What are the clinical manifestations of uterine fibroids in a reproductive-age woman?

Clinical Manifestations of Uterine Fibroids

Primary Symptom Categories

Uterine fibroids most commonly present with menorrhagia (heavy menstrual bleeding), which frequently leads to iron deficiency anemia, followed by bulk-related symptoms including pelvic pain, pressure, and urinary/bowel dysfunction. 1

Bleeding Symptoms

• Menorrhagia is the most frequent symptom of uterine fibroids, occurring in the majority of symptomatic patients 1
• Heavy menstrual bleeding often results in iron deficiency anemia, fatigue, and chronic tiredness 2, 3
• Abnormal uterine bleeding patterns may include prolonged or irregular menstrual cycles 2, 4
• Dysmenorrhea (painful menstruation) commonly accompanies the bleeding symptoms 1, 5

Bulk and Pressure Symptoms

• Pelvic pain and pressure represent cardinal manifestations, often described as bloatedness or fullness 1, 5
• Abdominal distension and increased abdominal girth occur with larger fibroids 2, 4
• Urinary urgency and frequency result from bladder compression by anterior fibroids 1, 5
• Constipation develops from posterior fibroid pressure on the rectum 1, 5
• Chronic vaginal discharge may occur in some patients 3
• Dyspareunia (painful intercourse) can be present 4, 3

Acute Complications Requiring Urgent Evaluation

• Acute severe pain from fibroid degeneration (infarction or hemorrhage) requires immediate assessment 5
• Torsion of pedunculated fibroids produces acute pain necessitating urgent imaging 5
• Prolapse of submucosal fibroids through the cervix causes acute pain and requires prompt evaluation 5

Reproductive Manifestations

• Impaired fertility may occur depending on fibroid size and location 1, 4
• Obstetric complications including pregnancy loss and conceiving difficulties 1, 3
• Adverse pregnancy outcomes in women with fibroids 3

Age-Related Symptom Patterns

• Fibroid-associated symptoms peak in the perimenopausal years and typically decline after menopause due to decreased circulating estrogen 1, 5
• In postmenopausal women, fibroids become the second most common cause of acute pelvic pain, accounting for more cases than in younger women 5
• The prevalence of fibroids increases with age, detectable in up to 80% of women by age 50 6

Asymptomatic Presentation

• Most fibroids are asymptomatic and require no treatment, making the true frequency underestimated as many women remain undiagnosed 2, 7
• The incidence of uterine fibroids in reproductive women ranges from 5.4% to 77% depending on the diagnostic method and population studied 3

Critical Clinical Pitfalls

• When acute pain develops, urgent imaging is warranted to exclude torsion, prolapse, or infarction/hemorrhage requiring intervention 5
• Contrast-enhanced CT demonstrates the best diagnostic performance for fibroid complications, with contrast enhancement showing 86% sensitivity and ascites showing 100% sensitivity 5
• In postmenopausal women with fibroids and persistent symptoms, maintain high suspicion for malignancy—endometrial biopsy is essential prior to intervention to rule out endometrial neoplasia and potentially diagnose sarcoma 1, 5
• Adenomyosis frequently coexists with fibroids (presenting with heavy menstrual bleeding, dysmenorrhea, and dyspareunia), which complicates pain patterns and increases treatment failure rates 8, 5
• Black women have higher incidence (exceeding 80% by age 50) and develop clinically significant disease at earlier ages compared to White women (approaching 70% by age 50) 1