Uterine fibroids are common, non-cancerous growths that develop within the muscular wall of the uterus. Also known as leiomyomas, these tumors vary widely in size and location. While many women remain unaware they have them, others experience a range of disruptive symptoms. Uterine fibroids can cause hip pain, a connection that depends heavily on the fibroid’s specific position and overall size within the pelvic cavity.
The Anatomical Link Between Fibroids and Hip Pain
The mechanism by which a growth in the uterus causes hip pain is anatomical proximity and physical compression. The uterus resides deep within the pelvic basin, close to an intricate network of nerves, blood vessels, and muscles that supply the lower body. When a fibroid grows large enough, it can displace or press against these adjacent structures, leading to referred pain.
Fibroids that grow on the outer surface of the uterus, known as subserosal fibroids, are the most common culprits for this type of discomfort. If a growth develops on the posterior (back) wall of the uterus, it can exert force directly onto the lumbosacral plexus. This complex network includes the large sciatic nerve, which runs from the lower back through the hip and down the leg.
Compression of the sciatic nerve can result in radiating pain described as sciatica, felt intensely in the hip, buttock, or thigh. Fibroid pressure can also affect other pelvic nerves, such as the obturator nerve, leading to pain localized to the groin or inner thigh. This discomfort is sometimes mistaken for a hip joint problem. Furthermore, sustained pressure from a bulky uterus can cause chronic tension in the pelvic floor muscles and ligaments, contributing to general lower back and hip discomfort. This pain is often felt persistently, unlike menstrual cramps, and may worsen with certain movements or prolonged sitting or standing.
Other Indications of Uterine Fibroids
Hip pain is only one potential manifestation of symptomatic fibroids, which often present with other distinctive signs. The most recognized symptom is menorrhagia, or heavy and prolonged menstrual bleeding, which can lead to iron-deficiency anemia and fatigue. Fibroids growing into the uterine cavity (submucosal fibroids) are particularly associated with this excessive blood loss.
As fibroids grow, they can create a constant sensation of pelvic pressure or fullness, often described as abdominal bloating. Depending on the direction of their growth, fibroids can press on the bladder, causing a frequent or urgent need to urinate. Conversely, a fibroid pressing on the rectum can interfere with normal bowel function, leading to chronic constipation. Pain during sexual intercourse (dyspareunia) is also a frequent complaint, often related to the fibroids’ location and size.
Diagnosing the Source of Hip Discomfort
Pinpointing uterine fibroids as the definitive cause of hip pain requires a careful process of elimination, known as differential diagnosis. A physician typically begins with a detailed pelvic exam, where an enlarged or irregularly shaped uterus may be detected. To confirm the presence and map the location of the fibroids, the next step is usually a pelvic ultrasound, which uses sound waves to create images of the pelvic organs.
For a more detailed assessment, particularly when nerve compression is suspected, a Magnetic Resonance Imaging (MRI) scan is often ordered. The MRI provides superior soft-tissue contrast, allowing the clinician to precisely determine the size and location of the fibroids and visualize their relationship to nearby nerves and blood vessels. Imaging also helps rule out other common causes of hip pain that mimic fibroid-related discomfort, such as arthritis, bursitis, or spinal conditions like a herniated disc.
Hip pain has many origins, and it is possible to have both fibroids and an orthopedic issue simultaneously. Other gynecological issues, including endometriosis or ovarian cysts, can also cause referred pain in the hip and groin area. This comprehensive diagnostic approach ensures that the treatment pathway chosen addresses the true source of the discomfort, whether it is the fibroid itself or another condition.
Treatment Pathways for Symptomatic Fibroids
Once fibroids are confirmed to be the source of hip pain or other symptoms, treatment focuses on shrinking the growths or removing them to alleviate pressure. For women with mild symptoms, a conservative approach known as watchful waiting may be recommended, involving regular monitoring of the fibroids’ size and growth. Medical management is often the first line of treatment for symptom control, though it rarely eliminates the fibroids entirely.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain, while hormonal therapies help control heavy bleeding. Gonadotropin-releasing hormone (GnRH) agonists and antagonists induce a temporary, reversible menopause-like state, leading to a significant reduction in fibroid volume and symptom relief. These are often used for a short period before surgery, or longer-term with “add-back” low-dose hormones to mitigate side effects like bone loss.
Minimally invasive procedures offer an alternative to traditional surgery. These include Uterine Fibroid Embolization (UFE), where small particles are injected to block the blood supply to the fibroids, causing them to shrink. Other options are magnetic resonance-guided focused ultrasound surgery (MRgFUS) and radiofrequency ablation (RFA), which use heat energy to destroy the fibroid tissue.
Surgical options are considered when other treatments fail or symptoms are severe, ranging from fertility-sparing myomectomy to hysterectomy. A myomectomy involves surgically removing only the fibroids, preserving the uterus, and can be performed through various techniques, including hysteroscopy, laparoscopy, or traditional open surgery. Hysterectomy, the complete removal of the uterus, is the definitive solution, ensuring the fibroids cannot return. It is typically reserved for women who have completed childbearing.