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Fibroid Symptoms

What’s Normal, What’s Not?

Uterine fibroids can cause heavy bleeding, pelvic pain, weight gain, and pregnancy challenges. Our Fibroid Specialists go in-depth on the common and the not-so-common symptoms of uterine fibroids.
Woman lying in bed with fibroid symptoms

For women that are affected by uterine fibroids, it’s no secret that heavy bleeding and pelvic pain are its most common symptoms, but your fibroids can affect your body and your health in other ways that you might not have realized. We’re talking about weight gain, period pain, and pregnancy challenges. We’re also talking about bloating, back pain, and bathroom difficulties.

Uterine fibroid symptoms can vary widely depending on number, location, and size of fibroids in the affected individual. Check out this fibroid symptom review to learn more. Generally speaking, severity of symptoms correlates with fibroid size, with larger fibroids causing more intolerable symptoms. This is why treatments that shrink fibroids are effective at alleviating heavy bleeding, fibroid pain, and other symptoms. Ask your doctor the right questions about fibroids.

You can use this quick navigation list to learn more about a specific type of symptom:

Fibroid Specialist Dr. Lalezarian provides fibroid symptom relief in Los Angeles, California

Fibroid Symptom Relief
in Los Angeles

ProFibroidMD is a leading provider of uterine fibroid embolization (UFE), the least invasive treatment option for uterine fibroid symptom relief. Our Fibroid Specialists have helped countless women overcome their fibroids and get back to their happy, healthy selves.
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Heavy Bleeding

Heavy menstrual bleeding is the most common symptom reported by women with uterine fibroids [1]. Bleeding abnormalities are not exclusive to uterine fibroids and may indicate another condition, but women with a diagnosis of uterine fibroids report bleeding problems 2-3 times more frequently than women without a diagnosis of uterine fibroids [2].

Bleeding abnormalities caused by uterine fibroids include [2]:

• Heavy menstrual bleeding with fibroids
• Prolonged duration of menstrual bleeding – longer than 6 days [3]
• Fibroids bleeding between periods
• Frequent periods – more often than every 24 days [3]
• Irregular / unpredictable periods

Many women with excessive menstrual bleeding mistakenly assume that their heavy periods are normal and do not seek care [4]. In some women, excessive bleeding can be severe enough to cause iron-deficiency anemia; leading to fatigue, weakness, headaches, dizziness, and other more severe complications. Other women experience day-to-day discomfort, social isolation, and loss of productivity as a consequence of managing heavy periods [1,2].

If your periods are abnormally heavy, last longer than a week, or you’re experiencing bleeding between periods, you may be living with uterine fibroids.

Woman holding her stomach from fibroid pelvic pain

Pelvic Pain

Although uterine fibroids aren’t life threatening, the symptoms of fibroids can be a major drag on quality of life. Persistent pelvic pain is a common complaint amongst women with fibroids, and one of the leading reasons that women seek treatment for their fibroids. Fibroids may also press on the sciatic nerve, causing pain that can radiate down the leg.

Variations in the number of fibroids, fibroid size, and fibroid location can cause a variety of pain patterns that differ from person to person [2,4,5]. These include:

• Chronic pelvic pain
• Acute pelvic pain
• Back pain
• Sciatic nerve pain / leg pain
• Pain during intercourse
• Pain when using the bathroom

Uterine fibroids can cause a persistent pain or pressure in the pelvis that lasts indefinitely called ‘chronic pain’. Posterior fibroids (on the back side of the uterus) may cause lower back pain or rectal pain as they impinge on the nearby anatomy, while anterior fibroids (on the front side of the uterus) can contribute to anterior pelvic pain, pressure sensations, and urinary complications.

