Yes, Your Heavy Periods from Uterine Fibroids Are Directly Causing Your Anemia
Uterine fibroids are one of the most common causes of heavy menstrual bleeding, which directly leads to iron deficiency anemia through chronic blood loss—this is an established causal relationship, not just a correlation. 1, 2
Why This Happens
The connection between your fibroids and anemia occurs through several mechanisms:
Heavy menstrual bleeding (menorrhagia) is the most common symptom of uterine fibroids, affecting approximately 30% of women with fibroids, and this excessive bleeding depletes your iron stores faster than your body can replace them 1, 2
Fibroids create abnormal vascular architecture around and within the uterus, including irregular blood vessel formation, venous lakes, and disrupted normal blood flow patterns that contribute to excessive bleeding 2
The chronic nature of fibroid-related bleeding means you lose blood month after month, progressively worsening anemia even if each individual period doesn't seem catastrophically heavy 1, 3
The Clinical Significance
This is not a trivial connection—fibroid-related anemia can become severe:
Life-threatening anemia can occur, with documented cases of hemoglobin levels dropping below 2.0 g/dL (normal is 12-16 g/dL for women), requiring emergency intervention 3
Iron deficiency and iron deficiency anemia are recognized complications that must be actively managed alongside the fibroids themselves, not treated as separate problems 1
Your symptoms of fatigue and other anemia-related complaints are directly attributable to the blood loss from fibroid-related heavy menstrual bleeding 4
What You Need to Do
You should correct your anemia with iron supplementation while simultaneously initiating medical therapy to control the bleeding and potentially reduce fibroid size. 5, 6
The treatment approach should address both problems together:
Start iron replacement therapy immediately to rebuild your depleted iron stores while addressing the underlying cause 1
First-line medical management includes estrogen-progestin oral contraceptive pills or levonorgestrel-releasing IUD to reduce menstrual blood loss 7, 5
If first-line options fail, GnRH antagonists (like relugolix) with hormone add-back therapy are highly effective at reducing both bleeding and fibroid volume 7, 5
Tranexamic acid is an effective nonhormonal option if you cannot or prefer not to use hormonal treatments 7, 5
Critical Point to Understand
The anemia will not resolve permanently unless you address the underlying fibroid-related bleeding. 1 Simply taking iron supplements without controlling the heavy bleeding is like trying to fill a bucket with a hole in it—you may temporarily improve your hemoglobin, but the ongoing blood loss will continue to deplete your iron stores.
If medical management fails to adequately control your bleeding and anemia, surgical options including myomectomy (if you want to preserve fertility) or hysterectomy (if childbearing is complete) provide definitive treatment. 7