What are uterine fibroids and how do they affect menstrual periods. How can you manage fibroid-related pain at home. What medical treatments are available for uterine fibroids. How do fibroids impact women’s health and quality of life.

Understanding Uterine Fibroids: What Are They and Who’s at Risk?

Uterine fibroids are abnormal growths of muscle tissue that develop in the uterus. While technically classified as tumors, these growths are almost always benign (non-cancerous). Fibroids are surprisingly common, affecting many women without their knowledge.

These muscular growths, also known as leiomyomas or myomas, can vary significantly in size and number. Some fibroids may be as small as a popcorn kernel, while others can grow to the size of a grapefruit or larger. In rare cases, extremely large fibroids can even cause visible abdominal swelling.

Are certain women more likely to develop fibroids? Research indicates that several factors may increase risk:

• Age (most common in women in their 30s and 40s)
• African American heritage
• Family history of fibroids
• Obesity
• High blood pressure
• Low vitamin D levels
• No history of pregnancy

While these risk factors are associated with higher rates of fibroids, it’s important to note that any woman can potentially develop them. Regular gynecological check-ups can help detect fibroids early, even if you’re not experiencing symptoms.

The Impact of Fibroids on Menstrual Periods: Why the Extra Pain?

For many women, uterine fibroids can significantly impact their menstrual cycle, often leading to more painful and heavier periods. To understand why fibroids cause increased discomfort, it’s helpful to review the normal menstrual process.

During a typical menstrual period, the uterus sheds its inner lining. This process is triggered by chemicals called prostaglandins, which cause uterine contractions. These contractions help expel the uterine lining, but they can also cause pain and cramping.

How do fibroids exacerbate this process? There are several ways:

1. Increased surface area: Fibroids enlarge the uterus, creating more lining to shed each month.
2. Altered uterine contractions: Fibroids can interfere with normal uterine muscle function.
3. Pressure on surrounding tissues: Larger fibroids may press on nearby organs or nerves.
4. Blood flow changes: Fibroids can affect blood supply within the uterus.

These factors combine to intensify menstrual symptoms. Women with fibroids often report:

• More severe cramping
• Heavier blood flow, often with clots
• Longer-lasting periods
• Increased pelvic pressure or feelings of fullness

Can fibroids cause pain outside of menstruation? Yes, some women experience chronic pelvic pain or discomfort, lower back pain, or pain during sexual intercourse due to fibroids.

Beyond Painful Periods: Other Symptoms of Uterine Fibroids

While painful and heavy periods are common symptoms of uterine fibroids, they’re not the only ways these growths can affect a woman’s health. Fibroids can cause a range of symptoms depending on their size, location, and number.

What other symptoms might indicate the presence of fibroids?

• Abnormal bleeding between periods
• Anemia due to excessive blood loss
• Frequent urination or difficulty emptying the bladder
• Constipation
• Persistent vaginal discharge
• Abdominal or pelvic discomfort
• Visible abdominal swelling (in cases of very large fibroids)

Is it possible to have fibroids without any symptoms? Absolutely. Many women have small or few fibroids that don’t cause noticeable issues. These “asymptomatic” fibroids are often discovered during routine pelvic exams or imaging studies done for other reasons.

When should you consult a healthcare provider about potential fibroid symptoms? It’s advisable to seek medical advice if you experience:

• Periods lasting longer than 7 days
• Heavy bleeding that soaks through more than one pad or tampon per hour
• Severe pelvic pain or cramping
• Difficulty urinating or frequent urination
• Unexplained weight gain or abdominal swelling

Early detection and management of fibroids can help prevent complications and improve quality of life.

Self-Care Strategies: Managing Fibroid-Related Pain at Home

While medical treatments are often necessary for managing uterine fibroids, there are several self-care strategies that can help alleviate pain and discomfort, especially during menstrual periods. These approaches can be particularly beneficial for women with mild to moderate symptoms.

Over-the-Counter Pain Relief

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation. For optimal effect, start taking these medications a day or two before your period is expected to begin. Always follow dosage instructions and consult with a healthcare provider if you need to use these medications regularly.

Heat Therapy

Applying heat to the lower abdomen can help relax muscles and improve blood flow, potentially easing cramps and discomfort. Options include:

• Heating pads
• Hot water bottles
• Warm baths or showers

Exercise and Movement

Regular physical activity, even during your period, can help alleviate pain. Exercise promotes blood circulation and triggers the release of endorphins, the body’s natural painkillers. Low-impact activities like walking, swimming, or yoga can be particularly beneficial.

