What are the signs and symptoms of leiomyomas (uterine fibroids)?

From the Guidelines

Uterine fibroids (leiomyomas) often cause no symptoms, but when they do, the most common signs include heavy or prolonged menstrual bleeding, which can lead to anemia, as well as pelvic pain or pressure, frequent urination, difficulty emptying the bladder, constipation, or backache, depending on the location and size of the fibroids. Women may experience these symptoms due to the location and size of the fibroids, which can compress surrounding structures and lead to various complications 1. The symptoms of uterine fibroids can be categorized into several groups, including:

• Menstrual symptoms, such as heavy or prolonged menstrual bleeding, which can lead to anemia
• Pelvic symptoms, such as pelvic pain or pressure, frequent urination, difficulty emptying the bladder, constipation, or backache
• Reproductive symptoms, such as infertility, recurrent miscarriages, or complications during pregnancy
• Other symptoms, such as pain during intercourse (dyspareunia) or an enlargement of the lower abdomen, giving the appearance of pregnancy. These symptoms typically develop gradually as fibroids grow, which happens in response to estrogen and progesterone, and the severity of symptoms doesn't necessarily correlate with the number or size of fibroids, as even small fibroids in critical locations can cause significant symptoms, while large ones may go unnoticed if positioned where they don't compress surrounding structures 1. According to the most recent study, the prevalence of fibroids varies with race, and Black women have an estimated incidence of fibroids by age 50 exceeding 80%, whereas White women have an incidence approaching 70% 1.

From the Research

Signs and Symptoms of Leiomyomas

The signs and symptoms of leiomyomas (uterine fibroids) can vary, but common symptoms include:

• Heavy menstrual bleeding and pain or pelvic discomfort 2, 3, 4
• Menometrorrhagia, which is characterized by heavy and irregular menstrual bleeding 4
• Pelvic pain, dysmenorrhea, or urinary and digestive compression when the fibroid is particularly large 4
• Iron-deficiency anemia due to heavy menstrual bleeding 3, 5
• Bulk symptoms such as pelvic pressure or pain, and obstructive symptoms 5

Asymptomatic Leiomyomas

Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth 2. The majority of fibroids are asymptomatic and require no intervention or further investigations 5.

Impact on Fertility

The association between infertility and fibroids increases with age 2. However, the presence of uterine fibroids can lead to a variety of clinical challenges, including concerns about possible complications related to fibroids in pregnancy 5.

Treatment-Related Symptoms

Treatment options for symptomatic fibroids can also have associated symptoms, such as:

• Medical treatments like gonadotropin-releasing hormone analogs, which can have numerous adverse effects 3
• Surgical treatments like hysterectomy, which can have serious complications 3
• Radiologically guided interventions like uterine artery embolization, which can have risks and complications 2, 5