Can uterine fibroids cause heavy and prolonged bleeding?

Question

Hello doctor,

I am a 36-year-old female experiencing very heavy menstrual bleeding lasting seven to eight days with large clots. My hemoglobin has been low for several years due to this condition. An ultrasound shows a uterus measuring 4.25 inches × 4.25 inches × 3.45 inches, with multiple intramural masses in the myometrium, including a 1.81-inch anterior mass, a 2.36-inch fundal mass, and a 1.53-inch posterior mass. The endometrial thickness is 17 mm. The left adnexa shows an ovary with a 22 mm dominant follicle.

Additionally, I suffer from lower back pain if I stand for more than 30 minutes. I am struggling to lead a normal life and am unable to plan for a child.

Please advise me on possible treatment options.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns.

Your symptoms and ultrasound findings suggest multiple uterine fibroids (intramural fibroids) and endometrial thickening, both of which could be contributing to your heavy, prolonged periods, clotting, and anemia. Your lower back pain may also be due to the pressure exerted by the fibroids on surrounding structures.

Next steps to discuss with a gynecologist:

A. Managing heavy bleeding and anemia:

Iron supplements and diet: Since you have anemia, take iron supplements and consume iron-rich foods such as spinach, liver, lentils, and beetroot.
Tranexamic acid or hormonal therapy: Medications like Tranexamic acid (to reduce bleeding) or hormonal treatments (birth control pills or Progesterone therapy) may help regulate your cycle.
Endometrial ablation: If medical treatment does not control the bleeding and you are not planning pregnancy immediately, this procedure can help reduce blood flow.

B. Fibroid treatment options (considering fertility): Since you are planning for pregnancy, fibroids need to be addressed carefully:

Myomectomy (surgical removal of fibroids): This is the best option for preserving the uterus and improving fertility.
Uterine artery embolization (UAE): This procedure shrinks fibroids but may not be ideal if you plan to conceive.
GnRH agonists (hormonal therapy): Temporarily shrinks fibroids but is not a long-term solution if you are trying to get pregnant.

C. Endometrial thickness (17mm): Possible causes are

Hormonal imbalance: This can lead to endometrial thickening and heavy bleeding.
Fibroids or polyps: These may require further evaluation.
Endometrial hyperplasia or other conditions: A biopsy may be necessary if abnormal cell growth is suspected.

4. Addressing lower back pain:

Fibroid pressure on nerves: This can contribute to persistent pain.
Physiotherapy and posture correction: These may help relieve discomfort.
Myomectomy: If fibroids continue to grow, surgical removal may help reduce pain.

What you should do now:

Consult a gynecologist: Discuss surgical versus non-surgical options based on your fertility goals.
Monitor blood work: Check hemoglobin, iron, thyroid, and hormone levels.
Consider a myomectomy: If planning pregnancy, this may be the best treatment option.

Since this condition has significantly affected your quality of life for years, seeking specialist advice soon will help you regain control of your health and fertility.

I hope this helps you.

Thank you.