Uterine fibroids (leiomyomas or myomas) are common, non-cancerous growths that develop within the muscular wall of the uterus. They are not associated with an increased risk of uterine cancer and often cause no symptoms. However, symptomatic fibroids can severely impact daily life and overall well-being. Leaving them untreated allows effects to progress, potentially leading to long-term health issues and acute medical events that affect multiple body systems and reproductive health.
Progression of Chronic Symptoms
Untreated fibroids frequently lead to a progressive worsening of symptoms, particularly as the tumors increase in size or number. The most noticeable decline in quality of life stems from the escalation of menstrual bleeding, known as menorrhagia. This is defined as abnormally heavy or prolonged menstrual flow, sometimes lasting longer than seven days.
This chronic, heavy bleeding may also include the passage of large blood clots, making the monthly period debilitating and unpredictable. Fibroid growth also leads to increased pelvic pain and a persistent feeling of pressure or “bulk” within the lower abdomen. This constant discomfort can interfere with daily activities.
The increasing size and weight of the uterus due to fibroids can also intensify pain during sexual intercourse, a condition known as dyspareunia. As the fibroids continue their growth, these chronic symptoms become more severe and frequent, causing significant physical and emotional distress.
Systemic Health Complications
The chronic symptoms caused by untreated fibroids can trigger cascading effects on overall health, extending beyond the pelvic region. The most frequent systemic complication is iron-deficiency anemia, which arises directly from persistent, heavy blood loss. The body cannot keep pace with the demand for iron to produce hemoglobin, the oxygen-carrying component of red blood cells.
Anemia leads to symptoms such as fatigue, weakness, and shortness of breath, which limit physical endurance and daily function. In severe cases, chronic blood loss may require ongoing management with high-dose iron supplements or even blood transfusions to maintain safe red blood cell levels.
Beyond blood loss, the bulk of large or strategically located fibroids can compress adjacent organs, causing pressure-related complications. Fibroids growing on the front of the uterus may press against the bladder, resulting in frequent urination, a sudden urge to urinate, or difficulty completely emptying the bladder. Conversely, fibroids situated toward the back of the uterus can compress the rectum and colon, leading to chronic constipation or painful bowel movements.
Impact on Fertility and Pregnancy
For women of reproductive age, untreated fibroids pose substantial risks to both conception and the progression of a pregnancy. Submucosal fibroids, which protrude into the uterine cavity, can interfere with fertility by distorting the endometrial lining. This distortion can impair the ability of a fertilized egg to successfully implant, or the fibroid may physically block the opening of the fallopian tubes.
Once pregnancy is achieved, the presence of fibroids increases the risk of various complications, depending on their size and location. Fibroids can increase the likelihood of early pregnancy loss. During later stages, they may contribute to preterm labor, placental abruption, or fetal malpresentation.
The physical presence of the fibroids can limit the space available for the fetus to grow and move, potentially necessitating a cesarean section for delivery. After childbirth, untreated fibroids increase the danger of postpartum hemorrhage. This occurs because the enlarged uterus may not contract effectively after delivery, which is necessary to compress blood vessels and stop bleeding.
Acute Fibroid Degeneration and Torsion
Although less common than chronic issues, untreated fibroids carry a risk of two acute, severely painful complications that require immediate medical attention. The first is fibroid degeneration, which occurs when a fibroid grows so rapidly that its blood supply becomes insufficient. This lack of oxygen and nutrients causes the tissue within the fibroid to die, a process called necrosis.
Degeneration causes a sudden onset of intense, acute abdominopelvic pain, sometimes accompanied by a low-grade fever due to the inflammatory response. The pain is often localized and can last anywhere from a few days to several weeks.
The second acute event is torsion, a risk for pedunculated fibroids—those attached to the uterus by a stalk-like structure. If the fibroid twists on its stem, the blood supply is immediately cut off, leading to rapid tissue death. Fibroid torsion causes sudden, severe, stabbing pain and is considered a surgical emergency to prevent complications like infection and gangrene.