Clinical Features of Uterine Fibroids
Menorrhagia is the most frequent symptom of uterine fibroids, often resulting in iron deficiency anemia, with other common presentations including dysmenorrhea, pelvic pain and pressure, urinary urgency and frequency, constipation, and potential impairment of fertility or obstetric complications. 1
Epidemiology and Risk Factors
Uterine fibroids are the most common benign neoplasm of the uterus, composed of smooth muscle cells embedded in an extracellular matrix of collagen, fibronectin, and proteoglycan. 1
Prevalence varies significantly by race: Black women have an estimated incidence exceeding 80% by age 50, whereas White women have an incidence approaching 70%. 1
Black women are more likely to develop clinically significant disease at an earlier age and experience racial disparities including higher rates of surgical intervention and lower rates of minimally invasive approaches. 1
Risk factors include: age (most common in women aged 30-50), nulliparity, race, family history, obesity, and body mass index. 1, 2
Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause. 1
Clinical Presentation Patterns
Bleeding Symptoms
Menorrhagia (heavy menstrual bleeding) is the most frequent symptom and often results in iron deficiency anemia requiring correction with iron supplementation. 1, 3
Abnormal uterine bleeding may present as prolonged menstrual bleeding or intermenstrual bleeding. 4, 5
Bulk and Pressure Symptoms
Pelvic pain and pressure are common complaints related to fibroid size and location. 1, 5
Urinary symptoms include urgency and frequency due to bladder compression. 1, 5
Abdominal distension and increasing girth may be noted with larger fibroids. 2, 5
Reproductive Complications
Fibroids may impair fertility through various mechanisms depending on location and size. 1, 4
Obstetric complications can occur during pregnancy. 1
During pregnancy, fibroids enlarge and may undergo red degeneration causing acute pain. 2
Pain Syndromes
Dysmenorrhea (painful menstruation) is a common associated symptom. 1
Acute pelvic pain may result from torsion of a pedunculated fibroid. 2
Suspect fibroid degeneration if patient presents with severe sudden-onset pain, fever, nausea, and leukocytosis, requiring supportive care with NSAIDs and observation. 3
Asymptomatic Presentation
In two-thirds of cases there are no symptoms, and fibroids are often discovered as an incidental finding on ultrasound. 2
If tumors are small and not causing symptoms, they do not require treatment. 2
Physical Examination Findings
Physical examination should include abdominal examination, speculum examination, and bimanual pelvic evaluation to characterize the location, shape, and mobility of the fibroids. 1
Pelvic mass may be palpable on examination. 2
Uterus may be palpable abdominally or >12 cm in size on scan in cases requiring referral. 2
Red Flag Features Requiring Urgent Evaluation
Rapid growth of fibroids can occasionally indicate malignant (sarcomatous) transformation, although this is rare and should prompt urgent referral. 6, 2
Persistent intermenstrual bleeding in women age >45 where treatment has failed or been ineffective warrants referral. 2
Urinary retention is a severe complication requiring immediate attention. 2
Economic and Social Impact
Total estimated societal costs range from $5.9 to $34.4 billion annually, with lost work hours accounting for the largest proportion of these costs. 1
Patients affected by uterine fibroids may experience significant physical, emotional, social, and financial toll as well as losses in their quality of life. 7