Symptom · Fibroids tracker
Heavy bleeding, pressure, exhaustion. Not just perimenopause.
Uterine fibroids affect up to 70–80% of women by 50, and they peak exactly when perimenopause turns the volume up: heavier bleeds, bigger clots, pelvic pressure, bloating, back pain, breathless-on-stairs anemia. Black women get them 2–3 times as often, earlier, and larger — and it's still the least-studied common gynaecological condition in the field. This page is the day-to-day tracker: what to log, what actually helps (Mirena, tranexamic acid, GnRH antagonists, uterine artery embolization, myomectomy, hysterectomy), and how to get taken past 'try the pill and come back'. For the sourced evidence, cross to the full evidence hub.
Educational · not medical advice
Fibroids are non-cancerous growths of the muscle wall of the uterus, and they are extraordinarily common — cumulative incidence by menopause is around 70% in white women and up to 80% in Black women, who also get them earlier, more often, and with worse symptoms. In perimenopause the bigger estrogen swings often feed them: heavier bleeding, bigger clots, pelvic pressure and bloating, urinary frequency, low-back pain, painful sex, and a slow drift into iron-deficiency anemia that gets misread as 'just tired'. Fibroids usually shrink after menopause when estrogen drops — but not always, and HRT can keep them active. The good news is the toolkit is real and getting better: the Mirena IUD and tranexamic acid for bleeding, GnRH antagonists like relugolix as a newer medical option, uterine artery embolization, myomectomy for uterus-sparing removal, and hysterectomy when it's the right call. The bad news is how long people wait to be offered any of it. Two months of specific tracking is how you move the conversation.
Why this is happening now
Fibroids are the most common benign tumours in the female body, and one of the most under-explained. Knowing the sub-types and the perimenopause pattern sharpens the conversation.
- 01
Estrogen-fed growths of the uterine muscle
Fibroids (leiomyomas, myomas) are made of the same smooth muscle as the uterus itself. They grow in response to estrogen and progesterone, which is why they typically appear from the 30s onward, peak in the 40s, and shrink after menopause when estrogen drops. Some women have one; some have a dozen; sizes range from a pea to a grapefruit. They are almost never cancerous — malignant leiomyosarcoma is rare (~1 in 1,000 presumed-fibroid masses).
- 02
Where they sit matters more than how big they are
Submucosal fibroids (bulging into the uterine cavity) cause the heaviest bleeding, even when small. Intramural (inside the wall) cause bulk and pressure. Subserosal (on the outside) can press on bladder or bowel. Pedunculated fibroids hang on a stalk and can twist. A single submucosal fibroid can cause more bleeding than a uterus full of subserosal ones — this is why the imaging report matters, not just the words 'you have fibroids'.
- 03
Black women get them earlier, larger, and more often
By age 50, roughly 80% of Black women vs 70% of white women have fibroids. Onset is earlier (frequently in the 20s and 30s), tumours are typically larger, symptoms more severe, and hysterectomy rates are 2–3× higher. Almost none of this shows up in the trial evidence because Black women are systematically under-recruited in fibroid research. If you are Black and your bleeding is being dismissed as 'normal for your age', name the evidence gap in the appointment — the answer is imaging, not reassurance.
- 04
Perimenopause usually makes them louder, then quieter
The estrogen swings of your 40s often feed a growth spurt: heavier bleeds, more pressure, faster fatigue. This is when many long-tolerated fibroids finally get named. After the final period they typically shrink over 6–24 months as estrogen drops. HRT — especially systemic estrogen — can slow that shrinkage or keep symptoms going; it doesn't have to rule HRT out, but the plan should acknowledge the fibroids explicitly.
- 05
Anemia is the silent second diagnosis
Years of heavy bleeding drop your iron stores long before hemoglobin looks abnormal. Breathless on stairs, exhausted, foggy, dizzy on standing, restless legs at night, hair shedding — that is often not perimenopause, that is ferritin. Ask specifically for ferritin (iron stores), not just a hemoglobin check. Ferritin under 30 warrants treatment even with a 'normal' hemoglobin.
- 06
Ultrasound sees most fibroids; MRI maps them
Transvaginal ultrasound is the first-line scan and picks up the majority of fibroids. If a uterine-sparing procedure is on the table (myomectomy, uterine artery embolization) an MRI is often needed to map size, number, position, and blood supply. A vague 'bulky uterus' on a generic pelvic scan is not enough to plan treatment from — ask for the detail.
What tends to help
The last decade has quietly transformed the fibroid toolkit. If your options were last discussed as 'the pill or a hysterectomy', that conversation is out of date.
Mirena (levonorgestrel IUD) for the bleeding
For fibroids that aren't distorting the uterine cavity, Mirena dramatically reduces bleeding volume and cramping, and it doubles as contraception. It doesn't shrink the fibroids themselves, but for many women it takes the day-to-day worst of it away. Insertion can be trickier in a bulky uterus and expulsion is a bit more common — worth asking whether ultrasound-guided insertion is available.
