What kind of pain do premenopausal women with uterine myoma (fibroids), polyps, and adenomyosis typically experience during menstrual flow?

Pain Characteristics in Premenopausal Women with Uterine Myomas, Polyps, and Adenomyosis During Menstrual Flow

Premenopausal women with uterine myomas (fibroids), polyps, and adenomyosis typically experience menorrhagia (heavy menstrual bleeding) as the predominant symptom during menstrual flow, accompanied by dysmenorrhea (painful menstruation) and chronic pelvic pain or pressure. 1

Pain Patterns by Specific Pathology

Uterine Myomas (Fibroids)

Menorrhagia is the most frequent symptom associated with fibroids, often resulting in iron deficiency anemia. 1

• Dysmenorrhea (painful menstruation) occurs commonly during menstrual flow 1
• Chronic pelvic pain and pressure sensations are characteristic symptoms 1
• Urinary urgency and frequency may accompany menstrual pain when fibroids compress the bladder 1
• Acute severe pain can occur if fibroids undergo torsion (if pedunculated), prolapse (if submucosal), or acute infarction/hemorrhage during degeneration 1

Adenomyosis

The relationship between adenomyosis and pain symptoms is more complex than traditionally believed. A critical study found that adenomyosis was equally common in women with and without pelvic pain, abnormal bleeding, or fibroids, suggesting it may be an incidental finding rather than the primary source of symptoms 2. However, clinical guidelines still recognize adenomyosis as a structural cause of abnormal uterine bleeding 1.

• When symptomatic, adenomyosis presents with dysmenorrhea during menstrual flow 1
• Heavy menstrual bleeding (menorrhagia) is a common associated symptom 1
• Chronic pelvic pain may occur, though the causal relationship remains debated 2

Endometrial Polyps

Polyps are primarily associated with abnormal uterine bleeding rather than pain. 1

• Abnormal bleeding patterns during menstruation are the predominant symptom 1
• Pain is not typically a primary presenting symptom of polyps alone 1
• When pain occurs, it is usually related to coexisting conditions like fibroids or adenomyosis 1

Combined Pathology Considerations

When multiple conditions coexist (fibroids, adenomyosis, and polyps), the clinical picture becomes more complex:

• Detection of adenomyosis on transvaginal ultrasound is significantly limited when coexisting fibroids are present, with sensitivity dropping from 97.8% to only 33.3% 1
• The presence of fibroids does not change the prevalence of adenomyosis (37% versus 43%) 2
• Abnormal bleeding and dysmenorrhea are the most consistent symptoms across all three conditions 1

Critical Clinical Pitfalls

Assuming adenomyosis is the primary pain source without considering other pathology can lead to inappropriate treatment decisions. 2

• Adenomyosis may be an "innocent bystander" rather than the cause of symptoms in many cases 2
• Imaging alone has limitations in differentiating the contribution of each pathology to symptoms 3
• The endometrial thickness in premenopausal women varies with menstrual cycle phase and is not a reliable indicator of pathology, even when <5mm 1
• Coexisting pathologies (fibroids with adenomyosis) significantly reduce diagnostic accuracy of ultrasound 1

Pain Severity and Quality of Life Impact

The economic and quality of life burden is substantial, with total societal costs ranging from $5.9 to $34.4 billion annually, primarily from lost work hours. 1

• Iron deficiency anemia from menorrhagia significantly impacts quality of life and requires treatment 1
• Chronic pelvic pain and pressure affect daily activities and work productivity 1
• Dysmenorrhea during menstrual flow can be severe enough to require pain management 1