‘Acute pain,’ on the other hand, typically refers to significant pain that has a rapid onset and is resolved with treatment. In the case of uterine fibroids, there are a few known sources of acute pain that are directly caused by fibroids:

• Pedunculated fibroids (fibroids that grow on stalks) can get twisted, which can be very painful [4].
• Submucosal fibroids that grow underneath the uterine lining can cause the cervix to stretch, causing pain [5].
• Fibroids can undergo ‘red degeneration’ (death of the fibroid cells), usually during pregnancy [5].
• Pain during intercourse is commonly reported by women with fibroids [2].

In less common cases, fibroids may also cause sciatica. Sciatica refers to pain that is associated with your sciatic nerve, which runs from your lower back to your legs. Sciatica can occur if the uterine fibroids are pressing against the sciatic nerve, causing sciatic nerve pain that can radiate down the leg [5].

If you’re experiencing persistent pelvic pain, pain during intercourse, sciatic nerve pain, leg pain, back pain, or pain when using the bathroom, you may be living with fibroids.

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Weight Gain

Uterine fibroids can vary in size from small ‘seedlings’ to large masses that fill the entire abdomen. As fibroids grow, the uterus expands to accommodate them similar to how it expands throughout a pregnancy [4].

As fibroids grow, women may experience:

• An enlarged uterus
• Unexplained weight gain
• Weight gain around the abdomen and pelvis
• Bloating

Growth rates of fibroids vary significantly depending on age and race [6]. In many cases, fibroids remain small and inconsequential, which is part of the reason why so many women have asymptomatic fibroids. In other cases, fibroids undergo phases of rapid growth, causing visible distention of the abdominal region and pelvic pressure, among other symptoms [7,8].

A physical exam is usually sufficient to estimate the size of your uterus. A normal sized uterus is roughly the size of a small pear and is deep inside the pelvis. As it grows due to fibroids, its size is described as compared to a gravid, or pregnant, uterus. A benchmark that many physicians use is that a 12 week pregnant uterus is felt at the pelvic bone and is the size of a grapefruit, while at 20 weeks the uterus is felt at the umbilicus (around the belly button) [9]. They can use this to estimate the size of the uterus depending on where they feel it in the abdomen. The bigger it is, the more likelihood that the symptoms a woman experiences are worse.

If you’ve experienced unexplained weight gain, abdominal bloating, or if you’ve noticed your tummy expanding, you may be living with uterine fibroids.

Tummy weight gain symptom of fibroids

Period Pain

Painful cramping just before or during your period is normal, but recurrent pain throughout the rest of your menstrual cycle (what we call ‘cyclic pain’) may be caused by uterine fibroids. It is 2 to 3 times more common for women with uterine fibroids to experience abnormal pain after their period ends or mid-cycle pain when ovulating than it is for women without uterine fibroids. In addition to more frequent cycle pain, women with uterine fibroids report more pelvic pain throughout all phases of their menstrual cycle than women without uterine fibroids [2].

Women should be particularly suspicious of uterine fibroids if they experience:

• Pain after their period ends
• Pain occurring mid-cycle (around 10 days after the end of your last period)
• Excessively painful periods
• Abnormal pain during their menstrual cycle

The exact relationship between fibroid size, location, and pain at various points throughout the menstrual cycle is not well understood. Uterine fibroids can grow to significant sizes very quickly [5], possibly causing menstrual cycle abnormalities. Women concerned about the possibility of having uterine fibroids should take extra care to monitor their entire menstrual cycle for recurring pain patterns and bleeding irregularities.

If you experience pain after your period, excessive pain during periods, or abnormal pain throughout your menstrual cycle, you may be living with uterine fibroids.

