What types of pain can uterine fibroids cause?

Types of Pain Caused by Uterine Fibroids

Uterine fibroids cause several distinct types of pain including dysmenorrhea (menstrual pain), chronic pelvic pain and pressure, and acute pain from complications such as torsion of pedunculated fibroids, prolapse of submucosal fibroids, or acute infarction/hemorrhage in degenerating fibroids. 1

Chronic Pain Presentations

Menstrual-Related Pain:

• Dysmenorrhea is a common symptom of fibroids, occurring alongside the most frequent symptom of menorrhagia 1
• Menstrual disturbances including dysmenorrhea and intermenstrual bleeding affect symptomatic women 2

Pelvic Pressure and Discomfort:

• Pelvic pain and pressure represent cardinal symptoms, often described as a sensation of bloatedness or fullness 1
• Abnormal bleeding, bloating, and pelvic discomfort due to mass effect constitute the most common symptom complex 2
• Bulk symptoms include pressure, pain, fullness affecting the pelvis 1

Pain Unrelated to Menstruation:

• Chronic pelvic pain can occur independent of the menstrual cycle 2
• Pelvic discomfort from mass effect is particularly common with larger fibroids 2

Acute Pain Complications

Fibroid Degeneration:

• Acute infarction or hemorrhage in a degenerating fibroid causes sudden severe pain 1
• This represents the second most common cause of acute pelvic pain in perimenopausal and postmenopausal women 1

Mechanical Complications:

• Torsion of pedunculated fibroids produces acute pain requiring urgent evaluation 1
• Prolapse of a submucosal fibroid through the cervix causes acute pain 1

Pressure-Related Symptoms

Urinary Symptoms:

• Urinary urgency and frequency result from bladder compression 1
• Urinary retention can occur with large anterior fibroids 3

Bowel Symptoms:

• Constipation from posterior fibroid pressure on the rectum 1
• Bowel dysfunction and disturbance from pelvic mass effect 3, 2

Other Pressure Effects:

• Low back pain from posterior fibroid location 3
• Dyspareunia (painful intercourse) from fibroid position 3

Age-Specific Considerations

Perimenopausal and Postmenopausal Women:

• Fibroids become a significantly more common cause of acute pelvic pain in the peri/postmenopausal group compared to premenopausal women 1
• Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause 1
• Uterine fibroids are the second most common cause of acute pelvic pain in postmenopausal women, accounting for more cases than in younger women 1

Clinical Pitfalls to Avoid

Distinguishing Acute from Chronic Pain:

• Acute pain from fibroids warrants urgent imaging to exclude torsion, prolapse, or infarction/hemorrhage requiring intervention 1
• Contrast-enhanced CT demonstrates the best diagnostic performance for fibroid complications, with contrast enhancement of the fibroid showing 86% sensitivity and ascites showing 100% sensitivity 1

Recognizing Concurrent Pathology:

• When fibroids coexist with adenomyosis, pain patterns may be more complex and treatment failure rates increase 1
• In postmenopausal women with fibroids and pain, maintain high suspicion for other gynecologic causes including ovarian cysts (one-third of cases) and ovarian neoplasm (8% of cases) 1