Uterine fibroids are non-cancerous growths that develop in or on the uterus. While many individuals with fibroids experience no symptoms, these growths can sometimes lead to abdominal pain. This article explores how fibroids can cause discomfort and other associated symptoms, helping you recognize when medical attention might be beneficial.
Understanding Fibroids
Uterine fibroids are common, affecting 40% to 80% of individuals with a uterus by age 50. They are the most common non-cancerous tumors in females.
These growths consist of smooth muscle cells and fibrous connective tissue. Fibroids vary greatly in size, from a grain of rice to larger than a grapefruit, sometimes filling the entire uterus. While a single fibroid can occur, multiple fibroids are more common.
Fibroids develop in different locations. Intramural fibroids grow within the muscular wall of the uterus, while subserosal fibroids are on the outer surface. Submucosal fibroids protrude into the uterine cavity, and pedunculated fibroids attach to the uterus by a stalk.
How Fibroids Cause Pain and Other Symptoms
Fibroids can cause abdominal pain and other symptoms through several mechanisms, influenced by their size, number, and location. Large fibroids, especially subserosal ones, can exert pressure on nearby organs like the bladder, rectum, or spinal nerves. This pressure often causes pelvic discomfort, a feeling of fullness, frequent urination, or constipation. Fibroids located towards the back of the uterus can also lead to lower back pain or radiating leg pain, sometimes resembling sciatica.
Pain also arises when fibroids undergo degeneration. This occurs if a fibroid outgrows its blood supply, causing its cells to die. Degeneration can release chemicals that lead to acute, stabbing pain and abdominal swelling, sometimes with a low-grade fever. This intense pain typically lasts a few days to several weeks before subsiding.
Pedunculated fibroids, attached by a stalk, can cause sudden, severe pain if their stalk twists (torsion). This twisting cuts off the fibroid’s blood supply, leading to acute discomfort that requires prompt medical evaluation. This rare pain is distinct due to its sudden onset and severity.
Fibroids frequently cause heavy menstrual bleeding (menorrhagia). This is often the most common symptom, with periods lasting longer than seven days and requiring frequent sanitary product changes. Excessive blood loss can lead to fatigue and anemia. Submucosal fibroids, located just beneath the uterine lining, are particularly prone to causing heavy and prolonged bleeding, even when small.
Other symptoms include constant pelvic pressure or a sensation of heaviness in the lower abdomen. Fibroids may also cause pain during sexual intercourse, depending on their size and position.
Diagnosing Fibroid-Related Pain
Diagnosing fibroid-related pain begins with a discussion of symptoms and medical history. The healthcare provider inquires about the nature, duration, and severity of symptoms, menstrual cycle patterns, and any family history of fibroids. This initial consultation guides the physical examination.
A pelvic exam is a common first step, where the doctor manually checks the uterus for irregularities in size or shape. While fibroids can sometimes be felt, imaging tests are usually necessary to confirm their presence and gather detailed information.
Ultrasound is the primary imaging technique for diagnosing uterine fibroids due to its non-invasive nature and effectiveness. It uses sound waves to create images of the uterus, identifying fibroids, their size, and location. Both transabdominal ultrasound (probe over abdomen) and transvaginal ultrasound (probe inserted into vagina) may be used for a comprehensive view.
For more detailed imaging, especially for treatment planning, a Magnetic Resonance Imaging (MRI) scan may be ordered. MRI offers higher resolution images and can sometimes detect fibroids not visible on ultrasound. Less commonly, hysteroscopy might visualize fibroids inside the uterine cavity, or laparoscopy might inspect fibroids on the outer surface.
Managing Pain and Treating Fibroids
Managing pain and treating fibroids involves various approaches, from watchful waiting to symptom relief and procedures addressing the fibroids. For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can provide relief, though they do not reduce heavy bleeding.
Hormonal therapies reduce symptoms or shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists temporarily lower estrogen levels, leading to fibroid shrinkage and reduced bleeding, but are short-term due to side effects. Birth control pills and progestin-releasing intrauterine devices (IUDs) also help manage heavy bleeding and cramps without shrinking fibroids.
For more severe symptoms, procedural and surgical options are available. Uterine artery embolization (UAE) is a minimally invasive procedure that blocks blood flow to fibroids, causing them to shrink and reducing symptoms. This uterus-preserving option is effective for many.
Myomectomy is a surgical procedure to remove fibroids while preserving the uterus, suitable for those desiring future fertility. It can be performed through open abdominal surgery, laparoscopy, or hysteroscopy, depending on fibroid characteristics. However, new fibroids can sometimes develop after myomectomy.
Hysterectomy, the surgical removal of the uterus, offers a definitive cure and prevents recurrence. This major surgery is considered when other treatments are ineffective, symptoms are severe, or fertility preservation is not a priority. Treatment choice depends on symptom severity, fibroid characteristics, and individual preferences, including future fertility goals.