Uterine fibroids are benign or noncancerous growths that develop from the smooth muscle of the uterus. These tumors may occur as solitary growth or in clusters and can vary in size from tiny seedlings to massive growths.
Symptoms will largely depend upon the size, location and number of growths. Often a woman may have no symptoms at all (asymptomatic). A uterine fibroid is detected only incidentally during a pelvic examination, when an ultrasound done for a totally unrelated condition such as a prenatal ultrasound, or in the course of investigations done to find the cause of infertility.
Certain symptoms and complications are more likely to be seen with certain types of uterine fibroids.
Signs and Symptoms of Uterine Fibroids
Menstrual problems and abnormal vaginal bleeding is the most common symptom of uterine fibroids. It is more likely to be caused by a submucosal fibroid. This includes :
- Prolonged periods
- Heavy periods
- Irregular periods – frequent or missed period
- Spotting or bleeding in between periods
- Dysmenorrhea – painful menstruation
Apart from menstrual pain, women with fibroids may also report intermittent or persistent pain and discomfort. This may include abdominal or pelvic pain and sometimes low back pain. There may also be pain during sexual intercourse.
There may also be a heaviness or pelvic discomfort with an enlarged uterus or abdomen that may be mistaken for pregnancy. Pressure on other pelvic organs like the rectum, bladder or even the spinal nerves may occur with a large fibroid on the outer surface of the uterus. Apart from pain and discomfort, there may also be associated symptoms like urinary frequency, retention, urgency and constipation.
Pregnancy with Uterine Fibroids
In most cases, fibroids do not cause any problems during pregnancy. However, certain complications may arise during pregnancy that can exacerbate the clinical presentation and jeopardize the pregnancy. Uterine fibroids often decrease in size after childbirth.
- Increased fibroid size may occur during pregnancy as the hormone levels rise and the blood flow to the uterus increases. This may cause additional discomfort and pain, especially between the first and second trimester.
- Red degeneration of the fibroid may cause severe pain during pregnancy.
- Recurrent miscarriage (spontaneous abortion) may occur in early pregnancy.
- Placental separation and bleeding may jeopardize the pregnancy.
- Premature labor and delivery, and abnormal presentations such as breech may occur in late pregnancy. This is more likely to occur with multiple fibroids or a large fibroid distorting the uterine cavity.
- Obstruction of the uterine opening by a large fibroid may complicate the delivery and require a Cesarean section.
- Postpartum hemorrhage or excessive bleeding after delivery of the baby may occur in the presence of a large fibroid.
Complications of Uterine Fibroids
Complications due to uterine fibroids are not common but may lead to one or more of the following :
- Torsion or twisting of a pedunculated fibroid on its stalk can cause severe abdominal or pelvic pain and may necessitate surgery.
- Acute pain may arise when large fibroids degenerate or break down if it outgrows its blood supply.
- Anemia due to excessive menstrual blood loss.
- Infertility is most often caused by a submucosal fibroid which may prevent implantation of the embryo in the uterine wall. In rare cases, infertility may arise due to distortion or blockage of the fallopian tube by the fibroid, or by it preventing sperm from reaching the fallopian tubes.
- Recurrent spontaneous abortion (miscarriage).
- Cancerous changes are extremely rare.