Uterine fibroids, also known as leiomyomas or myomas, are common non-cancerous growths that develop from the muscle tissue of the uterus. These benign tumors are extremely prevalent, affecting up to 77% of women by the time they reach age 50. Many people who have fibroids are unaware of their presence because they cause no symptoms and are often discovered incidentally during a routine examination. Because fibroids can sometimes grow large enough to cause noticeable changes, understanding their nature and the medical methods for identification is important.
What Uterine Fibroids Are and Where They Grow
Fibroids are solid tumors composed of smooth muscle cells and fibrous connective tissue that originate in the uterine wall. They range in size from microscopic to as large as a grapefruit or small melon. While a single growth is possible, multiple fibroids commonly develop simultaneously. Symptoms depend highly on the size and exact location of these growths within the uterus.
Fibroids are classified into three primary types based on their location relative to the layers of the uterine wall. The most common type is the intramural fibroid, embedded within the thick muscular layer (myometrium). Submucosal fibroids are positioned beneath the endometrium (the inner lining) and often protrude into the uterine cavity. This placement often leads to significant symptoms, even when the fibroids are small.
Subserosal fibroids develop on the outside of the uterus, beneath the serosa (the outermost covering). These growths may push outward into the pelvic cavity and can sometimes grow on a thin stalk of tissue, classifying them as pedunculated. Because they grow externally, subserosal fibroids are the type most likely to cause pressure symptoms on surrounding organs, such as the bladder or bowel.
Symptoms and Partner Detection
Many women with fibroids remain asymptomatic, but for those who do experience symptoms, they are typically related to the fibroid’s bulk or its effect on the uterine lining. Common complaints include heavy or prolonged menstrual bleeding, which can sometimes lead to anemia and fatigue due to chronic blood loss. Pressure symptoms, such as a feeling of fullness in the pelvis, frequent urination, or difficulty with bowel movements, occur when fibroids press on adjacent organs. Lower back pain or discomfort during intercourse can also be reported, depending on the tumor’s position.
Direct detection of a fibroid by a non-medical professional, such as a partner, is rare. The growths are contained deep within the pelvis, protected by the abdominal wall. However, if fibroids are numerous or a subserosal fibroid grows significantly, it can cause the uterus to expand and rise out of the pelvis. This expansion leads to noticeable abdominal swelling or distension, which a partner may observe.
During intimate contact, a partner may notice unusual firmness or a palpable mass in the lower abdomen if a very large fibroid has caused the uterus to swell considerably. A healthcare provider can only detect about one-third of fibroids during a routine physical examination because of their deep location or small size. While a partner might observe the effects of a large fibroid, such as abdominal swelling or firmness, relying on this observation alone is unreliable and should not replace professional medical evaluation.
Clinical Procedures for Diagnosis
The formal diagnosis of uterine fibroids begins with a thorough medical history review and a pelvic examination performed by a healthcare professional. During the bimanual pelvic exam, the clinician palpates the lower abdomen and pelvis to check the size, shape, and mobility of the uterus. An enlarged, irregular, or mobile uterus is a common initial sign that suggests the presence of fibroids, prompting further investigation. If heavy bleeding has been reported, a complete blood count (CBC) is often ordered to check for iron-deficiency anemia caused by excessive blood loss.
The preferred initial imaging technique to confirm a diagnosis is pelvic ultrasonography, which uses sound waves to map the uterus and ovaries. This is performed using a combination of a transabdominal approach (probe across the lower abdomen) and a transvaginal approach (smaller probe inserted into the vagina). Transvaginal ultrasound provides a high-resolution view, effective for detecting fibroids and determining their size and exact location.
For more detailed assessment, especially for growths protruding into the uterine cavity, specialized imaging may be necessary. Hysterosonography, or saline infusion sonography (SIS), involves injecting sterile salt water into the uterus during a transvaginal ultrasound to expand the cavity. This technique better outlines the inner uterine lining and is useful for visualizing submucosal fibroids. Magnetic Resonance Imaging (MRI) provides the most detailed images of the pelvic soft tissues, often used for surgical planning or differentiating fibroids from conditions like adenomyosis.