added risk of blood clots and stroke. There are also no long-term studies on these medications in the use for fibroids. Given the history of the SPRMs (see earlier) and the availability of treatment options that have over 25 years of safety and efficacy (Uterine Fibroid Embolization), caution should be used in this class of medications until more independent research is performed.

SERMs – Selective Estrogen Receptor Modulators block the effects of estrogen in specific targeted areas. SERMS are used to treat estrogen-receptor-positive breast cancer, tamoxifen being the best known, but there has not been sufficient research done to prove that fibroids shrink in response to these agents. They are known to cause serious side effects including blood clots, possibly uterine cancer, and stroke. Other side effects that can occur are abnormal vaginal bleeding/discharge, pelvic pain, chest pain, shortness of breath, dizziness, headaches, fatigue, night sweats, hot flashes, mood swings, etc.

Endometrial Ablation To Treat Heavy Bleeding

Endometrial ablation is a procedure that strips the outermost layer of the uterine lining to stop or reduce the flow of heavy or continual menstruation and is best used for patients who do not have fibroid-related bleeding. This is due to the fact that ablation only affects the lining, but does not do anything to the fibroids which are causing the heavy bleeding.

In addition, these patients often have bulk-relayed symptoms, i.e. pelvic pain and pressure, bloating, back and leg pain, increased urinary frequency, which are completely unaffected by ablating the uterine lining. These patients are better treated with Uterine Fibroid Embolization (UFE). UFE treats all of the fibroids and both bleeding and bulk-related symptoms. It can also be performed in women interested in fertility, whereas women interested in future fertility cannot undergo endometrial ablation.

Video: UFE Vs. Endometrial Ablation

Surgery For Fibroid Removal To Stop Heavy Bleeding

There are a few procedures for surgical removal of fibroids, and each surgery can be performed using several techniques.

Myomectomy is the surgery to remove fibroids one at a time by basically dissecting them out of the uterus. The surgeon will then stitch the uterus back together, but the uterus is often weakened. Different surgical techniques used to perform a myomectomy are open myomectomy, laparoscopic myomectomy, and hysteroscopic myomectomy (like MyoSure). The recurrence rate of fibroids is about 62% within 5 years, and patients usually undergo additional surgeries.

Hysterectomy is a surgery that removes a woman’s uterus and sometimes, the cervix, ovaries, and fallopian tubes. There are different methods to perform a hysterectomy as well. After a hysterectomy, a woman can not become pregnant, and there are side effects and risks associated with a hysterectomy including organ damage, hemorrhage, blood clots, sexual dysfunction issues, incontinence, bone density loss, early menopause, and increased risk for heart disease.

Non-Surgical Fibroid Treatment To Stop Heavy Bleeding

Uterine Fibroid Embolization (UFE) is an outpatient procedure that does not involve surgery. It works by cutting off the blood supply to the uterine fibroids and shrinks or eliminates them entirely. The blood supply is blocked to the fibroids and they immediately begin to die off. As this occurs, the fibroids soften and shrink, and within 3 months, fibroid bleeding and other the patient’s symptoms are significantly better or gone entirely.

This procedure does not require a hospital stay and the results are permanent. The recovery time is typically 5-7 days and one of the best things about UFE is that allows women to keep their uterus and even have children afterward!

John C. Lipman, MD, FSIR, is a board-certified Interventional Radiologist, with over 25 years of experience in performing UFE. He has one of the nation’s largest experience in the UFE procedure with over 9,000 women treated. Despite what a woman might hear from her Gynecologist, almost every woman that is a surgical candidate will be a candidate for UFE.

If you are experiencing fibroid bleeding and other symptoms related to fibroids, call today to set up a consultation and request a second opinion. At the Atlanta Fibroid Center®, we want to help you get your life back without any surgery and without sacrificing your uterus.