Relaxation Techniques

Stress and tension can exacerbate pain. Practicing relaxation methods may help manage discomfort:

• Deep breathing exercises
• Meditation
• Progressive muscle relaxation
• Gentle stretching

Dietary Adjustments

Some women find that certain dietary changes can help manage fibroid symptoms:

• Reducing caffeine intake
• Limiting alcohol consumption
• Eating a diet rich in fruits, vegetables, and whole grains
• Staying hydrated

Can dietary changes shrink fibroids? While there’s limited scientific evidence supporting specific diets for fibroid reduction, maintaining a healthy weight through proper nutrition may help manage symptoms and reduce the risk of fibroid growth.

Medical Interventions: Treatment Options for Uterine Fibroids

When self-care strategies aren’t sufficient to manage fibroid symptoms, various medical treatments are available. The choice of treatment depends on factors such as the severity of symptoms, size and location of fibroids, and the patient’s age and reproductive plans.

Medications

Several types of medications can help manage fibroid symptoms:

• Hormonal birth control (pills, patches, or intrauterine devices)
• Gonadotropin-releasing hormone (GnRH) agonists
• Tranexamic acid for heavy bleeding
• Iron supplements for anemia

How do these medications work? Hormonal treatments can help regulate menstrual cycles and reduce bleeding, while GnRH agonists can temporarily shrink fibroids. Tranexamic acid helps control heavy bleeding during periods.

Minimally Invasive Procedures

For women who don’t respond well to medication or prefer non-surgical options, several minimally invasive procedures are available:

• Uterine artery embolization (UAE)
• Magnetic resonance-guided focused ultrasound (MRgFUS)
• Endometrial ablation (for women who don’t want future pregnancies)

These procedures aim to shrink or destroy fibroids while preserving the uterus. They often have shorter recovery times compared to traditional surgery.

Surgical Options

In some cases, surgery may be the most appropriate treatment:

• Myomectomy: Surgical removal of fibroids while preserving the uterus
• Hysterectomy: Removal of the entire uterus (a last resort for women who have completed childbearing)

Surgical approaches can be traditional open surgery, laparoscopic (minimally invasive), or robotic-assisted, depending on the specific situation.

How do doctors determine the best treatment approach? Healthcare providers consider multiple factors, including:

• Severity and type of symptoms
• Size, number, and location of fibroids
• Patient’s age and overall health
• Desire for future pregnancies
• Previous treatments and their effectiveness

It’s crucial for women to have thorough discussions with their healthcare providers to understand all available options and choose the most appropriate treatment plan.

Fibroids and Fertility: Understanding the Connection

Uterine fibroids can potentially impact a woman’s fertility and pregnancy outcomes. While many women with fibroids can conceive and carry pregnancies to term without complications, others may face challenges.

How can fibroids affect fertility? There are several ways:

• Changing the shape of the uterus, which may interfere with embryo implantation
• Blocking fallopian tubes, preventing sperm from reaching the egg
• Altering blood flow to the uterine lining, affecting its ability to support a pregnancy
• Increasing the risk of miscarriage or preterm labor

Do all fibroids impact fertility equally? No, the effect of fibroids on fertility largely depends on their size and location. Submucosal fibroids, which grow into the uterine cavity, tend to have the most significant impact on fertility and pregnancy outcomes.

For women planning to conceive, it’s important to discuss fibroid management with a healthcare provider. In some cases, treating fibroids before attempting pregnancy may improve outcomes. Options might include:

• Myomectomy to remove problematic fibroids
• Medications to shrink fibroids temporarily
• Close monitoring during pregnancy for women with fibroids

Can fibroids grow during pregnancy? Yes, the hormonal changes of pregnancy can cause fibroids to increase in size. However, this doesn’t always lead to complications. Many women with fibroids have successful pregnancies with proper medical care and monitoring.

Living with Fibroids: Lifestyle Adjustments and Coping Strategies

Managing life with uterine fibroids often extends beyond medical treatments. Many women find that certain lifestyle adjustments and coping strategies can significantly improve their quality of life.