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Bathroom Difficulties

Women with fibroids may also experience dull pain or pressure sensations in their pelvic region. When fibroids grow, they can change the shape of the uterus and obstruct nearby organ systems. The urinary and gastrointestinal systems tend to suffer the most when fibroids enlarge beyond the uterus, contributing to uncomfortable pressure sensations throughout the pelvic region [10,11]. These include:

• Pressure sensations on the bladder or inside the abdomen
• Feeling bloated
• Frequent urination, difficulty urinating, or urinary incontinence
• Hydronephrosis (swelling of the kidneys due to the inability to drain urine)
• Constipation or tenesmus (persistent feeling of having to evacuate the bowels)

Pelvic pressure symptoms are rather common in fibroids. Around 30% of women with diagnosed uterine fibroids report sensations of chronic pressure on the bladder or inside the abdomen [2]. Pelvic pressure sensations can vary from mild discomfort to episodes of intense pain, and are sometimes accompanied by sensations of congestion, bloatedness, or heaviness [10].

Anterior fibroids (towards the front of the uterus) can obstruct the urinary tract and press on the bladder, causing frequent urination, difficulty urinating, pain while urinating, and even urinary incontinence. Larger fibroids can occasionally obstruct the ureters (the urine ducts between the kidneys and the bladder). In such cases, the kidneys may swell due to an inability to drain urine (a condition called ‘hydronephrosis’) [10,11].

Posterior fibroids (towards the back of the uterus) can impede on the gastrointestinal tract, causing rectal pain, constipation, or feeling like you have to go when you already have (a sensation referred to as tenesmus) [11].

If you’re experiencing pelvic pressure, urinary symptoms, bloating, or constipation, you may be living with uterine fibroids.

Woman with uterine fibroids holding pregnancy test in frustration

Pregnancy Challenges

Concerns about infertility, miscarriage, and other reproductive problems are perfectly normal when women learn that they have uterine fibroids. The effects of uterine fibroids on childbearing potential and pregnancy outcomes have been studied and debated from varying viewpoints.

Fibroids & Infertility

Uterine fibroids are present in up to 2.4% of women with fertility challenges without any other obvious cause of infertility [4]. In such cases, submucosal (just underneath the uterine lining) and intramural fibroids (in the wall of the uterus) are thought to distort the shape of the uterine cavity, while intramural fibroids could also obstruct the fallopian tubes [4,12]. In either case, these alterations to the uterus would interfere with sperm movement or possibly prevent egg implantation.¹ Subserosal fibroids (on the outside of the uterus) appear to have no effect on fertility [13].

Women seeking treatment for uterine fibroids should understand the implications of treatment on their childbearing potential. Hysterectomy (removal of the uterus) completely eliminates a woman’s ability to bear children, while myomectomy and uterine fibroid embolization are fertility sparing and can even improve fertility in some cases [13].

Fibroids & Miscarriage

Whether or not uterine fibroids cause miscarriage has been a subject of debate amongst the medical community throughout the last two decades. In the early 2000’s, fibroids were reported to increase risk of miscarriage by around 60%. Unfortunately, the studies that reported this finding were subject to some major scientific limitations: studies were retrospective with the majority of participants selected from prenatal care or ultrasonography clinics. In effect, these study populations were biased to include more women with a history of infertility, high risk pregnancy, and fibroids, and without adjusting for confounding factors, fibroids appeared to have a major influence on miscarriage rates. In the absence of better evidence, the American Society of Reproductive Medicine has endorsed fibroid treatment to reduce a woman’s chance of miscarriage by 50% [14].

Between 2002 and 2012, a high quality prospective study followed the pregnancies of 5,512 women. The study assessed the presence, distribution, and types of fibroids in each of the study participants. Women with fibroids had a 30% increased risk of miscarriage compared to women without fibroids, and risk appeared greater in intramural (50% increase) and submucosal (70% increase) cases. However, when adjusting for other factors that are known to contribute to miscarriage (age, race, type 2 diabetes, BMI, miscarriage history, and prior termination of pregnancy) the researchers found that fibroids did not significantly increase the risk of miscarriage [14]. These findings do not completely rule out a causal link between uterine fibroids and miscarriage, but they do emphasize that such a link is a rare occurrence. In general, women should not seek fibroid treatment with the sole expectation of reducing miscarriage risk.

