Fibroid Symptoms and Diagnosis – Brigham and Women’s Hospital

Symptoms

Fibroids cause symptoms in 20 to 50 percent of women. The most common symptoms are heavy uterine bleeding, pelvic pressure, frequent urination, constipation, painful periods and painful intercourse, infertility, and pregnancy complications.

Normal menstrual periods typically last four to five days. Women with fibroids often have periods lasting longer than seven days that can be very heavy, requiring changing sanitary protection frequently (perhaps every hour). Bleeding between periods is not usually due to fibroids and should always be evaluated by a physician. Although abnormal bleeding can occur with any type of fibroid, women with submucous fibroids are more likely to experience abnormal bleeding.

Pelvic pressure results from an increase in size of the uterus or from a particular fibroid. Most women with fibroids have an enlarged uterus; in fact, doctors describe the size of a uterus with fibroids as they would a pregnant uterus, for example, as a 12 week-size fibroid uterus. It is not unusual for a uterus with fibroids to reach the size of a four to five month pregnancy. Women can experience pressure on the bowel and/or bladder due to fibroids. This can cause constipation, frequent urination and incontinence. In some rare cases, fibroids can press on the ureters (tubes which carry urine from the kidneys to the bladder), leading to kidney dysfunction.

Women with fibroids also may experience reproductive problems including recurrent miscarriage, infertility, premature labor, abnormal presentation of a fetus (such as a breech presentation), and complications during labor.

Many doctors believe these reproductive complications most often occur when fibroids change the shape of the uterine cavity. Thus fibroids on the inside the uterus (submucous fibroids) which distort the uterine lining should be removed.

In general, fibroids only need to be treated if they are causing symptoms or affecting a woman’s fertility or ability to carry a pregnancy. Treatment for uterine fibroids should be based on a woman’s medical history, surgical history and goals of therapy.

Diagnosis

Fibroids can generally be felt by your doctor during a general gynecological examination, however diagnosis is made based on imaging tests such ultrasound, MRI (magnetic resonance imagery), and CT (computed tomography). Currently, ultrasound is the most common method used to diagnose uterine fibroids, but MRI may prove more useful because it can often distinguish fibroids from other growths in the uterus.

In patients experiencing menorrhagia (profuse and/or prolonged menstrual flow) or recurrent pregnancy losses, careful examination of the uterine cavity is important because the presence of a submucous fibroid can be missed on traditional ultrasound.

Hysterosalpingography, sonohysterography, and hysteroscopy are used to diagnose fibroids inside the uterus. Hysterosalpingography and sonohysterography use X-ray pictures and ultrasound pictures, respectively, to visualize the uterine cavity after fluid is injected into the uterus. Hysteroscopy allows your physician to look inside the uterine cavity by inserting a small camera on the end of a long tube (hysteroscope) into the uterus through the vagina and cervix.

Can Uterine Fibroids Cause Bladder Problems?

You’ve probably heard that uterine fibroids can cause heavy menstrual bleeding, abdominal pain and bloating, but did you know that there’s a link between fibroids and bladder problems?

Uterine fibroids are non-cancerous tumors that develop from smooth muscle cells and fibrous connective tissue. Also known as uterine myomas or leiomyomas, fibroids grow within and on the walls of the uterus. Fibroids are often confused with cysts. However, fibroids are solid tissue, while cysts are fluid-filled sacs.

Fibroids and Urinary Problems

Most women with uterine fibroids have an enlarged uterus. (i) In fact, a very large fibroid can expand the uterus to the size of a second-trimester pregnancy and press against the bladder, reducing its capacity for holding urine or blocking the outflow for urine to pass. (ii, iii)

The most common issue concerning fibroids and urinary problems is the need to urinate frequently. (iii) A woman may wake up several times during the night to empty her bladder and may occasionally experience an inability to urinate despite a full bladder. (iii)

In some cases, fibroids can cause urinary retention. (iv) This can happen when large fibroids press against a ureter. If a ureter becomes completely pinched off, surgery is needed quickly to prevent urine from flowing back, which may permanently damage the kidney on that particular side. It’s important for you to discuss fibroids and urinary problems with your doctor as soon as you notice any irregularities.