Dietary Considerations

While no specific diet has been proven to cure fibroids, some dietary changes may help manage symptoms:

• Increasing fiber intake to promote digestive health
• Consuming foods rich in iron to combat anemia from heavy bleeding
• Limiting red meat and high-fat dairy products
• Incorporating more fruits, vegetables, and whole grains

Some studies suggest that maintaining a healthy body weight may help control fibroid growth, as excess fat can contribute to higher estrogen levels, which may stimulate fibroid development.

Stress Management

Chronic stress can exacerbate fibroid symptoms and impact overall well-being. Effective stress management techniques include:

• Regular exercise
• Mindfulness meditation
• Yoga or tai chi
• Adequate sleep
• Engaging in enjoyable hobbies or activities

Clothing Choices

For women with larger fibroids or abdominal discomfort, choosing comfortable clothing can make a difference:

• Loose-fitting garments that don’t put pressure on the abdomen
• High-waisted pants or skirts to provide support
• Breathable fabrics to manage potential temperature changes

Planning for Heavy Periods

Women dealing with heavy menstrual bleeding due to fibroids often benefit from strategic planning:

• Keeping a period tracking app or calendar
• Carrying extra menstrual products
• Having a change of clothes available
• Considering menstrual cups or period underwear for added protection

Emotional Support

Living with chronic pain or heavy bleeding can take an emotional toll. Seeking support can be crucial:

• Joining support groups for women with fibroids
• Talking openly with friends and family about challenges
• Considering counseling or therapy if needed

How can partners or family members support someone with fibroids? Open communication, understanding, and practical help during difficult periods can make a significant difference. Educating oneself about fibroids and accompanying your loved one to medical appointments can also be valuable forms of support.

Remember, every woman’s experience with fibroids is unique. It may take time to find the right combination of medical treatments and lifestyle adjustments that work best for you. Regular communication with healthcare providers and a willingness to try different approaches can lead to improved symptom management and quality of life.

Obstetrics & Gynecology, Board Certified OBGYNs

A uterine fibroid is an abnormal growth of muscle tissue in your uterus. They are far more common than most women realize. Although a fibroid is technically a tumor, they are almost always benign or noncancerous. 

The highly skilled professionals at The Center for Women’s Health in Hampton and Newport News, Virginia, are experienced in treating uterine fibroids. Our team provides gynecology services to women who had no idea they had fibroids and others suffering from severe symptoms.

Symptoms related to fibroids 

A uterine fibroid, also known as a leiomyoma or “myoma”, can appear as a single muscular tumor nodule or as part of a multinodular cluster. Fibroids vary in how they affect you and in size. Some are very small, about the size of a popcorn kernel, while others are large, as big as a grapefruit. In rare cases, a fibroid can be so large it pushes out your abdomen.     

Large fibroids or clusters of fibroids are more likely to cause symptoms. Some of the symptoms you may experience include: 

• Painful periods and severe cramping
• Abnormal bleeding between periods
• Abnormally heavy menstrual bleeding
• Anemia (low iron) from heavy periods
• Pelvic pain or feelings of pelvic fullness
• Unexplained chronic lower back pain
• Discomfort during sexual intercourse

Fibroids can also bring about symptoms related to your urinary tract. For example, you may need to urinate often, have trouble emptying your bladder, be constipated, or have ongoing vaginal discharge.  

Uterine fibroids and period pain 

Each month, your uterus sheds its inner lining during your menstrual period. As that happens, your body releases chemicals called prostaglandins which trigger contractions that help shed the uterine lining. These chemicals can cause pain, inflammation, and intense cramping made worse by fibroids.  

The pain and cramping you feel during your period can be worse if you have fibroids because they increase the surface area of the uterine lining that must be shed. You may feel increased pelvic pressure, have a heavier blood flow with clots, or have severe cramps. 

Self-care for monthly fibroid pain

You can do several different things that may help your fibroid-related period pain. 

OTC medication

Over-the-counter medications can help reduce inflammation and ease your pain. Ibuprofen, naproxen, or acetaminophen may all be good choices when you first start feeling symptoms. Be sure to follow the instructions on the bottle, and start taking the medicine one or two days before you expect your period to start. 

Go for a walk

Regular exercise is excellent for your overall health. It improves blood flow and triggers the release of endorphins, which are your body’s naturally produced painkillers. Even if you feel uncomfortable and don’t want to walk, it may help. Exercising regularly throughout the month can improve symptoms during your period. 