Tranexamic acid for the worst bleed days
Non-hormonal, taken only on heavy days, cuts bleeding volume by around a third. Not a long-term fix, but a genuinely useful tool for getting through months while a bigger decision is being worked out. Safe for most people; contraindicated with a personal history of clots.
GnRH antagonists (relugolix/Ryeqo, elagolix) — the newer medical option
Oral daily tablets that suppress ovarian estrogen and shrink fibroids, combined with add-back hormones so you don't get menopause symptoms. Approved for heavy fibroid bleeding in the UK and US; typically used for up to 24 months. Worth asking about specifically — many family doctors don't yet mention them because they are new.
Uterine artery embolization (UAE) — uterus-sparing, day-case
An interventional-radiology procedure that cuts off the fibroids' blood supply so they shrink. Same-day or overnight stay, faster recovery than surgery, uterus stays in place. Best for women who don't want (or aren't offered) surgery and aren't planning pregnancy. Not first-line if fertility preservation is a priority — myomectomy is generally preferred there.
5 more practices, plus podcasts, books and research, live in Go deeper below.
03When to get help nowWhen this needs more than self-care
Emergency red flags, same-week signs, and where to find a menopause-trained practitioner.
When this needs more than self-care
7 more signs it needs a doctor this week
Soaking through a pad or tampon every hour, for hours
This is the clinical definition of heavy menstrual bleeding and warrants investigation regardless of cause. Ask for a pelvic ultrasound, ferritin, and a treatment conversation that includes Mirena, tranexamic acid, GnRH antagonists, UAE, myomectomy, or hysterectomy — not just 'try the pill'.
Large clots repeatedly, or bleeding that runs your life
Clots bigger than a coin, multiple per day, across multiple days — especially in your 40s — are a fibroid or adenomyosis signal, not 'just perimenopause'. Bring the tracker.
Symptoms of anemia — even with 'normal' hemoglobin
Breathlessness, exhaustion, dizziness, restless legs, palpitations, pica. Ferritin can be very low while hemoglobin is still in the reference range, and treatment changes how you feel within weeks. Ask by name.
Pelvic pressure, bloating, or urinary/bowel changes
A firm lower-belly bulge, waistbands not fitting, needing to pee constantly or overnight, constipation with a feeling of pressure — these are bulk-fibroid signals and warrant imaging. Not an IBS workup, not a diet plan.
Being told 'live with it until menopause'
Modern fibroid care includes Mirena, tranexamic acid, GnRH antagonists (relugolix/Ryeqo), uterine artery embolization, myomectomy, and hysterectomy — not just watchful waiting. If none of these have been offered and you're still bleeding heavily, ask for a gynaecology referral or a second opinion. 'Just wait it out' is a management gap, not a treatment plan.
Any bleeding after menopause
Post-menopausal bleeding always warrants investigation within weeks — transvaginal ultrasound plus biopsy where indicated. Most causes are benign (atrophy, polyps, fibroid changes on HRT) but endometrial cancer must be ruled out. Do not wait.
HRT being suggested without the fibroids named in the plan
HRT is not off-limits with fibroids, but the plan should acknowledge them: transdermal estrogen, adequate progestogen (often Mirena, which also manages bleeding and protects the endometrium), and closer symptom review in the first year. If a doctor is prescribing systemic estrogen without asking about your fibroids or your bleeding, ask for a menopause-specialist opinion.
Go deeper
One place for everything else.
Practices to try this week, voices worth hearing, books worth your bedside table, rooms where members are talking, the candid tips Nila would share over a cup of tea, and the research the editorial team is watching.
Bleeding volume — pads, tampons, flooding
Pad/tampon changes per day; nights you have to get up to change; any flooding through clothes or sheets; days you couldn't leave the house. Clinical heavy menstrual bleeding = soaking one pad/tampon per hour for several hours, OR a bleed that interferes with normal life. Either threshold warrants investigation.
Clot size and frequency
Clots bigger than a 50p coin (UK) or a US quarter / 2.5cm are clinically significant. Note how many days per bleed you're passing them, and roughly how many per day. Repeated large clots in your 40s should trigger imaging, not reassurance.
Cycle length and duration
Bleeds lasting 8+ days, or cycles consistently shorter than 24 days, are both red flags. Track first day to last day of every bleed and days between cycle starts. Even rough numbers, kept consistently, matter.
Pressure symptoms — bladder, bowel, back, belly
Urinary frequency and urgency, needing to pee two or three times overnight, constipation or feeling of incomplete emptying, bloating that doesn't shift with diet, low-back or hip ache, waistbands not fitting when weight hasn't changed. These are the classic bulk-fibroid symptoms and often the most under-reported.
Pain — cramping, painful sex, back
Cramp severity (1–10), when it starts, what it stops you doing. Whether sex has become painful and in what position (deep dyspareunia is common with larger fibroids). Low-back pain that maps to the cycle.
The anemia signals
Breathless on stairs, exhausted regardless of sleep, dizzy on standing, brain fog, restless legs at night, unusual hair shedding, palpitations, pica (craving ice, chalk, dirt). These are ferritin symptoms. Ask specifically for a ferritin test — not just hemoglobin — at your next bloods.