Harvard Health Letter

Ask the doctor: Heavy bleeding, fibroids, and polyps

Q. I am 53. I've had fibroids for some time but have experienced heavy menstrual bleeding lately. A recent ultrasound showed fibroids and polyps. My doctor presented me with three choices: do nothing and monitor the situation with ultrasounds (which have been part of my annual gynecological exams for a while); get a hysterectomy; or get a new procedure, which I think involves freezing the fibroids and polyps. I am not sure what to do.

A. As you know, you're almost certainly in perimenopause, the four to eight years leading up to menopause and the complete cessation of menstruation. Every woman's script for the transition to menopause is a little bit different, but it's very common for the menstrual cycle to be irregular and the amount of blood flow to vary. Erratic ovulation — the release of eggs from the ovaries — may result in hormonal changes that cause the lining of the uterus (the endometrium) to become thicker than usual, so when it sloughs off, the menstrual bleeding is heavier and more prolonged than women are used to.

But the fibroids and uterine polyps you have can also cause heavy bleeding. Fibroids are growths of muscle and fibrous tissue in the wall of the uterus (see illustration). They often develop in women between the ages of 35 and 50 and can make menstrual bleeding heavy and full of clots, before and during perimenopause. Uterine polyps are overgrowths of the endometrial tissue that lines the uterus, as opposed to the muscular tissue that makes up the uterine wall. Fibroids and uterine polyps can be cancerous, but that's rare (a chance of less than one in 1,000 for fibroids and about one in 100 for uterine polyps), and having them does not increase a woman's risk for developing uterine cancer. They are benign growths that, unlike a cancerous tumor, are incapable of spreading cells to other parts of the body.

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