Relax your muscles

Using a heating pad or a hot water bottle to soothe your abdomen may help. The warmth relaxes your muscles, stimulates blood flow, and may ease discomfort. A warm bath or shower may be equally relaxing and soothing. 

Rest 

Rest can help you take the edge off persistent period pain. Lying on your back with a pillow under your knees may ease the pressure, or you may find it comfortable to lay on your side with your knees pulled toward your chest. 

Breathing exercises

Focusing on your breath can help you relax. Find a comfortable place, place one hand over your chest, the other over your navel, and inhale slowly, filling your lungs. Feel your chest and belly rise in the process, and hold each breath briefly before you let it out; imagine your pain drifting out of your body with each exhale. 

Treating fibroids 

Sometimes at-home care isn’t enough. If painful periods disrupt your life, medical intervention could be the right approach. Depending on your situation, we may suggest medication to control heavy bleeding or to shrink your fibroids. You may also need iron supplements if you’re anemic due to heavy bleeding. 

In some cases, surgery to remove problematic fibroids is the best solution. Various surgeries can treat fibroids, and choosing the best approach depends on individual circumstances. Before making a recommendation, your provider discusses important factors to consider, such as your medical history and family planning goals. 

Schedule a visit with The Center for Women’s Health to learn more about fibroids, how they are treated, and your treatment options.

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Uterine Fibroid Pain Symptom Relief

Uterine fibroids can lead to painful periods and a heavier flow, but there are ways to ease these symptoms.

By Kerry WeissMedically Reviewed by Kara Leigh Smythe, MD

Reviewed: January 25, 2023

Medically Reviewed

Long-lasting period pain or menstrual pain that worsens as you get older may be a sign of noncancerous growths called uterine fibroids.Charday Penn/iStock

For most women, a certain degree of menstrual pain is normal. As many as 75 percent of women experience period pain during their reproductive years, notes a study in the August 2019 Journal of Women’s Health. But it can also be a sign of something more serious, like uterine fibroids.

What Are Uterine Fibroids?

If you’re experiencing long-lasting period pain, or pain that worsens as you get older, it may be a sign of uterine fibroids.

“Uterine fibroids are benign smooth muscle growths of the uterus,” says Linda Bradley, MD, the director of the fibroid and menstrual disorders center at Cleveland Clinic in Ohio. These growths are rarely cancerous, and they’re very common — about 80 percent of women develop fibroids by age 50, according to the U.S. Department of Health & Human Services.

That said, they’re more common in some populations than others. Although fibroids can develop at any age, uterine fibroids are most common in women ages 30 to 40. Black women are more likely to develop uterine fibroids than white women; fibroids tend to develop at a younger age and grow more quickly in Black women, as well.

Common Symptoms of Uterine Fibroids

Some women who have uterine fibroids may not experience any symptoms. Others, however, may experience a range of symptoms that affect their period and beyond, such as:

• Abdominal or lower back pain
• Pelvic pain and cramping
• Painful sex
• Heavy menstrual bleeding
• Long, frequent periods
• Bleeding between periods
• Anemia (from blood loss)
• Bladder or bowel pressure
• Frequent or urgent urination
• Bowel movements that are difficult, frequent, or urgent
• Increased abdominal size
• Miscarriage
• Infertility

“Your symptoms generally depend on the location and number of uterine fibroids,” says Dr. Bradley.

Why Uterine Fibroids Cause Painful Periods

Each month, your uterus goes through a cycle: It creates a thickened inner lining in case a pregnancy occurs. If pregnancy does not occur, your body sheds that lining — this is your period.

During a normal period, your body releases hormones called prostaglandins. These hormones can cause pain and inflammation and can increase the intensity of uterine contractions, which may worsen menstrual cramping. And women who have elevated levels of prostaglandins may experience even more severe menstrual pain.

Fibroids can make this pain more intense: First, fibroids put pressure on the uterine lining. Then, if you have fibroids within the uterine wall, or fibroids that protrude into the uterine cavity, more surface area is created, which means more thickened lining for your body to shed during your period — that is, a heavier flow.

“For women who bleed a lot, large clots can form,” says Bradley. “As all of this blood and clotting is trying to come through the narrow cervix and be expelled from the body, the uterus is contracting more, which can cause pain.”

