Uterine fibroids (leiomyomas or myomas) are non-cancerous growths developing from the muscle tissue of the uterus. These tumors are common, affecting up to 80% of women by age 50, though many remain unaware they have them. Fibroids are hormonal-sensitive, typically growing during reproductive years and often shrinking after menopause. While asymptomatic fibroids require no intervention, symptomatic fibroids severely affect health and quality of life if left unmanaged. Untreated symptomatic fibroids often lead to increasingly burdensome chronic conditions and severe complications.
Worsening of Chronic Symptoms
The most noticeable consequence of neglecting symptomatic fibroids is the gradual intensification of daily discomfort and bleeding patterns. Over time, the heavy and prolonged menstrual flow (menorrhagia) tends to become more severe. This increased blood loss interferes with work, social activities, and overall quality of life.
Fibroids, especially those growing within the uterine wall (intramural) or on the outer surface (subserosal), may increase in size, leading to pronounced bulk-related symptoms. As the uterus enlarges, it exerts pressure on adjacent pelvic structures, leading to a persistent feeling of fullness or heaviness in the lower abdomen.
This mechanical pressure also frequently causes urinary symptoms, such as an increased need to urinate, or bowel issues like chronic constipation. The pain associated with fibroids tends to progress from manageable menstrual cramping (dysmenorrhea) to more persistent, non-cyclic pelvic pain. This chronic discomfort may be due to the size of the fibroids or their location, potentially pressing on nerves. A sustained progression of these chronic symptoms often signals the need for intervention.
Systemic Health Complications
Beyond local pelvic symptoms, untreated fibroids can trigger consequences that impact the body’s systemic health. Prolonged and excessive menstrual bleeding causes a continuous depletion of iron stores, leading to chronic iron deficiency anemia. This condition results in symptoms like fatigue, weakness, shortness of breath, and pale skin, diminishing energy levels.
In advanced cases, severe anemia may necessitate emergency blood transfusions to stabilize low hemoglobin levels. Furthermore, the bulk of large, untreated fibroids can cause mechanical compression on the ureters, the tubes carrying urine from the kidneys to the bladder. This compression can obstruct urine flow, causing the kidneys to swell, a condition known as hydronephrosis.
If the obstruction is not relieved, hydronephrosis can lead to long-term renal damage or kidney failure. The cumulative burden of chronic pain, debilitating anemia, and disturbed sleep patterns contributes to a significant reduction in a person’s physical and mental well-being. Regular monitoring of hemoglobin and renal function is used to assess these systemic risks.
Risks to Fertility and Pregnancy
For women of childbearing age, allowing fibroids to go untreated introduces specific and serious risks to the ability to conceive and sustain a pregnancy. The location of the fibroids heavily influences fertility. Submucosal fibroids, which bulge into the uterine cavity, can interfere with embryo implantation and reduce the success rate of conception. Large intramural fibroids, embedded within the uterine wall, can also distort the shape of the cavity, leading to similar implantation difficulties or potentially blocking the fallopian tubes.
If pregnancy is achieved with untreated fibroids, the risk of complications increases significantly. Fibroids are associated with a higher incidence of first-trimester miscarriage and adverse outcomes later in gestation, including placental abruption and preterm labor. Large fibroids can also restrict fetal growth or necessitate a cesarean delivery due to fetal malpresentation, such as a breech position.
A particularly painful complication that can occur during pregnancy is “red degeneration,” where a fibroid outgrows its blood supply, causing tissue death and acute abdominal pain. Additionally, the presence of large fibroids can interfere with the uterus’s ability to contract effectively after childbirth, a condition called uterine atony. This failure of the uterine muscle to clamp down on blood vessels increases the risk of severe postpartum hemorrhage.
Acute Events Requiring Immediate Medical Intervention
While most consequences of untreated fibroids involve a gradual worsening of symptoms, certain events represent sudden, severe complications demanding immediate medical attention. One such event is acute hemorrhage, where a sudden and profuse episode of bleeding occurs, often originating from a degenerating submucosal fibroid. This massive blood loss can be rapid and severe enough to require emergency medical intervention, including blood transfusion or an urgent procedure to control the bleeding.
Pedunculated fibroids, which are attached to the uterus by a stalk, carry the risk of torsion, or twisting. If the stalk rotates, the blood supply to the fibroid is cut off, causing excruciating and sudden abdominal pain. This acute myoma torsion is a surgical emergency, necessitating rapid intervention, often a laparoscopy or laparotomy, to remove the dying tissue.
Finally, large fibroids situated low in the pelvis can suddenly compress the urethra or bladder neck, leading to acute urinary retention. This complete inability to empty the bladder causes severe pain and requires emergency catheterization. These acute events represent the most extreme, though less common, risks of allowing fibroid disease to progress unchecked, highlighting the potential for the condition to transition from a chronic nuisance to a medical crisis.