Uterine fibroids (also called leiomyomas or myomas) are common, non-cancerous growths of muscle and fibrous tissue that can develop in a woman’s womb (uterus). Fibroids are most common during a woman’s reproductive years – between 70–80% of women will have one or more fibroids by the age of 50. However, only about 30% of these women will experience symptoms, with most not requiring any treatment at all.1,2
When fibroids do produce symptoms, they can be painful and debilitating. Unfortunately, many women who have fibroid symptoms delay reporting them. By doing so, they forego treatment, which could improve their quality of life and put an end to related health problems, such as anaemia and iron deficiency. If you have one or more of the following symptoms, fibroids could be to blame. A gynaecologist can assess if this is the case and if so, explain the treatment options available to you.
1. Prolonged, painful or heavy periods
Abnormal menstrual activity is the most common symptom of fibroids. Fibroids can cause periods that are extremely painful, with heavy bleeding (menorrhagia) that lasts longer than seven days.
Menstruation (your period) is essentially the break down and removal of the inner lining of your womb (uterus), which builds up each month in preparation for a potential pregnancy. If fibroids grow within this lining, they cause it to enlarge, leading to heavier and longer bleeding when you menstruate.
2. Anaemia, i.e. low red blood cell count (with or without iron deficiency)
Periods associated with heavy bleeding can lead to a low red blood cell count (anaemia). If you have anaemia, you may feel tired, run down and short of breath, particularly when you exercise. This is because red blood cells help store and carry oxygen in the blood. If you have fewer red blood cells than normal, your organ and tissues, e.g. heart and lungs, won’t be getting as much oxygen as usual.
Over time, ongoing, heavy blood loss may also lead to low iron levels (iron deficiency). Without iron, your body is unable to make new, functional red blood cells – this is called iron deficiency anaemia. Left untreated, iron deficiency anaemia can lead to heart problems and other complications.
3. Non-cyclic bleeding and pain
Mild pelvic or lower back pain is not uncommon during menstruation. However, fibroids can produce pain at any time of the month. This pain tends to be more severe than period pain, particularly if the fibroids are large and putting physical pressure on the uterus. If blood vessels within the fibroids rupture, this may also cause bleeding at other times of the month. If you are experiencing pelvic pain and/or bleeding on and off throughout your entire cycle, it could be due to fibroids.
4. Pain during intercourse
Fibroids may increase the size of the uterus or grow in the cervix (close to your vaginal tract). When they grow in these areas, they can produce pressure and significant pain during sexual intercourse.
5. Abdominal bloating
Larger fibroids may push into your lower abdomen, causing a feeling of fullness unrelated to food consumption or bowel motions. If they continue to grow, the lower abdomen may even protrude (bulge out), creating an almost pregnant appearance.
6. Bowel and bladder issues
Fibroids may also put pressure on your bowel and bladder. Depending on their exact location, you may experience constipation, a frequent urge to urinate, an inability to urinate, or pain when attempting to use the toilet.
The location of your fibroids will determine the symptoms you experience
Fibroids are classified by where they grow in relation to the uterus. There are 4 different kinds of fibroids:
1. Intramural fibroids grow within the wall of the uterus.
All fibroids start growing within the wall of the uterus. Then, depending on which direction they grow (inside or outside the uterus), they turn into one of the other types of fibroids described below. Intramural fibroids are the most common and do not usually cause symptoms, unless they reach a significant size.
2. Subserosal fibroids grow outside the uterus.
Subserosal fibroids grow outwards from the uterus, into the abdominal cavity. These are the largest type of fibroid and can even weigh multiple kilograms. Your gynaecologist may be able to feel or even see them during a pelvic exam.
Usually, symptoms from these fibroids are due to the pressure they produce on nearby structures in the abdomen such as the bladder or bowel, e.g. you may experience back and pelvic pain or bowel and urinary issues.
3. Submucosal fibroids grow inside the uterus.
Because the inside of your uterus is so small (about 7 cm), submucosal fibroids do not have to reach a large size to cause significant symptoms. Submucosal fibroids tend to produce a lot of bleeding, pain and excessively long periods.
In very rare instances, submucosal fibroids may alter the shape of the uterus. This can lead to fertility issues or recurrent miscarriages.3 In this case, help from a fertility specialist may be required to fall pregnant or to assess the womb’s ability to carry a pregnancy to term.
4. Pedunculated fibroids are attached to the uterus via a stalk (peduncle).
This type of fibroid is defined by the stalk that attaches it to the uterus. Pedunculated fibroids usually cause mild to moderate pain, not unlike menstrual cramping. However, large pedunculated fibroids may twist on their stalk, producing sudden and severe pain.
If I’ve been diagnosed with uterine fibroids, should I be concerned?
If you’ve been diagnosed with fibroids but are symptom free, there is little cause for concern – the vast majority never cause symptoms and don’t impact on fertility. Fibroids can also wax and wane over time (and typically shrink after menopause), so sometimes symptoms will resolve on their own.
However, when symptoms do occur, they can be debilitating – particularly if they are affecting your ability to keep up with work and other day-to-day commitments. In this case, it is worth consulting a gynaecologist to understand the treatment options available to you.
- Fibroids, Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fibroids. Accessed March 13, 2019. ↩
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–107. ↩
- Farquhar C. Do uterine fibroids cause infertility and should they be removed to increase fertility? BMJ. 2009;338:b126. doi:10.1136/bmj.b126 ↩