Can uterine fibroids (myomas) cause pain?

Uterine Fibroids (Myomas) and Pain

Yes, uterine fibroids (myomas) can definitely cause pain, including pelvic pain, dysmenorrhea (painful periods), and pain during intercourse. 1

Pain Mechanisms and Presentation

Uterine fibroids can cause pain through several mechanisms:

• Direct pain symptoms:

  • Dysmenorrhea (painful menstruation)
  • Chronic pelvic pain
  • Pain during intercourse (dyspareunia)
  • Compression pain affecting adjacent organs

• Pain characteristics by fibroid location:

  • Submucosal fibroids: Often cause more severe menstrual pain and heavy bleeding
  • Intramural fibroids: Can cause pressure pain and menstrual pain
  • Subserosal fibroids: May cause pressure pain on surrounding structures

• Pain due to complications:

  • Degeneration (especially during pregnancy when rapid growth occurs)
  • Necrosis of central areas of tumors
  • Torsion of pedunculated fibroids

Clinical Significance of Pain

• While fibroids are extremely common (present in up to 70% of women by menopause), not all cause symptoms 1
• Pain severity doesn't necessarily correlate with fibroid size - small fibroids can cause significant pain while large ones may be asymptomatic 1
• The location of fibroids often determines the type and severity of pain more than their size

Differential Diagnosis

When evaluating pelvic pain in patients with fibroids, consider:

• Adenomyosis (often coexists with fibroids)
• Endometriosis
• Pelvic inflammatory disease
• Ovarian pathology
• Non-gynecologic causes of pelvic pain

Management of Fibroid-Related Pain

Medical Management

• First-line options:

  • NSAIDs for pain relief (reduce pain by 20-40%)
  • Combined oral contraceptives (effective for controlling symptoms with smaller lesions)
  • Progestin-containing IUDs (most effective hormonal option for pain relief)

• Second-line options:

  • GnRH agonists (reduce lesion volume by 40-50%, but limited to short-term use of 3-6 months)
  • Tranexamic acid (for heavy bleeding associated with pain)

Interventional Procedures

• Uterine Artery Embolization (UAE) - improves symptoms in 85-94% of patients
• MR-guided Focused Ultrasound (MRgFUS)

Surgical Management

• Myomectomy (preserves fertility)
• Hysterectomy (definitive treatment with highest satisfaction)
• Hysteroscopic myomectomy (for submucosal fibroids)

Key Considerations

• Pain is one of the main symptoms prompting treatment of fibroids, alongside abnormal bleeding and reproductive issues
• The presence of pain significantly impacts quality of life and often drives treatment decisions
• Treatment should target both the pain and the underlying fibroid pathology

Common Pitfalls in Managing Fibroid Pain

• Misattribution of pain: Not all pelvic pain in women with fibroids is caused by the fibroids themselves
• Undertreatment: Dismissing pain as "normal" menstrual discomfort
• Overtreatment: Performing major surgery for incidental fibroids not causing symptoms
• Delayed diagnosis: Failing to consider fibroids in women with chronic pelvic pain

Remember that while many women with fibroids remain asymptomatic, pain is a legitimate and common symptom that warrants appropriate evaluation and management.