In the days leading up to your period, you might feel more intense cramping as your uterus goes through its motions to force out the lining, and a stronger sensation of pressure when your period starts because of the heavier blood flow.

If the uterine fibroids are large, you also may feel a stronger sensation of pressure at the time of your period due to blood flow to the fibroids.

Treatment Options for Uterine Fibroid Pain

Aside from uterine fibroids, period pain can be caused by health conditions like endometriosis or ovarian cysts. So if you’re dealing with period pain, it’s important to see your doctor or gynecologist to determine the underlying cause and recommend the proper course of treatment, says Bradley.

If you are diagnosed with uterine fibroids, a variety of treatment options can help you manage symptoms like heavy menstrual bleeding, pelvic pain, and pressure, and certain medications also treat the underlying uterine fibroids.

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can help alleviate period pain and decrease bleeding, but do not shrink the size of the fibroids themselves.
• Hormonal birth control, such as the pill, the ring, injections, and intrauterine devices (IUDs), decrease bleeding and alleviate menstrual pain and cramping, but do not shrink the size of uterine fibroids.
• Oral medications, including hormonal or nonhormonal options, used to treat heavy menstrual periods can alleviate uncomfortable uterine fibroid symptoms.
• Hormone injections, such as gonadotropin-releasing hormone (GnRH) agonists, can induce a temporary menopause-like state and help shrink the size of uterine fibroids while you’re taking the medication, which in turn can improve your symptoms — but once you stop taking the drug, the fibroids usually grow back, and these medications cannot be taken long-term.
• Complementary therapies, ranging from heating pads to regular exercise and diet alterations, to strategies like acupuncture and massage, may help you manage pain and other symptoms related to uterine fibroids.

“If it’s getting to the point where your quality of life is bad — you’re staying home and missing work, activities, and hobbies — your physician needs to look at other therapies, such as surgical procedures,” says Bradley.

Hysterectomy, which removes the entire uterus, remains the definitive procedure for treating uterine fibroids. But today there also are a range of surgical options that are significantly less invasive and have a shorter recovery time.

A noninvasive procedure called MRI-guided focused ultrasound surgery (FUS) is performed while a patient is in an MRI scanner; MRI images allow the doctor to see where fibroids are located and target them with sound waves that destroy the tissue, according to the Mayo Clinic. Minimally invasive procedures, like radiofrequency ablation or embolization, also aim to shrink or remove the uterine fibroids. It’s important to note that MRI-guided FUS has a high re-intervention rate, according to research published in January 2022 in the International Journal of Hyperthermia, and isn’t as readily available as uterine artery embolization.

“The No. 1 cause of hysterectomies in America is uterine fibroids with pain, heavy bleeding, or discomfort,” says Bradley. “But we have new options — you’re not relegated to a hysterectomy. There are many other procedures that are less aggressive or less invasive. ”

Treatment is an individualized decision, and you need to see a physician who really looks at the whole patient, explains Bradley. The type of treatment you opt for should take into consideration your age, fertility plans, and the size and location of the uterine fibroids — and should be as minimally invasive as possible, she adds.

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causes of delayed and scanty menstruation, what to do and where to treat fibroids in Moscow

Updated: 02 September 2020

Boris Yurievich Bobrov — Head, Endovascular Surgeon | Endovascular surgeon, candidate of medical sciences, the largest personal experience of EMA in Russia

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Contents of the article

• Delayed menstruation with uterine myoma
• Treatment of fibroids with delayed menstruation
• Abundant menstruation with uterine myoma
• UAE in the treatment of uterine fibroids

Uterine fibroids is a disease that occurs mainly in women of reproductive age. One of the manifestations of pathology is a violation of the menstrual cycle. Monthly with uterine myoma are long, plentiful. Delayed menstruation with fibroids can be a sign of pregnancy. Blood loss depletes a woman’s body. In this case, doctors suggest removing the uterus. This news causes anxiety, can cause a depressive state. If you are faced with the problem of uterine fibroids, please contact us.

You will be booked in for an appointment and treatment will be organized in the leading clinics for the treatment of fibroids in Moscow. The doctors who work in them will find out why there is no menstruation in fibroids and perform embolization of the uterine arteries. After the procedure, the menstrual cycle is normalized. The procedure allows you to heal a woman and save the uterus. We will accompany you at all stages of treatment. You can send the research results to your e-mail address and, after analyzing them, get expert advice by e-mail.

