Uterine fibroids are common, non-cancerous growths that develop within the uterus. They can lead to various symptoms, with pelvic pain being a frequent concern.
What Are Uterine Fibroids?
Uterine fibroids, also known as leiomyomas, are benign tumors composed of muscle cells and fibrous tissue that grow in or on the uterine wall. They are the most common non-cancerous tumors in individuals with a uterus, affecting a significant percentage of women during their reproductive years. Fibroids vary in size, from microscopic to larger than a grapefruit, and can appear as single growths or in clusters.
Estimates suggest that 70% to 80% of women may develop fibroids by age 50. Their location determines their classification: intramural fibroids grow within the muscular wall of the uterus, subserosal fibroids develop on the outer surface, and submucosal fibroids grow just beneath the uterine lining, protruding into the uterine cavity. Pedunculated fibroids are attached by a stalk to either the inner or outer uterine wall.
How Fibroids Cause Pelvic Pain
Fibroids can cause pelvic pain through several mechanisms, often influenced by their size, location, and condition. Larger fibroids frequently exert pressure on surrounding organs, such as the bladder or rectum. This can lead to discomfort, radiating pain to the lower back or legs, or a feeling of fullness in the lower abdomen.
Rapid fibroid growth can sometimes outpace their blood supply, leading to degeneration where the fibroid tissue begins to die. This degeneration releases inflammatory chemicals, causing acute, sometimes severe, pelvic pain and swelling. This pain often subsides as the fibroid shrinks, but the cycle of growth and degeneration can recur.
Submucosal fibroids, located just beneath the uterine lining, are a common cause of heavy and prolonged menstrual bleeding. This excessive bleeding can lead to severe menstrual cramps and generalized pelvic pain as the uterus contracts forcefully to expel blood and tissue, or to try and expel the fibroid itself. Fibroids can also cause chronic inflammation within the uterus, contributing to heightened sensitivity and pain in the pelvic region.
Recognizing Fibroid Symptoms
Pelvic pain is one of many symptoms associated with uterine fibroids, but these growths can manifest in various other ways depending on their size, number, and location. Heavy or prolonged menstrual bleeding, known as menorrhagia, is a common symptom, sometimes leading to anemia due to significant blood loss. This heavy bleeding can be accompanied by blood clots and periods lasting longer than seven days.
Fibroids can also cause a persistent feeling of pressure or fullness in the lower abdomen, sometimes leading to abdominal enlargement. Pressure on the bladder can result in frequent urination or difficulty completely emptying the bladder. Pressure on the rectum or intestines may cause constipation or difficulty with bowel movements. Other potential symptoms include lower back pain, leg pain, or pain during sexual intercourse (dyspareunia).
Diagnosis and Treatment Approaches
Diagnosing uterine fibroids typically begins with a pelvic exam, where a healthcare provider may detect an enlarged or irregularly shaped uterus. Imaging tests confirm the diagnosis, with ultrasound (transabdominal and transvaginal) being the primary tool to visualize, map, and measure fibroids. For more detailed assessment, particularly before surgical interventions, a Magnetic Resonance Imaging (MRI) scan provides comprehensive information on fibroid size, location, and number, and helps differentiate them from other conditions.
Treatment approaches for fibroid-related pelvic pain and other symptoms vary, tailored to the individual’s symptom severity, fibroid characteristics, and reproductive plans. Initial management often involves pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to alleviate discomfort. Hormonal medications, including birth control pills, progesterone-releasing intrauterine devices (IUDs), and gonadotropin-releasing hormone (GnRH) agonists, can help manage heavy bleeding and, in some cases, temporarily shrink fibroids by reducing estrogen levels.
For those seeking less invasive options, procedures like Uterine Fibroid Embolization (UFE) involve blocking the blood supply to the fibroids, causing them to shrink. Radiofrequency ablation (RFA) uses heat to destroy fibroid tissue. When medical and minimally invasive options are insufficient, surgical interventions are considered. Myomectomy is a procedure to remove fibroids while preserving the uterus, often preferred by individuals who wish to maintain fertility. Hysterectomy, the surgical removal of the entire uterus, offers a definitive solution for fibroids and their symptoms, though it eliminates the possibility of future pregnancy.