Fibroid Basics: Symptoms

Studies estimate that 60-90% of all fibroids do not cause any symptoms. When symptoms develop they tend to occur in the late 30s and 40s, often with an increase in symptoms in the perimenopausal period. Though most fibroids are smaller than a golf ball they can grow to the size of a melon. While some women have only one fibroid others can have dozens, on average six to seven. A combination of the size, number, and location of fibroids may determine the extent and type of symptoms.

Fibroid symptoms can be grouped into abnormal bleeding, pelvic pain, and those caused by mass effect by the enlarged uterus (bulk-type symptoms). Women may develop one or more of the following symptoms:

• Abnormal bleeding - submucous and intramural fibroids can both cause menorrhagia (prolonged and/or profuse menstrual bleeding) sometimes leading to severe anemia. Gushing, or flooding, and passage of large clots can occur. In some cases there can be bleeding between periods (metrorrhagia).
• Pelvic pain - typically associated with heavy menstrual flow with cramping (dysmenorrhea). An uncommon cause of fibroid related pain is acute degeneration where the blood supply is spontaneously disrupted and the fibroid infarcts (dies) and then shrinks. Carneous or red degeneration is an unusual complication where there is bleeding into the substance of the fibroid, occasionally occurring during pregnancy. The pain can be quite severe but is usually self-limited.
• Bulk-type symptoms - those caused by individual fibroids, or the enlarged uterus, compressing adjacent structures.
• Pelvic pressure or discomfort - a generalized feeling of heaviness/pain caused by displacement of nearby structures. If nerves are compressed there can be pain in the lower back, flank, or legs.
• Abdominal distortion - as the fibroids enlarge the uterus it can extend above the pelvic bone and cause from a small paunch to a very distended abdomen with an appearance suggestive of pregnancy. In fact, gynecologists frequently size the enlarged uterus by referencing it to a comparably sized pregnant uterus (# of weeks gestational size).
• Frequent urination - caused by compression of the bladder leading to decreased capacity. This can be disruptive to sleep and daytime activities. Occasionally compression of the bladder can result in stress incontinence (leakage of urine during straining) or bladder outlet obstruction. Rarely, the ureter (connecting the kidney to the bladder) can be compressed and compromise kidney function.
• Constipation or bloating can occur when there is compression of the rectum.
• Pain during sexual intercourse (dyspareunia) can have a variety of causes including fibroids that distort the vagina.
• Reproductive dysfunction - including infertility, recurrent miscarriages, premature labor, and complications of labor. While controversial, and not well studied, these complications are thought to occur when fibroids distort the uterine cavity. Infertility caused by fibroids is thought to represent only 2-3% of all infertility cases. Fibroids can block the cervix or opening to the fallopian tubes thus causing infertility. A submucous fibroid can distort the cavity enough to prevent implantation of the fertilized ovum and result in recurrent miscarriages. It is less clear whether intramural or subserosal fibroids cause reproductive dysfunction.

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