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Women's Health Guide

Fibroids & Period Health

When your period is telling you something

Up to 70%
of women will develop fibroids by age 50, though many have no symptoms
⚠
Medical disclaimer

This page provides general health information. It is not a substitute for personalised medical advice, diagnosis, or treatment. Every person's situation is different. If you have concerns about your health, please speak to your GP or a qualified healthcare professional.

Fibroids (uterine leiomyomas) are benign (non-cancerous) growths of the smooth muscle and connective tissue of the uterus. They are extremely common - research suggests that up to 70% of women will develop fibroids by the age of 50, though many will never know because their fibroids cause no symptoms at all.

When fibroids do cause symptoms, the most common are heavy or prolonged periods and pelvic pressure. Heavy menstrual bleeding is frequently normalised or dismissed, when in fact it is defined clinically as any blood loss that impacts quality of life - and it can lead to iron deficiency anaemia if left unaddressed.

Your period is not just an inconvenience. Changes in cycle heaviness, duration, timing or pain are worth paying attention to - they can be the first indication of an underlying and treatable condition.

Symptoms to know

Heavy menstrual bleeding (HMB)
NICE guidelines defines HMB as excessive menstrual blood loss that interferes with physical, social, emotional and material quality of life. Practically: soaking through a pad or tampon every hour or two, passing clots larger than a 10p coin, or having periods lasting longer than 7 days. This warrants investigation.
Pelvic pressure or a feeling of fullness
A sensation of heaviness or pressure in the pelvis, particularly if new or worsening. Larger fibroids can press on surrounding structures.
Frequent urination or difficulty emptying the bladder
Fibroids positioned towards the front of the uterus can press on the bladder, causing urgency, frequency, or incomplete emptying.
Bowel symptoms or lower back pressure
Fibroids growing towards the posterior aspect of the uterus can press on the bowel or cause lower back aching.
Pain during sex
Depending on location, fibroids can cause pain during penetrative sex. This should always be mentioned to a clinician, as it may prompt investigation for co-existing conditions such as endometriosis.
Abdominal swelling
An enlarged uterus due to fibroids can cause visible abdominal distension. Women sometimes describe looking pregnant. This should be assessed by a clinician.
Fatigue
Often a secondary symptom of heavy periods and the iron deficiency anaemia that can result. NICE guidelines recommends checking full blood count and ferritin (stored iron) in women with heavy periods. Ferritin can be low even when haemoglobin appears normal.

What actually helps

Know what counts as heavy
NICE guidelines defines heavy menstrual bleeding as blood loss that impacts quality of life - not a specific volume. Practically: soaking a pad or tampon every hour or two, passing clots, bleeding for more than 7 days, or needing to use both a pad and tampon. If this sounds familiar, a GP appointment is warranted. You do not have to simply manage it.
Check ferritin, not just haemoglobin
Iron deficiency can be present - and causing symptoms - before anaemia shows up on a standard full blood count. NICE guidelines recommends checking ferritin (stored iron) in women with heavy periods. Chronic iron deficiency causes fatigue, brain fog, breathlessness, and hair loss - symptoms often attributed to stress or a busy lifestyle. Ask specifically for ferritin to be checked.
Tranexamic acid reduces blood loss by around 40-50%
Tranexamic acid is a non-hormonal antifibrinolytic tablet that reduces menstrual blood loss. NICE guidelines reports it reduces blood loss by approximately 40-50% compared to placebo. It is taken only during the period, has a good safety profile, and is a reasonable first-line option if you prefer to avoid hormonal treatment. It is available on NHS prescription.
The Mirena coil is highly effective for heavy periods
The levonorgestrel IUS (Mirena) is recommended by NICE guidelines as first-line treatment for HMB. It reduces blood loss by around 90% in most women within one year. It is effective for fibroid-related heavy bleeding, long-lasting (5-7 years), and is also a highly effective contraceptive. If you have not been offered this as an option, it is worth asking about.
Understand the non-surgical and surgical options
For women where medical management is insufficient, options include: myomectomy (surgical removal of fibroids preserving the uterus), uterine fibroid embolisation (UFE - a minimally invasive radiology procedure that cuts off blood supply to fibroids), and hysterectomy. UFE in particular is underutilised - NICE guidelines supports its use and it has high patient satisfaction rates. These options should be discussed with a specialist.
Track your cycle
Keeping a record of cycle length, period duration, heaviness, clot passing, and associated symptoms provides invaluable information for a GP or gynaecology appointment. NICE guidelines suggests a pictorial blood assessment chart (PBAC) as a validated way to quantify blood loss. Many period tracking apps can help with this.

