Uterine fibroids are common, non-cancerous growths composed of muscle and fibrous tissue that develop within or on the uterus. Also known as leiomyomas or myomas, they are the most common non-cancerous tumors found in women of childbearing age. An estimated 40% to 80% of individuals with a uterus develop them by age 50. While almost always benign, fibroids can lead to various symptoms, including pain.
Fibroids and Pain During Intercourse
Fibroids can cause pain during intercourse, known as dyspareunia. This discomfort often relates to the fibroid’s location, size, and impact on surrounding pelvic structures. Fibroids situated near the cervix or in the lower part of the uterus, particularly those growing into the uterine cavity (submucosal) or within the muscular wall (intramural), can be directly compressed or cause pressure during penetrative intercourse.
This pressure can extend to nearby organs like the bladder or rectum, intensifying the pain. Large fibroids can also cause generalized pelvic pressure or a feeling of fullness, which is exacerbated during sexual activity. Fibroids can also contribute to inflammation in the pelvic region or cause heavy menstrual bleeding and cramping, which may increase overall pelvic sensitivity and lead to discomfort during or after intercourse.
Other Indicators of Fibroids
Beyond pain during intercourse, fibroids can cause several other symptoms. One common sign is heavy or prolonged menstrual bleeding, known as menorrhagia, which can sometimes include blood clots. This excessive bleeding can lead to anemia, causing fatigue, weakness, and dizziness.
Fibroids often cause pelvic pressure or fullness in the lower abdomen, which can be constant or worsen with activity. Depending on their size and location, fibroids can press on the bladder, leading to frequent urination or difficulty fully emptying it. If fibroids press on the bowel, they can cause constipation or rectal pressure. Some individuals also experience backache or leg pain due to fibroids pressing on pelvic nerves.
Identifying Fibroids
Identifying fibroids typically begins with a healthcare provider consultation to discuss symptoms. A physical examination, including a pelvic exam, is often the first step, where a healthcare provider may feel irregularities or an enlarged uterus.
Imaging tests are crucial for confirming the presence, size, and location of fibroids. Ultrasound is the most common diagnostic tool, using sound waves to create images of the uterus and ovaries. Both transabdominal and transvaginal ultrasounds can visualize fibroids. For more detailed imaging, especially with larger or numerous fibroids, a magnetic resonance imaging (MRI) scan may be performed. MRI provides a comprehensive view of the uterus and surrounding structures, helping distinguish fibroids from other growths and plan treatment strategies.
Treatment and Relief Options
Managing fibroid-related pain, including discomfort during intercourse, involves various approaches. Temporary pain relief options include over-the-counter medications like ibuprofen or acetaminophen. Applying a heating pad to the lower abdomen may offer comfort, and adjusting positions during intercourse can help reduce direct pressure on fibroids.
Medical treatments manage symptoms and, in some cases, shrink fibroids. Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) agonists, can induce a temporary menopause-like state, shrinking fibroids and reducing bleeding by lowering estrogen and progesterone. Birth control pills or progestin-releasing intrauterine devices (IUDs) can help control heavy bleeding and menstrual pain, though they do not typically shrink fibroids.
Minimally invasive procedures offer alternatives to surgery. Uterine fibroid embolization (UFE) blocks blood supply to fibroids, causing them to shrink. Radiofrequency ablation (RFA) uses heat to destroy fibroid tissue, reducing symptoms. These procedures involve shorter recovery times compared to open surgery.
Surgical options are considered for severe symptoms or when other treatments are ineffective. Myomectomy removes only the fibroids, preserving the uterus for those who wish to maintain fertility. It can be performed through open abdominal surgery, laparoscopy, or hysteroscopy, depending on fibroid size and location. Hysterectomy, the surgical removal of the uterus, is a definitive solution for fibroids but ends fertility. Treatment choice depends on symptom severity, fibroid characteristics, and individual preferences, including fertility plans.