Fibroids & Birth Complications

A number of obstetrical (child birth) outcomes have been studied in women with symptomatic uterine fibroids [15]. Women with fibroids are more susceptible to:

• Preterm labor
• Malpresentation (abnormal position of the fetus at time of delivery)
• Placenta previa (placenta blocks the neck of the uterus)
• Placental abruption (separation of placenta from the wall of the uterus)
• Cesarean section
• Postpartum bleeding / hemorrhage
• Retained placenta

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More Resources
Woman discussing surgical vs. non-surgical fibroid treatment options with Fibroid Specialist
Surgical vs. Non-Surgical Fibroid Treatments: Which Is Best?

When it comes to fibroid treatment, we believe that less is more. A less invasive procedure means less trauma, less risk, and shorter recovery time. Learn more about why we opt for UFE, the least invasive treatment for uterine fibroids.

Uterine artery embolization
Uterine Artery Embolization
Uterine artery embolization is a minimally-invasive procedure that we offer at ProFibroidMD to relieve heavy bleeding, pain, and other symptoms in patients with uterine fibroids. Learn more about our specialty procedure.
Fibroid Specialist in Los Angeles
Fibroid Specialist in Los Angeles
Learn more about Los Angeles Fibroid Specialist Dr. Michael Lalezarian.
References

[1] Gupta, S., Jose, J., & Manyonda, I. (2008). Clinical presentation of fibroids. Best Practice and Research: Clinical Obstetrics and Gynaecology, 22(4), 615–626.
[2] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.
[3] Marret, H., Fauconnier, A., Chabbert-Buffet, N., Cravello, L., Golfier, F., Gondry, J., … Fernandez, H. (2010). Clinical practice guidelines on menorrhagia: Management of abnormal uterine bleeding before menopause. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 133–137.
[4] Duhan, N., & Sirohiwal, D. (2010). Uterine myomas revisited. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 119–125.
[5] Bukulmez, O., & Doody, K. J. (2006). Clinical features of myomas. Obstetrics and Gynecology Clinics of North America, 33(1), 69–84.
[6] Peddada, S. D., Laughlin, S. K., Miner, K., Guyon, J.-P., Haneke, K., Vahdat, H. L., … Baird, D. D. (2008). Growth of uterine leiomyomata among premenopausal black and white women. Proceedings of the National Academy of Sciences, 105(50), 19887–19892.
[7] Funaki, K., Fukunishi, H., Tsuji, Y., Maeda, T., & Takahashi, T. (2013). Giant cystic leiomyoma of the uterus occupying the retroperitoneal space. Journal of Radiology Case Reports, 7(12), 35–40.
[8] F., S., I., I., O., A., R., H., C., D., A., I., … T., R. (2011). Giant uterine leiomyoma. Chirurgia (Bucharest, Romania : 1990), 106(5), 665–668.
[9] Reference needed
[10] Stewart, E. A. (2001). Uterine fibroids. Lancet, 357(9252), 293–298.
[11] Khan, A. T., Shehmar, M., Gupta, J. K., & Gupta, J. (2014). Uterine fibroids: current perspectives. International Journal of Women’s Health, 6, 95–114.
[12] Donnez, J., & Dolmans, M. M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665–686.
[13] Pritts, E. A., Parker, W. H., Olive, D. L., & D, M. (2009). UTERINE FIBROIDS Fibroids and infertility : an updated systematic review of the evidence. Fertility and Sterility, 91(4), 1215–1223.
[14] Hartmann, K. E., Edwards, D. R. V., Savitz, D. A., Jonsson-Funk, M. L., Wu, P., Sundermann, A. C., & Baird, D. D. (2017). Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk. American Journal of Epidemiology, 186(10), 1140–1148.
[15] Guo, X. C., & Segars, J. H. (2012). The Impact and Management of Fibroids for Fertility: an evidence-based approach. Obstetrics and Gynecology Clinics of North America, 39(4), 521–533.

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