Fibroids and Pressure on the Bowels, Rectum and Abdomen

Uterine fibroids may also cause pressure on the bowels. This pressure can lead to feelings of bloating or constipation.

Fibroids may press against the rectum and cause a sense of rectal fullness, difficulty having a bowel movement, and/or pain with bowel movements. (iii) Sometimes, fibroids may lead to the development of hemorrhoids. (iii)

Women with large fibroids may experience a sense of heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague sense of discomfort rather than a sharp pain. Sometimes, an enlarged uterus can make it hard to lie face down, bend over, or exercise without discomfort. (iii)

Other Complications of Uterine Fibroids

In addition to fibroids and bladder problems, as well as unusual sensations of pressure, uterine tumors can cause other issues, including:

Pain

Pedunculated fibroids are attached to the uterus by a stem and may twist and can result in pain, nausea or fever. (v) Fibroids that grow rapidly, or start breaking down, may also cause pain. (v)

Lower back pain

In rare circumstances, fibroids may press against the muscles and nerves of the lower back. (iii) A large fibroid growing towards the rear of the uterus is more likely to cause back pain than a small intramural fibroid. (iii)

Uncomfortable or painful sexual intercourse

Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue, so be sure to discuss it with your doctor.

Infertility

If fibroids are the only cause of infertility, many women are able to become pregnant after they are treated. (v)

Blood clots

Large fibroids that reach the size of a cantaloupe may lead to a rare association with blood clots in the lung, which can be deadly. (vi)

While doctors are still unclear about the causes of uterine fibroids, women can experience a variety of symptoms and medical complications.

Treatment will depend on many factors, including your age, the severity of the bleeding, and whether you want to have children. Common medical treatment options include the use of birth control pills, hormone injections, a hormone-releasing intra-uterine device, and surgical or non-surgical procedures.

When considering surgical or non-surgical procedures, talk with your doctor about the risks and benefits of each procedure. A more conservative option is uterine fibroid embolization or UFE, a minimally invasive procedure. It safe and effectively shrinks uterine fibroid tumors and offers relief from many of the unpleasant symptoms that come with them. It doesn’t require open surgery and is performed in an outpatient setting, so patients can go home the same day.

Download our free information sheet, Understanding Uterine Fibroid Embolization, or call 844-UFE-CARE (833-2273) to schedule an appointment with a vascular specialist.

Sources:
ⁱ Brigham and Women’s Hospital. (n.d.). _About Uterine Fibroids._Retrieved June 15, 2018, from http://www.fibroids.net/fibroids.html
ⁱⁱ Harvard Health Publishing. (2008, July). _What to do about fibroids – Harvard Health._Retrieved June 19, 2018, from https://www.health.harvard. edu/womens-health/what_to_do_about_fibroids
ⁱⁱⁱ UCSF National Center of Excellence in Women’s Health. (2017, April 25). _Fibroid Symptoms. Retrieved_June 20, 2018, from http://coe.ucsf.edu/coe/fibroid/symptoms.html
^iv Institute for Quality and Efficiency in Health Care. (2017, November 16). _Uterine fibroids: Overview._Retrieved June 19, 2018, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072719/
^v American College of Obstetricians and Gynecologists. (2011, May). _Women’s Health Care Physicians._Retrieved June 17, 2018, from https://www.acog.org/Patients/FAQs/Uterine-Fibroids
^vi Bradley, J. G., MD. (2011, June 22). _Uterine Fibroids._Retrieved June 15, 2018, from http://www.obgyn.net/laparoscopy/uterine-fibroids

Uterine fibroids: symptoms and treatment

Uterine fibroids are benign tumors that develop in the uterus. Knots range in size from a pea to a melon. They are also called leiomyomas or fibromyomas.

Uterine fibroids are very common and occur in approximately 20-50% of all women. Most often detected in women aged 30 to 40 years, many have a hereditary character. Fibroids can grow during the reproductive period, but in some cases remain at the same level for many years. Fibroids stop growing after menopause.

NB! If the nodes continue to increase after menopause, you should definitely consult your doctor!

