Are Uterine Fibroids Painful? Understanding Symptoms, Causes, & Treatment Options.

What Are Uterine Fibroids?

Fibroids are non-malignant tumours of the uterus. They can form both in the uterus and around it and consist of muscle and connective tissue. Their sizes range from small to large enough to alter the shape of the uterus. Many women who have fibroids are not aware of their presence and consequently experience no symptoms.

There are three types of fibroids, depending on where they are located within the uterus.

• Intramural fibroids are located within the uterine wall.
• Subserosal fibroids are formed on the exterior of the uterus.
• Submucosal fibroids are found within the uterus cavity.

The location of fibroids influences the likelihood and severity of symptoms, including pain.

Different Types of Uterine Fibroid Pain

If you have non-cancerous uterine tumours, you could experience pain in the following regions:

Many women with uterine fibroids complain of pelvic discomfort because fibroids grow and put pressure on the pelvis.

• The size of a fibroid can press against nerves and muscles in the back, creating inflammation and back discomfort.
• Pain from fibroids often feels like pressure or fullness in your abdomen. However, if the pain is stabbing, sharp, or does not improve after taking pain medications, please discuss it with your doctor.
• Women who have fibroids often experience pain during sex because the act of penetration puts the fibroids under pressure. Painful sex occurs more often if your fibroids are located close to your cervix.
• Rectal or bladder discomfort can occur when larger fibroids develop or when the tumour forms outside the uterus and attached by stalk-like structures (pedunculated fibroids).

In addition to pain, you may experience changes in urination and bowel habits, such as frequent urination or difficulty having a bowel movement, due to these fibroids.

Why Do Fibroids Cause Pain?

The development of pain related to fibroids can be attributed to three different factors: pressure on an adjacent organ, inflammation, and alteration to the blood supply to the fibroid. When fibroids grow, they can put pressure on one or more organs in the pelvis, including the bladder, bowel, and pelvic nerves. Possible symptoms of pressure on nearby pelvic organs include:

• Pelvic discomfort
• Abdominal bloating
• Frequency of urination
• Constipation

Fibroid degeneration is another factor concerning fibroids and the development of pain. As a fibroid increases in size, the blood supply to it is reduced. When this happens, the fibroid tissue starts to break down. The result in inflammation and localised sharp pain.

Other factors associated with pain from fibroids are hormonal changes. Fibroids grow in the presence of estrogen and progesterone; therefore, fibroid symptoms may be aggravated during pregnancy due to hormonal changes.

In addition to the above, in some women, the presence of fibroids can increase uterine contractions during menstruation, leading to more pronounced menstrual cramps.

Symptoms of Painful Fibroids

Fibroids often cause many visible symptoms, including the most well-known symptom - pain, but in most cases, there are usually other indicators that something is wrong in addition to the pain.

The following symptoms are often seen with painful fibroids.

• Heavy bleeding during menstruation
• Painful cramps during menstruation
• Pressure in the pelvic area or fullness in the pelvic area
• Pain in the lower back
• Frequent urination
• Pain during intercourse
• Swelling of the abdomen

Some of these symptoms may be very mild to severe, depending on the individual woman. Some women may only have mild symptoms during their periods, while some women have chronic pain in the pelvic area that interferes with daily activities. It's important to remember that symptoms can change as the fibroids grow or decrease in size so it is very important for women diagnosed with fibroids to have regular visits to a healthcare provider.

Causes and Risk Factors of Uterine Fibroids

The cause of uterine fibroids is unknown; however, it is presumed that the hormones estrogen and progesterone play a significant role. Most fibroids are seen in women of reproductive age. Research indicates that fibroids tend to grow during periods of high hormone levels (e.g., pregnancy) and contract during periods of low hormone levels (e.g., as one approaches menopause).

Many risk factors are associated with the occurrence of fibroids. Some of these include:

• Obesity and a higher body mass index (BMI)
• A family history of fibroids
• Not having children
• Beginning menstruation early (getting your period at a younger age)
• Having a later onset of menopause

Do All Fibroids Cause Pain?

