Uterine fibroids are common, non-cancerous growths that develop in the muscular wall of the uterus. They can vary in size, ranging from tiny seedlings to large masses that can alter the shape of the uterus. While many individuals with fibroids remain without symptoms, others experience effects that profoundly impact their overall quality of life, affecting daily functioning, sexual health, and emotional well-being.
Physical Symptoms Affecting Daily Life
The physical presence of uterine fibroids can cause a range of chronic symptoms that disrupt routine activities. One of the most common and debilitating issues is heavy, prolonged menstrual bleeding, known as menorrhagia. This excessive blood loss often leads to iron-deficiency anemia, which manifests as persistent fatigue, weakness, and low energy levels. The constant state of exhaustion makes engaging in work, exercise, or social activities difficult.
Fibroids can also cause “bulk symptoms” due to their size and location within the pelvis. Large fibroids can press against adjacent organs, creating a constant feeling of pelvic pressure or fullness. This pressure frequently affects the bladder, leading to urinary urgency and the need for frequent urination, sometimes throughout the night.
Fibroids situated near the bowel may cause issues like constipation or difficulty with bowel movements. The chronic nature of these symptoms, including persistent pelvic pain unrelated to menstruation or intercourse, can severely limit a person’s mobility and comfort.
Fibroids and Sexual Function
Fibroids frequently interfere with sexual function. The most direct impact is the experience of painful intercourse. This pain often results when fibroids are positioned near the cervix or deep within the uterine wall, causing pressure or impact during penetration.
Larger fibroids can cause an enlarged uterus, intensifying discomfort during sexual activity. This physical barrier and the anticipation of pain can lead to a reflexive avoidance of intimacy. Some women also experience post-coital bleeding, which discourages future sexual encounters.
The reduction in sexual desire, or libido, is often a secondary effect rather than a direct one. Chronic fatigue caused by anemia from heavy bleeding leaves many individuals without the necessary energy for intimacy. Additionally, the constant discomfort and worry about bleeding accidents can make a person feel undesirable or too preoccupied to focus on sexual arousal.
The Emotional and Mental Health Toll
Living with the unpredictable and chronic physical symptoms of fibroids places a burden on mental health. The fear of heavy bleeding “accidents” in public or at work can lead to social anxiety and isolation. This constant worry about managing blood loss reduces overall confidence.
Chronic pain and fatigue contribute to depression and irritability. The persistent feeling of being unwell, coupled with sleep disruption from pain or frequent nighttime urination, can deplete emotional reserves.
Fibroids can also cause abdominal distension, which leads to body image issues and reduced self-esteem. Feeling self-conscious about an enlarged abdomen or weight gain can cause women to withdraw from intimate relationships and avoid sexual situations.
Diagnosis and Management Options
The first step in addressing fibroid-related symptoms is obtaining an accurate diagnosis, typically initiated through pelvic examination and imaging techniques. Transvaginal ultrasonography is the preferred initial method for detecting and mapping the location of fibroids. Magnetic resonance imaging (MRI) may be used to provide a more detailed assessment of fibroid size, number, and exact location.
Management options are tailored to the individual’s symptoms, fibroid characteristics, and desire to maintain fertility. Non-surgical medical treatments are often the first approach, including hormonal contraceptives or a progestin-releasing intrauterine device to manage heavy bleeding. GnRH agonists or antagonists may temporarily shrink fibroids.
For individuals with persistent or severe symptoms, procedural or surgical interventions offer more definitive relief. Uterine artery embolization (UAE) is a minimally invasive technique that blocks the blood supply to the fibroids, causing them to shrink. Surgical removal of the fibroids, known as a myomectomy, preserves the uterus and is often preferred by those who wish to become pregnant in the future. A hysterectomy, the complete removal of the uterus, provides a definitive cure for symptoms and is an option for those who do not desire future fertility.