Fibroids usually do not cause any symptoms and do not require treatment. But if symptoms occur, you should seek medical attention.

• Bleeding Heavy or prolonged menstrual bleeding is the most common symptom. Women have to change sanitary pads almost every hour, they are forced to stay at home on the most abundant day of menstruation. As a result, anemia develops, which can cause fatigue, dizziness, headache, and reduced performance.

NB! If your periods become more abundant than before, you should definitely consult a doctor.

• T basic discomfort. Women with large nodules may feel heaviness or pressure in the lower abdomen or pelvis. This is often described by patients as pelvic discomfort rather than acute pain. Sometimes unpleasant sensations are aggravated in the prone position, with the torso tilted.
• Pelvic pain. A less common symptom is sharp and severe pain. There is a degeneration of the myomatous node, i.e. violation of its blood supply. Usually the pain is localized in a certain place. Chronic pelvic pain may occur. This type of pain is usually less intense but persistent and limited to a specific area.
• Bladder problems. The most common urinary tract symptom is frequent urination. A woman may wake up several times during the night to empty her bladder. Sometimes women cannot urinate despite having a full bladder.
• Pain in the lower back. Occurs when fibroids are localized on the back of the uterus and pressed against the muscles and nerves of the lower back, which causes pain.
• Rectal pressure. Fibroids may press against the rectum and cause a feeling of fullness, difficulty with bowel movements, and pain during bowel movements. Sometimes uterine fibroids can lead to the development of hemorrhoids.
• Discomfort or pain during intercourse. Pain occurs only in certain positions or during certain periods of the menstrual cycle.

Diagnosis of uterine fibroids:

Usually, uterine fibroids are discovered during a routine pelvic exam, which allows the doctor to determine the size and shape of the uterus. If it is enlarged, has an irregular shape, a bumpy surface, uterine myoma can be suspected. Or, you may notice new symptoms appear and tell your doctor.

After a gynecological examination, there are several ways to confirm the diagnosis. The main method is ultrasound of the pelvic organs. Other methods are more specialized and are performed only when necessary. Below is a brief description of each study.

Ultrasound is a safe and reliable way to detect fibroids. As a rule, a transabdominal and transvaginal examination is used. In the first case, in the presence of a full bladder, the sensor is placed on the patient’s stomach, in the second case, with an empty bladder, a special vaginal sensor is used and the uterus and ovaries are examined.

Go to the page “Ultrasound in gynecology”

Magnetic resonance imaging (MRI) – gives a detailed picture of the number, size and exact location of fibroids. Not all women with fibroids require an MRI.

Hysteroscopy – a procedure for examining the uterine cavity, which allows you to identify nodes growing into the cavity (submucosal, or submucosal fibroids). The study is performed on an outpatient or inpatient basis.

Uterine fibroids: Symptoms, Causes, Diagnosis and Treatment

Attention!

The information in the article is for reference only and cannot be used for self-diagnosis and self-treatment.
To decipher the results of the analyzes, contact a specialist.

Contents

• Classification and stages
• Who is at risk
• Causes
• Symptoms
• Complications
• Diagnostics
• Methods of treatment
• Methods of prevention

Treated by gynecologist

Uterine fibroids is a hormone-dependent benign tumor. It occurs in women of childbearing age and develops with elevated estrogen levels. Smooth muscle cells of the myometrium and connective tissue fibers are involved in the formation of the tumor node.

Myomatous node looks like a ball of smooth muscle fibers with a rounded shape. They are randomly intertwined. This tumor formation is located in the walls of the uterus or may be in its cavity.

Fibroids can vary in size. They range from a small nodule, which is located in the muscular layer of the uterus, to a huge formation weighing several kilograms. It may still be on the outer shell of the uterus.

As fibroids grow, they compress the bladder, urethra, and rectum. The degree of dysfunction of these organs depends on the localization of the node in the uterus. At the initial stage, clinical signs of fibroids are not expressed.

As the knot enlarges, pain occurs in the lower abdomen. Pain in the genital area occurs during intercourse. Most cases of the disease are detected in the late reproductive period, which precedes the onset of menopause.

