Uterine fibroid symptoms can include heavy or painful periods, bleeding between periods, lower-abdominal fullness or bloating, frequent urination, pain during sex, low back pain, constipation or rectal pressure, chronic vaginal discharge, incomplete bladder emptying, and increased abdominal distention [1]. Heavy bleeding can cause tiredness or shortness of breath from blood loss, which may lead to anemia [2]. In an ultrasound-screened cohort, the estimated cumulative incidence of uterine fibroid tumors by age 50 was over 80% for Black women and nearly 70% for white women [5]. Write down what happens, when it happens, and how it differs from your usual pattern.
What can fibroid bleeding look like?
Cleveland Clinic lists excessive or painful bleeding during periods and bleeding between periods among uterine fibroid symptoms [1]. Heavy menstrual bleeding means losing more blood than is typical during menstruation. Cleveland Clinic describes typical blood loss as about two to three tablespoons and heavy bleeding as more than five tablespoons [2].
A period lasting longer than seven days is one sign of heavy bleeding [2]. Other signs include soaking through a pad or tampon every hour for several hours, needing to wear more than one pad at a time, changing pads in the middle of the night, and passing blood clots the size of a quarter or larger several times a day [2].
Write down the dates of bleeding between periods, how long it lasted, and what protection you needed. Add whether the bleeding was part of the period you expected or occurred outside it.
The threshold for prompt professional evaluation is specific. If you’re soaking at least two pads or tampons per hour and that continues for two to three hours in a row, Cleveland Clinic says to seek prompt professional evaluation [2].
Cleveland Clinic lists hormone imbalance, polyps, fibroids, adenomyosis, infections, pregnancy complications, bleeding disorders such as von Willebrand disease, liver or kidney disease, cancers, and some medicines, including blood thinners, among causes of heavy menstrual bleeding [2].
What pressure, urinary, bowel, and pain symptoms are listed?
Cleveland Clinic lists a feeling of fullness or bloating in the lower abdomen, low back pain, constipation or rectal pressure, and increased abdominal distention [1]. Its symptom list also includes frequent urination and inability to empty the bladder completely [1].
Pain during sex and chronic vaginal discharge are also on the list [1].
Describe these symptoms in your own words. Include when they occurred and whether they are still present.
For urinary symptoms, record whether they occurred during the day, at night, or both. For pain during sex, record when it happened. For fullness, bloating, or distention, record when you noticed it.
Could blood loss feel like stress?
Cleveland Clinic says heavy bleeding can cause tiredness or shortness of breath from blood loss, which may lead to anemia [2]. Iron-deficiency anemia is usually caused by bleeding, and blood loss from periods is a listed cause [3]. People with heavy periods are at increased risk of iron-deficiency anemia [3].
The iron-deficiency anemia symptom list includes fatigue, headaches, irritability, muscle cramps, pale skin, pica, shortness of breath, a sore tongue, spoon-shaped nails, and a fast heart rate [3]. Add any of these symptoms to your notes, with when they occurred and whether heavy bleeding was happening at the same time.
Cleveland Clinic lists ferritin and total iron-binding capacity among blood work for iron-deficiency anemia [3]. Ask whether those tests should be part of the evaluation.
What should you record before an appointment?
| Symptom as Cleveland Clinic names it | What it can look like in an ordinary week | Detail worth recording |
|---|---|---|
| Excessive bleeding during periods | A period that lasts longer than seven days or requires frequent protection [2] | Start and end dates, heaviest bleeding, and protection changes |
| Bleeding between periods | Bleeding outside the period you expected [1] | Date, how long it lasted, and whether it required protection |
| Feeling of fullness or bloating in the lower abdomen | Fullness or bloating low in the abdomen [1] | When it occurred and whether it is still present |
| Frequent urination | Needing to urinate often [1] | Whether it occurred during the day, at night, or both |
| Pain during sex | Pain connected with sex [1] | When it happened and whether it is still happening |
| Fatigue or shortness of breath | Tiredness or shortness of breath during heavy bleeding [2] | Which symptom occurred, when it started, and whether bleeding was present |
Add low back pain, constipation, rectal pressure, chronic vaginal discharge, inability to empty the bladder completely, or increased abdominal distention if they apply [1]. Record when each happened and whether it is still present.
What are the four fibroid types?
A uterine fibroid, also called a leiomyoma, is a growth of muscle and tissue that develops within the wall of the uterus or on its surface [1].
Cleveland Clinic defines the types by position:
- Intramural fibroids are embedded in the muscular wall of the uterus and are the most common type [1].
- Submucosal fibroids grow under the inner lining of the uterus [1].
- Subserosal fibroids grow under the lining of the outer surface and can become quite large [1].
- Pedunculated fibroids attach to the uterus with a stalk or stem [1].
Cleveland Clinic lists ultrasonography, magnetic resonance imaging, computed tomography, hysteroscopy, hysterosalpingography, sonohysterography, and laparoscopy as tests used to find or assess fibroids [1]. For heavy bleeding, Cleveland Clinic lists pelvic ultrasound, blood tests, transvaginal ultrasound, MRI, a Pap test, cervical culture, endometrial biopsy, sonohysterogram, and hysteroscopy [2].
Ask which test is being considered and what it is intended to assess.
What does the research say about who develops fibroids?
The Office on Women’s Health puts the share of women who develop fibroids by age 50 at 20 percent to 80 percent and reports that fibroids are more likely in African-American women than in white women [4]. Cleveland Clinic reports that approximately 40% to 80% of people with a uterus have fibroids, most often between ages 30 and 50 [1].
In the ultrasound-screened cohort, fibroid tumors developed in Black women at earlier ages than in white women, and most Black and white women in the United States developed them before menopause [5]. Among premenopausal women in that cohort, 35% had a previous diagnosis of fibroid tumors. Of the premenopausal women with no previous diagnosis, 51% had ultrasound evidence of fibroid tumors [5].
What to do next
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Write down the dates and descriptions of bleeding, pain, pressure, urinary symptoms, bowel symptoms, discharge, fatigue, and shortness of breath.
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Note whether bleeding lasts longer than seven days, soaks protection every hour for several hours, requires more than one pad at a time, wakes you to change protection, or includes quarter-sized clots [2].
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Ask whether you need an evaluation for heavy menstrual bleeding and whether blood work should include ferritin and total iron-binding capacity [2][3].
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Ask which test is being considered to find or assess fibroids, and say: “What is this test meant to assess?” [1]
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Open the appointment with: “I’m having heavy or painful bleeding and these other symptoms: [name them]. I recorded the dates and how they differ from my usual pattern.”
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If you soak at least two pads or tampons per hour for two to three hours in a row, seek prompt professional evaluation [2].
Related on Ruby: fibroid symptoms and what are fibroids.
Sources
- Cleveland Clinic, Uterine fibroids. https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids
- Cleveland Clinic, Menorrhagia (heavy menstrual bleeding). https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding
- Cleveland Clinic, Iron-deficiency anemia. https://my.clevelandclinic.org/health/diseases/22824-iron-deficiency-anemia
- Office on Women’s Health, Uterine fibroids. https://womenshealth.gov/a-z-topics/uterine-fibroids
- Baird 2003, High cumulative incidence of uterine leiomyoma in black and white women, PubMed. https://pubmed.ncbi.nlm.nih.gov/12548202/