Pain associated with fibroids can differ significantly. Many women will have fibroids but will not experience any symptoms; these fibroids are commonly found during a routine pelvic examination or through ultrasound imaging. Small fibroids may be completely benign and cause no symptoms whatsoever; larger fibroids or those located in a sensitive area of the uterus have an increased likelihood of causing a problem. Whether or not fibroids will cause discomfort is dependent upon several variables, including:

• Fibroid size
• Number of fibroids
• Fibroid location within the uterus
• Hormonal influence

As symptoms may vary substantially, physicians generally recommend periodic follow-up assessments of fibroids to determine if treatment is required.

How Are Uterine Fibroids Diagnosed?

In many instances, a pelvic exam by a healthcare professional will reveal uterine fibroids. There are several ways to confirm the presence of uterine fibroids, their sizes and locations, which include:

• Ultrasonography - A noninvasive imaging test that uses sound waves to create a picture of your internal organs.
• Magnetic Resonance Imaging (MRI) - A test that uses magnets and radio waves to produce highly detailed images of your internal organs.
• Computed Tomography (CT) Scan - A CT scan takes a series of X-ray images of the same internal organ from multiple angles and combines them to produce a detailed image of the organ.
• Hysteroscopy - A hysteroscopy is performed by inserting a device called a scope (which is a small, flexible tube with a camera at the end) into your vagina, through your cervix, and into your uterus to visualise the fibroids that are located in your uterus.
• Hysterosalpingography (HSG) - An HSG is performed by injecting contrast material (to visualise the uterine cavity and fallopian tubes) and then taking an X-ray of your uterus.

What Are the Possible Treatment Options for Uterine Fibroids?

Fibroids can be treated in many different ways. The treatment depends on how many fibroids there are, their size, location, what symptoms they are causing (if any), and whether or not you want to keep your uterus. If you do not have symptoms from your fibroids, you might not require treatment. If you have a small fibroid, it can usually just be left alone. Many women never develop any problems or symptoms associated with fibroids; therefore, the doctor will likely recommend that you simply be monitored with routine pelvic exams and ultrasounds for changes. The best treatment option may also depend upon any plans for future pregnancies. When discussing treatment options, be sure to discuss your fertility goals with your healthcare provider. The treatments available for uterine fibroids include:

Medications

• Over-the-counter (OTC) drugs are available for pain and discomfort caused by fibroids.
• If you have anaemia due to excessive blood loss, your doctor might recommend taking an iron supplement.
• The birth control pill is often prescribed for women who suffer from fibroids, particularly those whose periods are heavy or who have menstrual cramps.
• Gonadotropin-releasing hormone (GnRH) agonists are used to shrink fibroids. They may be used before surgical removal, because they help make the fibroid easier to remove.
• Oral medication may be prescribed to manage severe uterine bleeding in patients who have not experienced menopause and have symptomatic fibroids. Treatment may be given for 24 months as directed by your prescriber.

Surgical options

There are many factors to consider when discussing fibroid removal, and the type of surgery will depend on fibroid size, number, and location. One of the many factors to consider may also include future childbirth. Some fibroid removal methods will preserve the uterus and allow for future childbearing, while others may affect fertility or require removal of the uterus.. Doctors may recommend non-surgical or less invasive techniques first before opting for more invasive options. Surgical options include myomectomy (removing the fibroid) and hysterectomy (removing the uterus).

Conclusion

Uterine fibroids are benign growths and fairly common in women during their childbearing years. Many women have no symptoms associated with their fibroids; however, some women do have considerable discomfort. Symptoms depend upon the size, number, and location of the fibroids. Pressure in the pelvic area from fibroids, menstrual cramps due to heavy bleeding, lower back pain, and pain with day-to-day activities are the common symptoms. Numerous options are available for the effective management of symptoms related to fibroids. Management options include medications, exercise, changing diet and lifestyle, non-surgical methods (contraceptive options), aided methods (ultrasound for fibroid reduction), and surgical removal of fibroids. By obtaining early diagnosis and receiving appropriate medical care, women may reduce the severity of symptoms. Knowing how to identify the signs of fibroids and how to alleviate fibroid symptoms enables women to make informed choices regarding their reproductive health.