Classification and stages

According to the number of myoma nodes located in the uterus, there are single and multiple variants. Forms of fibroids based on the location of nodular neoplasms are as follows:

• Submucosal (submucosal). The formations are located closer to the internal cavity of the uterus. They are rarely found. Some of them are equipped with a leg, which descends into the uterine cavity, and then migrate into the cervical canal and vagina.
• Interstitial (intermuscular). With this form, the nodules are located in the muscular layer of the uterine walls.
• Subserous (subperitoneal). The tumor is located on the outside of the walls of the uterus. Their main part is in the abdominal cavity.
• Intraligamentary (interligamentous). The nodular formation is localized between the sheets of the uterine ligaments.
• Cervical. The tumor node is located in the cervix.

The most common variant of this tumor is interstitial uterine fibroids. According to the location of the tumor node, several varieties are also distinguished. The retroperitoneal form is located in the retrocervical or retroperitoneal tissue. It peels off the peritoneum from the spine. It is characterized by early onset of pain.

Antecervical tumor growing in front of the cervix. It compresses the bladder and urethra, causing urinary incontinence. Subperitoneal fibroids are located in the isthmus of the uterus. It causes exfoliation of the peritoneum from the anterior part of the abdominal wall.

Retrocervical neoplasm located on the posterior wall. This formation, even if small in size, causes a breakdown in the defecation process. Paracervical myoma is localized on the entire lateral zone of the neck.

Who is at risk

There is a hereditary dependence on the formation of myomatous nodes. But the direct influence of the hereditary factor in myoma has not been identified. It is customary to single out the following risk factors:

• a large number of abortions;
• later than menarche;
• presence of copious menstrual flow;
• ovarian cysts;
• inflammatory pathologies in the organs of the genital area;
• hepatic dysfunction;
• long-term use of improperly selected contraceptives;
• lack of lactation and childbirth in a woman by the age of thirty;
• carbohydrate metabolism disorder;
• overweight;
• physical inactivity, lack of exercise;
• chronic stress.

Today it is impossible to reliably identify the causes that caused the development of fibroids. It is impossible to determine the likelihood of its formation in a particular patient.

Causes

The exact causes of uterine fibroids have not yet been identified. The myomatous node begins its formation from the progenitor cell. It is believed that it was damaged during the prenatal period. Another theory is based on the presence of damage that has already occurred in the formed uterus. Factors that increase the likelihood of growth of the myomatous node have been established:

• Microtrauma of the muscular layer of the uterus. When curettage is performed, frequent medical abortions and other gynecological manipulations inside the uterus, the muscle layer is damaged. Inflammatory mediators attack muscle cells. This leads to the appearance of myocytes with the presence of morphological changes. They become the source of the formation of the myomatous node.
• Endocrine disorders. Late onset of menstruation and obesity accompany changes in the production of female sex hormones. The exact route of damage to the muscular layer of the uterus has not been determined. There are patterns that fibroids are detected in most overweight patients.
• Absence of pregnancies that end in childbirth. During menstruation, vascular spasm in the basal layer disrupts blood flow in the tissues of the uterus. This contributes to hypoxic damage to muscle cells. Pregnancy reduces the risk of morphological changes in the myometrium.
• Gynecological diseases. Hyperplastic processes in the endometrium, endometriosis, chronic inflammation lead to changes in the hormonal status. damage to myometrial cells. This provokes the development of fibroids.

An increase in the content of progesterone and estrogen in her body is of particular danger to the patient.

Symptoms

Myoma in the initial stages of its growth does not show any clinical manifestations. As the nodule grows, characteristic symptoms appear. The following symptoms are typical for this pathology:

• menorrhagia – it is expressed in an increase in the volume of bloody discharge during menstruation;
• anemia – a symptom manifested by increased fragility of nails and hair, and this condition is also characterized by severe dryness of the skin;
• marked weakness;
• abdominal enlargement;
• fatigue;
• inability to conceive;
• problems with gestation;
• presence of uterine acyclic bleeding;
• the appearance of aching pain in the lower back or lower abdomen, which occurs during physical exertion.