Myths worth busting

Myth
“Fibroids always cause problems”
The majority of fibroids are entirely asymptomatic and are discovered incidentally on scans performed for other reasons. Asymptomatic fibroids do not require treatment - only monitoring where appropriate. NICE guidelines and the Royal College of Obstetricians and Gynaecologists (RCOG) reflect this in their guidance.
Myth
“Heavy periods are just part of being a woman”
Heavy periods are common, but not inevitable, and should not simply be tolerated. They can indicate underlying conditions including fibroids, adenomyosis, endometrial polyps, thyroid disorders, or bleeding disorders. NICE guidelines sets out a clear pathway for investigation and management. Treatment options are effective.
Myth
“Fibroids always need surgery”
Many women with symptomatic fibroids are effectively managed with medical treatments such as tranexamic acid, the hormonal IUS, or GnRH analogues (which temporarily shrink fibroids). NICE guidelines sets out a stepped approach to management. Surgery is not the automatic or only recommendation.
Myth
“You cannot get pregnant with fibroids”
Most women with fibroids conceive naturally and have uncomplicated pregnancies. The exception is submucosal fibroids (those that distort the uterine cavity), which can impair implantation. The RCOG advises that submucosal fibroids should be assessed and managed before fertility treatment. The majority of fibroid types do not significantly affect fertility.

Frequently asked questions

How do I know if I have fibroids?
Fibroids are most commonly diagnosed on pelvic ultrasound. Your GP may suspect fibroids based on heavy periods, an enlarged or irregular uterus on examination, or pelvic symptoms. Many are found incidentally. If symptoms are significant but ultrasound is normal, MRI can identify fibroids that are harder to see on ultrasound - particularly adenomyosis (a related condition) and deeper fibroids.
What counts as a heavy period?
NICE guidelines defines heavy menstrual bleeding as any blood loss that interferes with your quality of life. Clinically: soaking through a pad or tampon every hour or two, passing clots larger than a 10p coin, bleeding for more than 7 days, or needing to use both pad and tampon at the same time. Any of these warrant a GP appointment and investigation.
Can fibroids affect fertility?
Most fibroids do not significantly affect fertility. Submucosal fibroids - those that protrude into the uterine cavity - are the exception, as they can interfere with implantation. The RCOG recommends assessing and treating submucosal fibroids before attempting assisted conception. If you have fibroids and difficulty conceiving, a referral to a specialist in reproductive medicine alongside a gynaecologist is appropriate.
Can fibroids shrink on their own?
Fibroids are oestrogen-sensitive and typically shrink after menopause when oestrogen levels decline. Before menopause, they generally do not disappear on their own, though growth rate varies. GnRH analogues (short-term medical treatment) can shrink fibroids temporarily. Pregnancy can cause fibroids to grow due to elevated oestrogen, although they often regress postpartum.
Are fibroids linked to cancer?
Fibroids are benign (non-cancerous) growths. In very rare cases, a uterine sarcoma can appear similar to a fibroid on imaging. The RCOG and NICE advise that new, rapidly growing fibroids in postmenopausal women warrant careful evaluation. The incidence of uterine sarcoma is estimated at less than 1 in 1,000 of women who undergo surgery for presumed fibroids (Parker et al., 2010). The vast majority of fibroids are entirely benign.
What causes heavy periods other than fibroids?
Common causes include adenomyosis (endometrial tissue within the uterine muscle), endometrial polyps, thyroid disorders, clotting disorders (such as von Willebrand disease - underdiagnosed in women with lifelong heavy periods), and hormonal imbalances. In some women, no structural cause is found (dysfunctional uterine bleeding). NICE guidelines sets out a comprehensive investigation and management pathway.

Sources & references

All clinical claims on this page are grounded in current evidence and published guidelines. Links open external websites.

  1. NICE NG88: Heavy menstrual bleeding - assessment and management (2018, updated 2021)
  2. NICE IPG367: Uterine artery embolisation for fibroids
  3. NHS: Fibroids

Last reviewed: July 2026. This page will be updated as guidelines change. If you spot an error or an outdated reference, please get in touch.

Dr Hiba Sher Khan
© 2026 Dr Hiba Sher Khan · drhiba.co.uk