Symptoms and Signs of Uterine Fibroids (Myoma Uteri)
Primary Clinical Presentation
Uterine fibroids most commonly present with heavy menstrual bleeding (menorrhagia) leading to iron deficiency anemia, followed by bulk-related symptoms including pelvic pressure, pain, and urinary or bowel dysfunction. 1
Bleeding Manifestations
- Menorrhagia is the most frequent symptom, occurring in the majority of symptomatic patients and often resulting in iron deficiency anemia and fatigue 1, 2
- Dysmenorrhea (painful menstruation) commonly accompanies the bleeding symptoms 1
- The severity of bleeding correlates with fibroid location—submucosal fibroids (protruding into the uterine cavity) cause the most severe bleeding due to direct endometrial disruption, while subserosal fibroids (projecting outward) typically cause minimal to no bleeding 2
- Intramural fibroids can cause heavy bleeding when they distort the endometrial cavity or reach significant size 2
Bulk and Pressure Symptoms
- Pelvic pain and pressure represent cardinal manifestations, often described as bloatedness or fullness 1
- Urinary urgency and frequency result from bladder compression by anterior fibroids 1
- Constipation develops from posterior fibroid pressure on the rectum 1
- Abdominal protrusion may be visible with larger fibroids 3
- Chronic vaginal discharge can occur 3
- Dyspareunia (painful intercourse) is reported, particularly when adenomyosis coexists 1, 3
Acute Complications Requiring Urgent Evaluation
- Acute severe pain from fibroid degeneration (infarction or hemorrhage) requires immediate assessment 1
- Torsion of pedunculated fibroids produces acute pain necessitating urgent imaging 1
- Prolapse of submucosal fibroids through the cervix causes acute pain and requires prompt evaluation 1
When acute pain develops, contrast-enhanced CT demonstrates the best diagnostic performance for fibroid complications, with contrast enhancement showing 86% sensitivity and ascites showing 100% sensitivity 1
Reproductive Manifestations
- Impaired fertility may occur depending on fibroid size and location 1
- Obstetric complications including pregnancy loss and conceiving difficulties 1
- Recurrent pregnancy loss and adverse obstetric outcomes are associated 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
- In postmenopausal women, fibroids become the second most common cause of acute pelvic pain, accounting for more cases than in younger women 1
- The incidence of fibroids peaks in the fifth decade of age 4
Critical Clinical Pitfalls to Avoid
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
Adenomyosis frequently coexists with fibroids (presenting with heavy menstrual bleeding, dysmenorrhea, and dyspareunia), which complicates pain patterns and increases treatment failure rates 1
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
Many women remain asymptomatic, and symptoms appear gradually, so the condition often remains undiagnosed—the true frequency is underestimated 3
Twenty-five percent of reproductive women experience symptoms, and among them, around 25% require hospitalization due to disease severity 3