Delayed menstruation due to uterine myoma

Can there be a delay in menstruation with uterine fibroids? Violation of hormonal balance entails a violation of the cyclical nature of menstruation. Sometimes menstruation occurs 2 times a month, and other patients have scanty periods with uterine myoma. Much less often, patients note a delay in menstruation with myoma. The reasons are as follows:

• ovarian dysfunction at the initial stage of uterine fibroids formation;
• altered structure of the muscular wall of the uterus, covered from the inside by the endometrium;
• violation of the vascular system of the endometrium.

The absence of menstruation with fibroids is observed in case of pregnancy. Hard physical work, nervous strain, acute and chronic stress, climate change, taking certain medications, including contraceptives, are often the causes of delayed menstruation.

Treatment of fibroids with delayed menstruation

Women often ask: “If there is a delay in menstruation with uterine fibroids, what should I do?”. Call us immediately. The gynecologists of the clinics we cooperate with find out the cause of menstrual irregularities using modern research methods. Treatment for delayed menstruation is aimed at normalizing the hormonal background. The drugs nafarelin, zoladex, decapeptyl inhibit the production of hormones. When taking these medicines, menstruation stops for a while. Reduce the production of estrogen duphaston and norkolut.

Quite often, doctors prescribe to patients suffering from uterine fibroids, with a delay in menstruation, herbal preparations, which consist of the following ingredients:

• nettles;
• hops;
• chamomile flowers;
• wheatgrass rhizomes;
• valerian root;
• shepherd’s bag;
• upland uterus (red brush).

With scant discharge during menstruation, traditional healers recommend taking seeds and parsley root. Doctors of gynecological clinics with whom we cooperate perform uterine artery embolization in case of uterine myoma. Due to the cessation of the supply of nutrients to the fibroid tissue, the nodes decrease in size, the normal structure of the uterus is restored, and the menstrual cycle is normalized.

Abundant menstruation with uterine myoma

Pathologically heavy periods with fibroids occur for the following reasons:

• thickening of the endometrium (inner layer of the uterus) due to an increased level of the hormone estrogen in the blood, which leads to uneven detachment of the endometrium or its incomplete detachment during menstruation;
• increase in the size of myomatous nodes, which is accompanied by a violation of the integrity of the vessels of the uterus;
• violations of uterine contractility, as a result of which the spiral arteries lose the ability to be clamped.

With uterine fibroids, the volume of blood released during menstruation increases to 150 ml. Allocations are scarlet, with an admixture of blood clots. With menorrhagia, a woman is forced to change hygiene products (sanitary pads or tampons) every hour or more often. The duration of menstruation increases to 10 days. Chronic blood loss leads to the development of iron deficiency anemia. The disease is manifested by the following symptoms:

• weakness;
• dizziness;
• fatigue;
• pallor of skin and mucous membranes;
• brittle nails;
• hair loss.

If you have these symptoms, you should immediately consult a doctor. Gynecologists conduct therapy aimed at normalizing hormonal levels and stopping bleeding. Iron supplements are used to prevent and treat anemia. With heavy menstruation, doctors carry out hemostatic therapy with tranexam, dicinone, vikasol, etamsylate. In order to increase the contractility of the uterus, patients are prescribed oxytocin. Askorutin strengthens the vascular wall.

With the ineffectiveness of conservative therapy, the development of severe anemia, surgical treatment is performed. In most cases, it consists in removing the uterus. After the operation, the woman loses her reproductive organ, loses the opportunity to give birth to a child. After removal of the uterus, many patients develop posthysterectomy syndrome, mental health is disturbed.

Doctors of the clinics with whom we cooperate, based on their own extensive experience and statistical data, believe that the indications for removal of the uterus in case of myoma are unreasonably expanded. We perform uterine artery embolization (UAE), a procedure originally used to stop postpartum uterine bleeding. Endovascular surgeons inject inert microparticles into the uterine arteries, which block the lumen of the vessels supplying blood to the myoma. Bleeding stops, the menstrual cycle normalizes over time. The woman manages to save the uterus.

In some cases, menstruation becomes so abundant and long in time that it develops into acyclic bleeding. This happens when the myomatous nodes are located in the submucosal layer or intermuscular space of the uterus. Bleeding with uterine fibroids can open in the middle of the cycle due to the release of endometrial residues, which, due to the unevenness of the mucous layer, not all stood out during menstruation, and the loss of the uterus’s ability to contract. The arteries are not compressed, which causes bleeding.

