Uterine fibroids (leiomyomas) are non-cancerous growths that develop from the muscle tissue of the uterus. These tumors are highly common, affecting a large percentage of women by age 50, though many may not experience symptoms. Fibroid “shedding” or “expulsion” occurs when a fibroid, or pieces of it, detach from the uterine wall and are passed through the cervix and vagina. This typically happens when certain fibroids lose their necessary blood supply, initiating a natural, self-removal process.
How Fibroids Degenerate and Shed
The process preceding shedding is degeneration, which begins when a fibroid’s blood supply is compromised. Fibroids rely on a steady flow of blood; if they grow too large too quickly, the existing vasculature cannot keep up with the demand, leading to ischemia. Ischemia (lack of adequate blood) causes the fibroid cells to die, a process known as necrosis, which weakens the fibroid’s attachment to the uterine wall.
Several types of degeneration exist, including hyaline and cystic forms where the tissue breaks down and becomes fluid-filled. Red degeneration, often seen during pregnancy, is an intense form where hemorrhage occurs within the fibroid due to acute lack of blood flow. Loss of blood supply can also happen if a pedunculated fibroid, which hangs by a stalk, twists on its axis.
Shedding is primarily associated with submucosal fibroids, located just beneath the uterine lining and protruding into the uterine cavity. When these fibroids degenerate, the uterus recognizes the dead tissue as foreign material and attempts to push it out. This expulsion is achieved through powerful uterine contractions, similar to labor, which force the tissue through the narrow cervical opening.
Visual Characteristics of Expelled Fibroid Tissue
The expelled material differs fundamentally from a typical menstrual blood clot because it consists of firm, necrotic tumor tissue rather than just coagulated blood. While blood clots are generally soft and jelly-like, fibroid tissue is often described as dense, rubbery, or fleshy. This structural difference makes the shed tissue feel more solid and substantial.
The color of the tissue varies widely depending on the type of degeneration and the time it takes to pass. Necrotic tissue that has been dead for a while may appear grayish-white or pale pink, reflecting the breakdown of muscle cells. If the fibroid underwent red degeneration, the expelled material may be a deep reddish-brown or dark maroon due to internal hemorrhage.
Expelled fibroids range significantly in size, from small, stringy fragments mixed with discharge to large, distinct masses. Some women pass pieces or entire fibroids the size of a golf ball or a lemon, often accompanied by heavy, dark, clotted discharge. The tissue’s shape is often irregular, but sometimes a small, rounded mass resembling the fibroid’s original form is expelled whole.
When to Consult a Healthcare Provider
While fibroid shedding can be a natural resolution, it often involves intense symptoms requiring medical attention. The uterine contractions needed to expel the tissue can cause severe abdominal and pelvic pain, often likened to labor. Although this pain may sometimes be managed with over-the-counter relievers, professional medical advice is needed for persistently severe discomfort.
A major concern during expulsion is excessive blood loss or hemorrhage. Seek immediate care if you are soaking through one or more sanitary pads or tampons every hour for several consecutive hours. Such heavy bleeding can quickly lead to anemia, indicated by profound fatigue, dizziness, weakness, or a rapid heart rate.
Signs of infection also necessitate an urgent medical evaluation. These symptoms include fever, chills, or a vaginal discharge with a foul or abnormal odor. It is important to consult a healthcare provider even after the tissue has passed to confirm the diagnosis and rule out other conditions, such as a miscarriage, which presents with similar symptoms of tissue passage and cramping.