Uterine fibroids are common, non-cancerous growths that develop in the uterus. While many women may have them without experiencing any noticeable symptoms, for others, pain can be a significant and disruptive concern.
What Are Uterine Fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are benign muscular tumors that grow within the wall of the uterus. They are common, affecting many women of reproductive age, with estimates suggesting up to 70% of women in the U.S. may develop them by age 50.
These growths can vary considerably in size, from as small as a seed to as large as a grapefruit. Fibroids can also develop in different locations: intramural fibroids grow within the muscular wall, submucosal fibroids protrude into the uterine cavity, and subserosal fibroids form on the outer surface of the uterus. Some fibroids, called pedunculated fibroids, are attached by a stalk.
How Fibroids Lead to Pain
Fibroids can cause pain through several mechanisms, often related to their size and location. Large fibroids can press on surrounding organs, leading to sensations of pressure or specific types of pain. This pressure can affect the bladder, causing frequent urination, or the bowel, leading to constipation. Fibroids located on the back wall of the uterus can press against nerves, contributing to back or leg pain.
Fibroids may outgrow their blood supply, leading to a process called degeneration. When this occurs, the tissue within the fibroid begins to die, releasing chemicals that trigger inflammation and acute, severe pain. This type of pain can be sharp and sudden, sometimes accompanied by a fever. Rapid fibroid growth or degeneration can also induce inflammation, contributing to a persistent, dull ache often experienced as chronic pelvic pain.
Submucosal fibroids, which grow into the uterine cavity, are a frequent cause of heavy and prolonged menstrual bleeding (menorrhagia). The uterus contracts more forcefully to expel the excessive blood and clots, resulting in severe menstrual cramps (dysmenorrhea). Submucosal fibroids can be perceived by the uterus as foreign bodies, prompting it to contract intensely in an attempt to expel them, leading to intense cramping pain often worse than typical menstrual discomfort. This chronic blood loss can lead to anemia, causing fatigue and weakness.
Common Pain Patterns and Related Symptoms
Fibroid pain can manifest in various ways, from a dull ache to sharp, acute episodes. Common experiences include pelvic heaviness, pressure, or a persistent dull ache in the lower abdomen. Menstrual pain (dysmenorrhea) is often significantly worse with fibroids, characterized by severe cramping during periods.
Fibroids can also cause referred pain, such as in the lower back or legs due to nerve pressure. Pain during sexual intercourse (dyspareunia) can occur, especially if fibroids are located near the cervix or are large enough to cause pressure during penetration. This can manifest as deep pain during thrusting or a general discomfort.
Other symptoms often accompany fibroid pain. These include frequent urination or difficulty emptying the bladder due to pressure, constipation or rectal pressure from fibroids pressing on the rectum, and abdominal bloating or a visible enlargement of the stomach. Anemia from heavy bleeding can lead to fatigue and weakness.
When to Consult a Doctor
Consult a healthcare professional if you experience symptoms suggesting fibroids, especially if they impact daily life. Warning signs include severe or persistent pelvic pain, unusually heavy or prolonged menstrual bleeding, bleeding between periods, or difficulty urinating or having bowel movements.
Diagnosis typically involves a physical examination and imaging techniques, such as ultrasound or MRI. Seeking medical advice is the first step toward understanding and managing fibroid-related pain.