If the patient has a large myomatous node, the nearby organ and tissues are compressed. A woman has difficulty emptying her bladder. She suffers from constant constipation.

When the pathological process reaches the advanced stages, severe complications appear. Conditions that threaten the life and health of the patient develop. They include such pathologies:

• malignant transformation of myoma;
• profuse bleeding from the uterine cavity;
• necrotic processes in the tumor node;
• miscarriage;
• compression of the structures of the small pelvis;
• chronic miscarriage;
• torsion of the tumor pedicle;
• peritonitis.

These complications are characteristic of large masses, exceeding eight centimeters. This corresponds to the twelfth week of pregnancy. For timely detection of pathology, women should regularly visit a gynecologist for examination.

Complications

The most common complication of fibroids is iron deficiency anemia. It occurs against the background of a constant increase in the volume of blood loss during menstruation. The patient does not always notice her manifestations in time.

With anemia, increasing weakness is noted. Worried about the decrease in working capacity, the deterioration of cognitive functions. There are pathological changes in the condition of nails, skin and hair. Myoma complicates the reproductive function. The myomatous node, localized in the uterine cavity, significantly deforms it. Education prevents conception and gestation.

When large nodules or multiple myoma lesions form, the enlarged organ takes up a lot of space in the abdominal cavity. The uterus compresses the ureters and interferes with the outflow of urine, which leads to damage to the kidneys.

Pregnancy with fibroids is often accompanied by a retardation of the fetus in development. Premature birth and rupture of the membranes are possible. With such a pregnancy, a low fetal weight is noted. Weakness develops during labor.

Diagnosis

The patient visits an obstetrician-gynecologist for an examination for uterine fibroids. Diagnosis is carried out using non-invasive methods. The main methods for detecting myomatous lesions of the uterus include:

• Gynecological examination. It makes it possible to suspect the presence of a large formation in the uterus.
• Microflora and cytology tests. They allow you to identify the nature of inflammation in the tissues and signs of malignancy.
• Hysteroscopy. Defines submucosal myomatous nodes of small size.
• Laparoscopy. With the help of it, the myomatous node is examined with subserous localization.
• Research on sex hormones. Allows you to identify hyperestrogenism, which supports the growth of nodes.
• Ultrasound with transvaginal or transabdominal. For the diagnosis of this pathology, it is considered the most informative method. Formations are visible as rounded foci with reduced echogenicity. The myometrium has a denser structure compared to tumor nodes.
• Biopsy. The study is carried out in order to search for atypical cells.

If it is necessary to differentiate between uterine fibroids and ovarian tumors, MRI is prescribed.

Methods of treatment

Both conservative and surgical methods are used to treat fibroids. This is what gynecologists do. Choose a method depending on the size of the tumor. Another important factor is its growth rate. The decision is influenced by other chronic pathologies in the patient, her age, the need to preserve reproductive functions.

Surgical

Surgery for fibroids is indicated in the following situations:

• the size of the node exceeds 12 weeks;
• intensive node growth;
• submucosal location;
• the presence of prolonged bleeding that caused anemia.

A number of surgical operations are performed for fibroids. Preference is given to minimally invasive methods. Patients of reproductive age undergo organ-preserving types of operations. When they perform husking of myomatous nodes. Resection is performed with submucosal localization of fibroids.

Uterine artery embolization is performed to preserve fertility. Blood circulation in the tumor node stops. It slows down tumor growth. Removal of the uterus along with the cervix is ​​carried out with a combination of fibroids with adenomyosis or an ovarian tumor.

Medication

In conservative therapy, it is customary to prescribe hormonal drugs in long courses. Their duration is determined by the doctor. They are needed to slow tumor growth before menopause. During this time, the fibroids may shrink on their own. Medicines of the following groups are used:

• Gonadotropin-releasing hormone agonists;
• gestagens;
• androgen derivatives;
• hormonal oral contraceptives.

Gynecologists for patients for five years install an intrauterine device of the Mirena type in the uterine cavity.

Methods of prevention

The cause of fibroids is unknown, there are no specific preventive methods. Sometimes contraceptives are prescribed to reduce the likelihood of fibroids.