The following factors provoke the opening of bleeding:

• thickening of the mucous membrane of the uterus;
• enlarged uterus;
• changes in uterine arterial vessels and venous plexuses.

If the amount of bloody discharge from the vagina exceeds 80 ml per day, we are talking about uterine bleeding. The woman urgently needs hospitalization, where our gynecologists will prescribe appropriate treatment for her. If indicated, doctors perform curettage. Our doctors perform uterine artery embolization for patients suffering from uterine fibroids during heavy periods.

UAE in the treatment of uterine fibroids

Uterine fibroids is a disease that develops when the female body is exposed to damaging factors, the main of which is menstruation. Often, uterine fibroids have many foci in the uterus or cervix. The size of the nodes can vary from a few millimeters to several centimeters. The main source of blood supply to myomatous nodes are the uterine arteries. An extensively developed network of blood supply collaterals allows maintaining the blood supply to the uterus at a sufficiently high level even when the uterine arteries are turned off from the bloodstream. This allows embolization of the uterine arteries without the risk of disturbing the blood supply to areas of the uterus that are not affected by the pathological process.

The uterine arteries are the main source of blood supply to the uterus. They are almost always the only source of blood supply to myomatous nodes. Myomatous formations, due to their structural features, are not able to build a network of arterial collaterals, therefore, in the absence of blood supply to the myomatous node, they become completely cut off from the bloodstream. This is due to the fact that the arterial vessels that feed the myomatous nodes are the terminal branches of the uterine arteries.

An endovascular surgeon, when performing embolization of the uterine arteries through a thin catheter, introduces small emboli into the lumen of the uterine artery. The embolizing particles are made of a special polymer. Each embolus has a strictly specific size. When entering the uterine arteries, these particles selectively penetrate into their terminal branches, through which blood enters the myomatous nodes.

A small number of emboli enter the small arteries that take part in the blood supply to the uterus. In this case, the blood supply to the uterus is not disturbed, because the number of emboli is minimal, they are quickly excreted through the well-developed vascular network with the blood flow. Due to the absence of collaterals, the blood flow in the myoma nodes is not restored. Emboli that have entered the terminal branches of the uterine arteries remain in them. They are enclosed between fibrin fibers and thrombotic masses that form in a clogged vessel.

After that, the tissue of the myomatous node is replaced by connective tissue. During the procedure, the doctor slowly injects a suspension of emboli into the lumen of the uterine arteries until the “end point” of embolization is reached. This is a combination of angiographic signs, which with a high degree of probability allow us to judge that the arterial vessels of the myomatous node are clogged. These signs are determined using a radiopaque substance that doctors use during the embolization process.

The use of a contrast agent simplifies the intervention, as it allows embolization of only the uterine arteries and excludes the entry of emboli into other arteries.

After the cessation of blood supply to the myomatous node, fibrosis begins in it – the process of replacing smooth muscle cells with connective tissue. It lasts a year. During this time, the node decreases in size and is an accumulation of connective tissue that does not grow and does not create problems for the woman.

Part of the myomatous nodes that grow into the lumen of the uterus, after embolization, may behave differently. Fibrous changes that occur in them lead to the fact that the node loses contact with the wall of the uterus, is pushed into its cavity and after a while exits through the vagina. The uterus itself gets rid of myoma formation.

After embolization of the uterine arteries, the structure of the muscular layer of the uterus and endometrium is restored. The menstrual cycle is normalized, menstruation comes on time and lasts the allotted time. A woman’s libido is restored, if desired, she can become pregnant and give birth to a healthy child. Then a delay in menstruation can be a sign of pregnancy.

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References:

1. Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of tumor nodes in uterine myoma // Obstetrics and Gynecology. – 1983. – T. 4. – S. 13-16.
2. Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
3. Meriacri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib honey journal 1998; 2:8-13.
4. Bobrov B.Yu. Uterine artery embolization in the treatment of uterine fibroids. The current state of the issue // Journal of obstetrics and women’s diseases. 2010. №2. pp. 100-125
5. B. Yu. Bobrov, SA Kapranov, VG Breusenko et al. Uterine artery embolization: a modern view of the problem. “Diagnostic and Interventional Radiology” Volume 1 No. 2 / 2007

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Bleeding with uterine fibroids, uterine bleeding

Myoma is a benign neoplasm that occurs in many women. But in most cases, there are no symptoms, and the woman does not even know that there are myomatous nodes in her uterus. The diagnosis is established by chance, for example, during an ultrasound examination of the pelvic organs or the abdominal cavity.

