Uterine fibroids (or uterine leiomyomas) are found in close to 20% of women between the ages of 15 to 44 (reproductive age group). The cause of fibroids is not known, although there is association of fibroids with high estrogen levels and obesity. Many times they cause no symptoms.
When they are causing concern due to their symptoms like menstrual or reproductive disturbance they can be managed medically with drugs or surgically with either myomectomy (removal of the fibroid portion of the uterus) or hysterectomy (removal of the entire uterus).
Symptoms of Uterine Fibroids
Asymptomatic fibroids could be present in nearly 50% of women over the age of 35 years. They tend to shrink after menopause. When the symptoms do occur, there are usually problems with menstrual bleeding or problems due to the pressure they exert on surrounding area and tissues. Symptoms can include the following.
Menorrhagia (prolonged or excessively heavy menstrual bleeding) is a very common symptom of fibroids. The bleeding can soak through any sanitary protection within an hour. The reason for menorrhagia is thought to be the larger surface area of endometrium, due to the fibroid, that is involved in bleeding during menstruation.
It could also be due to pressure by the fibroid on venous drainage increasing the blood flow, disturbance of prostaglandin metabolism or ulceration of endometrium covering a fibroid which is present just beneath the mucosal surface of the uterus. Sometimes, there can be bleeding between periods.
Weakness and Fatigue
When the menorrhagia is severe it can lead to anemia, that is decrease in red blood cells count. Anemia in turn can lead to symptoms like weakness, fatigue, lightheadedness and headaches.
Subfertility or Infertility
It is not clear whether subfertility or infertility is a symptom or cause of fibroids, but the association between subfertility or infertility and fibroids is well recognized.
Pedunculated fibroids (fibroids with a stalk) can block the opening of fallopian tubes into the uterus, decreasing fertility.
If the fibroids are large they can cause heaviness or vague discomfort in the pelvis or lower abdomen. Sometimes, bending over or exercising can cause discomfort.
Acute and severe pelvic pain is less common. It usually occurs when there is degeneration of the fibroid. The pain is localized to a spot and goes away on its own in 2–4 weeks. Pelvic pain can also be chronic, which is usually mild and localized to a circumscribed area. Sometimes there can be lower back pain when the fibroid is pressing on the nerves and muscles in the lower back.
This is more likely when the fibroid is in the back portion of uterus than when it is confined to the middle or inner side of uterus. Sexual intercourse could be uncomfortable or painful (dyspareunia), particularly in certain positions and during certain phase of menstrual cycle.
When the fibroid is pressing on the bladder it can decrease its capacity, leading to increased frequency of urination. Sometimes there can be difficulty in urination and urinary retention.
When the fibroids are pressing against the large intestine (usually rectum) they can cause feeling of fullness in the rectum. Bowel movements could be difficult or painful. Sometimes, bleeding can occur due to development of hemorrhoids.
Difficulties with Pregnancy and Delivery
Fibroids could distort the uterine cavity and interfere with proper implantation of the embryo, thus leading to recurrent abortions. There could be premature labour. If the fibroid is blocking the birth canal, then cesarean section may be necessary.
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