Symptoms of Uterine Fibroids
Most uterine fibroids are asymptomatic (at least 50% of women with fibroids have no symptoms), but when symptomatic, they present with abnormal uterine bleeding, pelvic pain and pressure, bulk-related symptoms, and reproductive complications. 1, 2
Asymptomatic Presentation
- The majority of fibroids (50-80%) cause no symptoms and are discovered incidentally, requiring only surveillance to document stability rather than intervention 1, 3, 2, 4
Bleeding Symptoms
- Abnormal uterine bleeding occurs in 30% of symptomatic women, manifesting as heavy menstrual bleeding (menorrhagia), prolonged menstrual bleeding, or intermenstrual bleeding 5, 6, 2
- Menorrhagia frequently leads to iron deficiency anemia, causing fatigue and weakness that significantly impacts quality of life 7, 5, 4
- Dysmenorrhea (painful periods) commonly accompanies the abnormal bleeding 8, 2
Pelvic Pain and Pressure
- Chronic pelvic pain and pressure represent cardinal symptoms, often described as bloatedness, fullness, or pelvic discomfort unrelated to menstruation 8, 7, 2
- Acute severe pain indicates fibroid complications including degeneration with infarction or hemorrhage, torsion of pedunculated fibroids, or prolapse of submucosal fibroids through the cervix 8, 7
- Pain during intercourse (dyspareunia) occurs in some women 5, 9
Bulk-Related Symptoms
- Urinary symptoms include frequency, urgency, and occasionally urinary retention from bladder compression by anterior fibroids 8, 7, 9, 4
- Constipation results from posterior fibroid pressure on the rectum 8, 5, 4
- Abdominal distension or increased abdominal girth occurs with large fibroids, which may be aesthetically displeasing 9, 2, 4
Reproductive Complications
- Infertility or subfertility can occur, particularly with submucosal and intramural fibroids that distort the endometrial cavity 1, 9, 6
- Pregnancy complications include spontaneous abortion, preterm delivery, abnormal fetal presentation, pelvic outlet obstruction, postpartum hemorrhage, and puerperal sepsis, especially with submucosal fibroids 1, 2
- Recurrent pregnancy loss may occur 6, 2
Symptom Determinants
The size, position, number, and location of fibroids determine symptomatology and severity, though the exact mechanism why some fibroids are symptomatic while others remain quiescent is not fully understood 1, 2
Location-Specific Patterns:
- Submucosal fibroids (protruding into the uterine cavity) cause the most severe bleeding and reproductive complications 1
- Intramural fibroids (within the uterine wall) cause bleeding, pain, and reduced fertility even without cavity distortion 1
- Subserosal fibroids (projecting outward) primarily cause bulk symptoms with minimal impact on bleeding or fertility 1
Age-Related Considerations
- Symptom prevalence peaks in the perimenopausal years (ages 40-50) and declines after menopause 8, 2
- Fibroids occur in 20-50% of women over age 30, with prevalence reaching 70-80% by age 50 1, 3
- In postmenopausal women, fibroids are the second most common cause of acute pelvic pain, and any growth warrants urgent evaluation to exclude malignancy 8, 7
Critical Clinical Pitfalls
- Acute onset of severe pain with fever, nausea, and leukocytosis suggests fibroid degeneration requiring urgent imaging (contrast-enhanced CT shows 86% sensitivity for complications) 8, 7
- Rapid fibroid growth, particularly in postmenopausal women, requires endometrial biopsy to exclude leiomyosarcoma 7
- When fibroids coexist with adenomyosis, pain patterns become more complex and treatment failure rates increase 8
- In postmenopausal women with fibroids and pain, maintain high suspicion for ovarian pathology rather than attributing all symptoms to fibroids 8