In general, fibroids are not dangerous. These are benign formations, they never transform into cancer. But they can cause quite unpleasant symptoms. One of the most common is uterine bleeding.

Long periods for uterine fibroids

Women normally have a monthly cycle of 25-31 days. Menses last from 3 to 7 days. During this time, a woman on average loses 50 ml of blood, about 2-3 tablespoons. Maximum – 80 ml.

The phrase “uterine bleeding” can refer to different conditions, each of which has its own medical term:

• Menorrhagia – long, heavy periods that last more than a week, and during which a woman loses more than 80 ml of blood. They occur regularly, at approximately the same time intervals, like regular periods.
• Metrorrhagia – irregular bleeding that occurs between periods.
• Polymenorrhea – periods that recur more than 21 days later.
• Menometrorrhagia – frequent, profuse and irregular bleeding.
• Dysmenorrhea – painful periods.

Irregular, painful, profuse and prolonged periods are most characteristic of uterine fibroids. These symptoms are most pronounced in reproductive age. During menopause, they usually disappear (but not for everyone), as the level of hormones in the body drops, and the fibroids shrink in size.

As a rule, submucosal nodes that are located under the mucous membrane in the uterine cavity lead to heavy menstruation and bleeding in fibroids.

They prevent the mucosa from contracting, which makes bleeding longer and more profuse. It is they who are most often manifested by vivid symptoms, while nodes of other localizations (in the thickness of the uterine wall, outside) are often “silent”. Significant symptoms can be caused by a submucosal nodule as small as 1–3 cm in diameter.

What symptoms may occur?

You need to see a gynecologist if you have the following symptoms:

• You notice that your periods are heavier than before. A woman may notice that she began to spend more hygiene products, she has to choose more “drops”.
• During menstruation, you feel worse, soreness occurs. Worried about weakness, increased fatigue.
• The duration of menstruation has increased.
• There is pressure, discomfort, pain in the pelvis.
• Enlargement of the abdomen, something solid can be felt in it. If the fibroid is large enough, it protrudes, is noticeable when the woman lies on her back.
• Disturbed by pain in the pelvis, legs.
• Urination has become frequent or difficult.
• Constant constipation.
• Your vagina bleeds when you don’t have your period.

These signs may indicate not only fibroids, they occur in various diseases. An accurate diagnosis will be established by a gynecologist after examination and ultrasound.

Anemia due to fibroids

Continuous blood loss due to fibroids can lead to anemia. The level of erythrocytes and hemoglobin in the blood decreases. The woman constantly feels tired, becomes pale, suffers from headaches and dizziness. Sometimes the appetite is perverted and drawn to inedible things – for example, you may want to gnaw on a piece of chalk. Hair loss and brittle nails are also possible symptoms of anemia.

The brain of an anemic woman is constantly in conditions of oxygen starvation. There is “fog” in the head, the quality of life is reduced. Appearance deteriorates. And all this is due to fibroids.

How to reduce and stop bleeding in uterine fibroids?

To stop bleeding and normalize periods, you need to remove the cause of the problem. Everything else, including taking iron supplements and painkillers, are only temporary half-measures. Myoma, which is accompanied by symptoms, is a direct indication for treatment.

Previously, by and large, only two operations were available – removal of fibroids (myomectomy) or the entire uterus (hysterectomy). No uterus – no bleeding – no problem. Unless, of course, we take into account the risks that are present during any operation, the relatively high probability of recurrence in the next two years and complications after the removal of one of the main organs of the female reproductive system.

Currently, there is a minimally invasive intervention – uterine artery embolization, abbreviated UAE. During the procedure, the doctor makes a puncture in the upper part of the thigh, inserts a special catheter through it into the uterine artery, and injects an embolizing drug. The latter consists of microspheres that block the blood flow of the myomatous node, the myoma is deprived of oxygen and “dries out” – it is replaced by connective tissue. Fast, safer than myomectomy, no anesthesia (but not painful – local anesthesia is performed at the puncture site), and the efficiency reaches 98%.