Statistics show that approximately 25% of women experience abnormal bleeding during their cycle, which includes heavy bleeding, irregular bleeding, spotting, breakthrough bleeding, or abnormally prolonged bleeding. Today we want to talk about how uterine fibroids and bleeding between periods are related.
Menstrual periods vary among women, but there are universally accepted standards for the duration of each, how much bleeding there should be, and how often they should occur. Periods that last 3-7 days with blood loss between 3-5 tablespoons total occurring approximately every 21-35 days and is considered normal.
Abnormal bleeding or spotting between regular menstrual periods can cause anxiety and frustration so a consultation with your OB/GYN is the best course of action. The cause behind irregular bleeding patterns could be related to the cervix, vaginal wall, contraceptives, uterine fibroids, and more rarely, cancer.
What Is Spotting Between Periods?
The term “spotting” is used by many people to indicate bleeding that may or may not be normal outside of their usual menstrual cycle but each may mean something different so let’s break down some common terms and what they mean.
Spotting medically means a very slight amount of bleeding or a reddish tinge when wiped with tissue, or a few small drops in the underwear that is outside of your period and does not require the use of a tampon or a pad.
Light bleeding is considered part of your menstrual cycle and is very light bleeding that occurs just before or after your period.
Breakthrough bleeding is heavy enough to require the use of sanitary products and occurs mid-cycle when your period has already finished and it is not time for the next one yet. Some women who take oral contraceptives experience breakthrough bleeding due to low estrogen levels. If the mid-cycle bleeding is not related to contraceptives it is considered abnormal uterine or vaginal bleeding.
What Can Cause Spotting or Breakthrough Bleeding?
Abnormal bleeding coming from the cervix could be due to:
- Sexually transmitted infections;
- Irritation from a tampon or spermicide;
- Benign cervical polyps often randomly bleed or can bleed after intercourse or after a routine pap test;
- Cervical ectropion is a common cause of spotting in younger women who are taking birth control pills and occurs when cervical canal lining tissue is also present on the surface of the cervix. It is not a serious condition but can be annoying because the cervix can start bleeding from any type of contact.
Abnormal bleeding coming from the uterus could be due to:
- Uterine fibroids – these non-cancerous tumors can grow in and on the uterus and can cause prolonged and heavy periods. Depending on where the fibroids grow, like if they protrude into the uterus, can cause breakthrough bleeding. Spotting due to fibroids will often manifest with a discharge that is brown or dark in color often containing coagulated blood. Fibroids contain blood vessels that can break off and be expelled if damaged;
- Uterine polyps are similar to cervical polyps but they originate on the uterine wall. Like cervical polyps, they can be unpredictable and randomly start bleeding. About 8% of women who are of reproductive age experience uterine polyps;
- Hyperplasia is most often caused by an excess of estrogen and causes the lining of the uterus to build up abnormally;
- Endometriosis causes irregular bleeding and breakthrough bleeding originating from the tissue and cells inside the uterus and outside of the uterus;
- Pelvic inflammatory disease (PID) can cause abnormal vaginal discharge or abnormal breakthrough bleeding;
- Thyroid issues;
- Pregnancy or implantation;
Why Do Fibroids Cause Abnormal Bleeding?
Experts do not understand exactly how fibroids cause spotting or irregular bleeding in some women but there are several theories. Possible causes could be:
- Excess hormones;
- Fibroids can exert pressure on the uterine lining causing trauma to the veins and create excess bleeding;
- Fibroids can interrupt the normal functionality of the uterus and inhibit it from contracting properly, preventing it from stopping the bleeding;
- Fibroids can cause increased growth of blood vessels which can cause more bleeding.
Is My Spotting Between Periods Caused By Fibroids?
Abnormal bleeding can be a result of many women’s health issues or it can be a normal side effect of contraception or medication. Experiencing breakthrough bleeding between periods is most often considered abnormal and should be explored further to determine a cause.
It is often helpful to keep a diary of your monthly cycle including the days of unusual or unexpected bleeding, how long the bleeding lasts, the amount of bleeding, any associated pain, as this can help your doctor create a treatment plan.
Apart from bleeding between periods and heavy prolonged menstrual bleeding, there are some common “bulk” symptoms that are associated with fibroids and if one or more of these shows up in your diary along with the abnormal vaginal bleeding it may point to uterine fibroids as the cause.
Bulk symptoms of fibroids include:
- Pelvic pain & pressure;
- Urinary frequency;
- Enlarged uterus.
Lesser-known symptoms include back or leg pain, diarrhea, nausea, fatigue, and other symptoms resulting from anemia – a condition that can occur due to chronic blood loss.
What Test Can Show If Fibroids Are Causing Spotting?
An MRI test can be done to determine if uterine fibroids are present in the abdomen and also identify their location, size, and number. If fibroids are discovered, and you have experienced bleeding between periods, heavy prolonged bleeding, or the discharge of blood clots then the fibroids are most likely the cause. The best course of action would be to eliminate the fibroids which would result in the elimination of the symptoms.
How To Stop Irregular Bleeding Between Periods Caused By Fibroids?
Most doctors attempt to use the least invasive type of treatment available to address irregular bleeding symptoms. The treatment chosen will depend on each woman’s specific situation but treatments may be hormonal, surgical, or non-surgical.
Hormonal treatment – many doctors will try treating abnormal bleeding issues with hormone therapy. This could include oral contraceptives, IUD, or GnRH agonists.
Surgical treatment – a myomectomy or a hysterectomy are the surgical treatments available to remove uterine fibroids and both involve the significant risks of surgery. A myomectomy attempts to remove the fibroids one at a time from the uterus while a hysterectomy removes the entire uterus. A myomectomy is often not sufficient to remove all the fibroids and patients have reoccurring fibroid growth within 5 years and a hysterectomy results in the total loss of the uterus. Both surgeries have significant downsides.
Endometrial ablation can be suggested to women who are not interested in future fertility and suffer from heavy bleeding. While some patients with fibroids and heavy bleeding undergo ablation, these patients are better served with UFE (see below). Ablation only addresses the lining but does not treat the fibroids. These patients often have bulk-related symptoms, e.g. pelvic pain/pressure, bloating, increased urinary frequency, that is not relieved at all by the ablation.
Video: Why Endometrial Ablation Isn’t A Good Option for Fibroid-Related Bleeding
Nonsurgical treatment – Uterine Fibroid Embolization (UFE) is a non-surgical, outpatient treatment method for fibroids that is safe, highly effective, less invasive and has a much shorter recovery time than the surgical options. UFE is performed by an Interventional Radiologist (IR), unlike the surgical options that are done by an OB/GYN.
Dr. John Lipman of the Atlanta Fibroid Center® has over 25 years of experience in UFE and a proven track record of excellent results. Before settling on a surgical approach and subjecting your uterus to possible damage or imminent removal, please consider a second opinion from an experienced IR like Dr. John Lipman. After UFE, most women share a common sentiment: “Why didn’t I do it sooner!”
UFE treats all fibroids and eliminates their symptoms, including spotting between periods, breakthrough bleeding, and heavy prolonged menstrual bleeding. If you want to learn more about the procedure and confirm that you are a candidate for UFE, contact Atlanta Fibroid Center® at (770) 953-2600 or request an appointment online.