Heavy Periods and Fibroids: When to Pay Attention

Heavy periods may be worth discussing with a doctor if you bleed for longer than seven days, soak through a pad or tampon every hour for several hours, pass clots larger than a quarter, feel dizzy or unusually tired, or have pelvic pressure or pain. These symptoms can have several causes, including uterine fibroids.

Understanding Uterine Fibroids and Preparing for a Better Conversation With Your Doctor

By Susan Hanna, Co-Founder

July is widely recognized as Uterine Fibroid Awareness Month: a time to make a common but often quietly endured condition easier to recognize and discuss. Awareness matters because symptoms such as heavy bleeding, fatigue and pelvic pain can gradually become someone’s “normal”—even when they are disrupting daily life or affecting their health. Fibroids are especially common by age 50, and Black women are more likely to develop them than white women.

What are uterine fibroids?

Uterine fibroids—also called leiomyomas (pronounced “lie-oh-my-OH-muhz”) or myomas (pronounced “my-OH-muhz”)—are growths made from muscle and connective tissue that develop in or around the uterus. They are almost always benign, meaning they are not cancerous.

Fibroids can be very small or grow much larger. Someone may have one fibroid or several, and their location can affect the symptoms they cause. Many people have no symptoms and may only learn about a fibroid during a pelvic examination or imaging test.

Symptoms worth paying attention to

Possible signs of fibroids include:

• Periods that are unusually heavy, painful or last longer than seven days
• Bleeding through a pad or tampon every hour for several hours
• Passing clots as large as a quarter or larger
• Pelvic pressure, fullness or pain
• A lower abdomen that appears or feels enlarged
• Frequent urination or pressure on the bladder
• Constipation or rectal pressure
• Lower-back pain
• Pain during sex
• Fatigue, weakness, dizziness or shortness of breath, which may be signs of anemia
• Difficulty becoming pregnant or complications during pregnancy

These symptoms do not automatically mean that you have fibroids. Heavy bleeding and pelvic discomfort can have several possible causes, which is why a medical assessment is important.

Your appointment checklist: what to track and bring

A physician can help more effectively when they understand not only that something feels unusual, but exactly what has changed. Before your appointment, write down the following information or notes from a period-tracking app. Estimates are fine—do not worry if you have not tracked everything perfectly.

Your bleeding pattern

☐ The first and last day of each recent period
☐ How many days the bleeding lasted
☐ Approximately how often you changed your pad, tampon, cup or period underwear
☐ Whether you needed to change products during the night
☐ Whether you used two products together to prevent leaking
☐ Whether you bled through clothing or bedding
☐ The approximate size and frequency of any blood clots
☐ Any bleeding or spotting between periods
☐ How often you changed your pad, tampon, cup or period underwear

Pain and pressure

☐ Where you feel pain or pressure
☐ Whether it happens only during your period or at other times
☐ Your pain level from zero to ten
☐ Whether pain affects sleep, exercise, work, school or sex
☐ Any increased urination, constipation, back pain or abdominal swelling

Changes in your overall health

☐ Unusual tiredness, weakness, dizziness or headaches
☐ Shortness of breath or a racing heartbeat
☐ Changes in appetite, weight or abdominal size
☐ Any medications, supplements or birth-control methods you use
☐ A family history of fibroids, heavy bleeding or anemia
☐ Whether you are pregnant, trying to conceive or may want children in the future

You may also find it helpful to bring notes from a period-tracking app, photographs of unusually large clots, or a record of how many menstrual products you used. The goal is not to prove that something is wrong. It is to give your healthcare professional a clearer picture of what you are experiencing.

Questions to ask your physician

Consider taking these questions with you:

1. Could fibroids explain my symptoms, and what other possible causes should we consider?
2. Should I have a pelvic examination, blood tests for anemia or an ultrasound?
3. If fibroids are found, how many are there, how large are they and where are they located?
4. Do they need to be monitored or treated?
5. What treatment options fit my symptoms and my future pregnancy preferences?
6. What changes should prompt me to contact you again or seek urgent care?

Fibroids are often confirmed through imaging, commonly an ultrasound. A complete blood count may also be considered when heavy bleeding could have caused anemia. Treatment is individualized: some fibroids require only monitoring, while symptomatic fibroids may be managed with medication, procedures or surgery. Decisions should consider the severity of symptoms, fibroid size and location, age, overall health and future fertility goals.

When bleeding may be an emergency

Seek emergency medical care if you are changing pads or tampons every hour for more than two hours and also feel lightheaded or dizzy, have chest pain, or are short of breath.

A difficult period should not automatically be dismissed as something you simply have to tolerate. Knowing what to notice—and arriving at your appointment with clear information—can help turn an uncertain conversation into a productive one.

This article is for general education and is not a substitute for medical diagnosis or treatment. Speak with a qualified healthcare professional about symptoms or concerns.

Trusted Resources for More Information

For reliable information about uterine fibroids, symptoms, diagnosis and treatment options, visit:

• Office on Women’s Health: Uterine Fibroids
  A clear, comprehensive overview from the U.S. Department of Health and Human Services, covering symptoms, risk factors, diagnosis and treatment. A Spanish-language version is also available.
• American College of Obstetricians and Gynecologists: Uterine Fibroids FAQ
  Patient-friendly guidance from the leading U.S. professional organization for obstetricians and gynecologists. It explains the different types of fibroids, possible tests and available treatment options.
• National Institute of Child Health and Human Development: Uterine Fibroids
  Research-based information from the National Institutes of Health, including how fibroids may affect bleeding, pain, pregnancy and fertility.
• Mayo Clinic: Uterine Fibroids—Symptoms and Causes
  An accessible explanation of symptoms, possible causes, risk factors and circumstances in which someone should seek medical care.
• ACOG: Abnormal Uterine Bleeding
  A useful companion resource for understanding what may constitute abnormal bleeding and when heavy bleeding may require urgent attention.

These resources are for education and preparation. They cannot determine whether an individual has fibroids or replace an examination by a qualified healthcare professional.