Chioma had been living with heavy, clot-filled periods for two years. She had been treated for anaemia — but no one had looked for the cause. A single pelvic ultrasound at Mascot Healthcare found three uterine fibroids, including one the size of a lemon. Finally, she had an answer.
Marketing manager, Victoria Island. Presented with 2-year history of excessively heavy periods — soaking 8–10 pads per day on heavy days, passing large clots, and experiencing pelvic pressure and bloating. Haemoglobin 9.2 g/dL on blood test. Had been told by two different pharmacies she likely had "blood weakness" requiring haematinics only.
Pelvic Ultrasound ScanChioma's heavy periods had begun at age 36 — gradually worsening over 18 months until she was keeping a change of clothing in her office bag for heavy period days. She had seen two pharmacists and one clinic doctor. Each time, her low haemoglobin was noted, iron tablets were prescribed, and she was sent home.
Her sister — a nurse in Abuja — called her one evening and asked, "Has anyone actually scanned you?" She hadn't considered it. A scan felt like something for pregnancy. Her sister explained that a pelvic ultrasound looks at the uterus for fibroids — and that fibroids were the most common cause of this exact presentation.
Chioma booked a scan at Mascot Healthcare the following week. The sonographer began the scan. Within 90 seconds, the screen showed something clearly — three rounded, hypoechoic masses within the uterine wall. "I can see three fibroids," the doctor said quietly. "The largest is approximately 6.8 cm."
Uterine fibroids are the most common cause of heavy periods in women aged 30–50 in Nigeria. They are invisible to clinical examination when small, but clearly visible on pelvic ultrasound. A scan is the first-line investigation for any woman with unexplained heavy periods.
Saturating ultra-thick pads within 1–2 hours on the heaviest days — clinically significant menorrhagia.
Passing clots larger than a 50-kobo coin — a hallmark of fibroid-related heavy bleeding.
A constant feeling of heaviness and bloating in the lower abdomen — caused by fibroid bulk pressing on adjacent structures.
Iron-deficiency anaemia from months of heavy monthly blood loss — causing fatigue, pallor, and reduced exercise tolerance.
Multiple pharmacy visits and one clinic visit — all attributed the heavy periods to "hormonal imbalance" without investigation.
Chioma had spent two years in a low-level fear about her heavy periods. She had quietly googled "heavy periods clots cause" at 2 am more than once. She had read about cancer. She had closed the tab quickly.
When her sister pushed her to get the scan, her primary fear was not finding fibroids — it was finding something worse. "What if it's cancer?" she asked the Mascot Healthcare doctor before the scan started. "A scan will tell us," the doctor said. "And the symptoms you're describing are far more consistent with fibroids than anything malignant."
Knowing what to expect before the scan helped. The doctor explained: the scan takes 15–20 minutes, uses a probe on the lower abdomen (and sometimes a smaller internal probe for detail), causes no pain or radiation, and produces results immediately.
Three intramural fibroids were identified: the largest measured 6.8 × 5.9 cm in the posterior uterine wall; a second measured 3.4 cm in the right lateral wall; a third measured 2.1 cm anteriorly. The uterus itself was enlarged and globular — measuring 13 × 9 × 8 cm (normal: up to approximately 8 × 5 × 4 cm). No submucosal component was identified, but the largest fibroid was abutting the endometrium.
The ovaries were normal bilaterally. The endometrial stripe was regular. No free fluid. The scan confirmed a benign, fibroid-related cause for Chioma's heavy bleeding — no features suspicious for malignancy.
Chioma was referred to a gynaecologist with the scan report. Treatment options discussed: medical management (medication to reduce bleeding, a cycle-regulating hormone, or hormone-suppressing medication to shrink fibroids before surgery); uterine fibroid embolisation (UFE); myomectomy (surgical fibroid removal with uterus preservation — Chioma's preferred option as she had not completed her family).
Three intramural uterine fibroids: 6.8 cm, 3.4 cm, 2.1 cm. Enlarged uterus (13 × 9 cm). No malignant features. Bilateral ovaries normal.
Gynaecology referral for fibroid management; medication to reduce bleeding, plus iron supplementation, pending surgical planning; myomectomy counselled as first choice given desire for future pregnancy.
Myomectomy performed 3 months later. All three fibroids removed. Histology: benign leiomyomas. Post-operative haemoglobin 12.1 g/dL.
Six months after myomectomy, Chioma's periods are normal — 4 days, light to moderate flow, no clots. Haemoglobin 12.8 g/dL. She is considering starting a family.
Heavy periods with large clots in a woman aged 30–50 are fibroids until proven otherwise. A pelvic ultrasound scan is the first investigation — not a repeat course of iron tablets.
Fibroids are benign and common, but they cause real harm through blood loss and anaemia. Early diagnosis means earlier treatment and less cumulative damage. Two years of untreated heavy periods left Chioma significantly anaemic.
If your periods are soaking through pads and you are passing large clots — get a pelvic scan. Don't treat the anaemia without finding the cause.
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