Fibroid Symptoms

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.

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 sciatic nerve 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].

Can Fibroids Cause Sciatica?

In less common cases, fibroids may 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.

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.

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.

• 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.

Fibroids & Infertility

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

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

• 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