FIBROIDS SYMPTOMS
AND DIAGNOSIS
Facts About Fibroids
This section will help with understanding the diagnosis and cause of fibroids as well as the complications fibroids can cause. For more information on CIGC Hyper-Specialists, the Treatment of Fibroids, as well as information on Publications, Insurance and other issues, please go the section on Treatment Options – Fibroids.
Fibroid Symptoms
The most common symptoms of fibroids include heavy bleeding and severe pain during a period, frequency of urination, and infertility.1
Physical Symptoms:
- Bleeding – heavy flow, clots, prolonged bleeding, spotting between periods
- Anemia – low blood counts causing fatigue
- Pain – during period with cramps, back and leg pain, pelvic pressure, pain during intercourse
- Acute pain due to degenerating fibroids
- Urinary – frequency and retention
- Abdomen – Bloating and distension, swelling of the abdomen
- Bowel – Constipation and diarrhea
- Pelvic/Leg – pressure, clots, pain
- Infertility – prevent implantation, normal pregnancy
Emotional Symptoms:
- Severe bleeding and/or pain can lead to extreme discomfort and a negative effect on quality of life.4
- Fatigue from anemia, stress, anxiety
- Negative body image or poor self-esteem
- Sadness and depression
Fibroid Diagnosis
Fibroids need to be detected and treated early to prevent them from growing larger and causing severe symptoms and infertility.
Diagnostic Tests
Ultrasound is safe, inexpensive, convenient, well tolerated and accurate. This is the best evaluation of the number, size, and location of fibroids in the uterus. ALL patients suspected of fibroids should have an Ultrasound. If your OBGYN does not suggest it, then ASK.
Abdominal Ultrasounds look at the fibroids through the abdomen. This is less accurate than a Transvaginal Ultrasound that looks at the fibroids through the vagina. Often both must be used to locate fibroids in a larger uterus. Ultrasound is the best way to identify and follow fibroid growth.
- ALL patients suspected of fibroids should have an Ultrasound. If your OBGYN does not suggest it, then ASK.
- Abdominal Ultrasounds look at the fibroids through the abdomen. This is less accurate than a Transvaginal Ultrasound that looks at the fibroids through the vagina. Often both must be used to locate fibroids in a larger uterus.
- Ultrasound is the best way to identify and follow fibroid growth.
Hysterosonography, also known as a saline infusion sonogram, uses salt water in the uterine cavity at the time of the ultrasound to increase the sonogram’s ability to evaluate fibroids in or near the cavity of the uterus.
Hysterosonogram showing a fibroid in the uterine cavity, which is filled with water.
Pelvic exams are NOT effective. Cannot identify the size, location, and number of fibroids. There are better, more effective methods.
Compared to an ultrasound, an MRI is a more expensive technique for imaging fibroids but it is not necessary for the majority of fibroid patients.
The following image is an MRI showing multiple fibroids in the uterus.
A CT Scan is not used for fibroids, there are better tests such as Ultrasound and MRI.
Fibroid Types
Fibroids can occur anywhere in or on the uterus and are named for their location.
Intramural means “within the muscle” – growing in the uterine muscle wall, or myometrium.
- Growth – as the fibroids grow, the uterus becomes larger
- Symptoms – heavy menstrual flow, frequent urination and lower back or pelvic pain, distension of the abdomen or swelling
- Infertility – preventing the embryo from growing in the wall of the uterus, or blocking the tubes and preventing transport to the uterine cavity
Subserosal fibroids develop on the outside of the uterus and involve the serosal lining of the uterus.
- Growth – these fibroids tend to grow outward from the uterus pushing on other organs. Less likely to cause bleeding
- Symptoms – Pelvic pain, pressure.
- Fertility – less likely
Submucosal fibroids develop under the endometrial lining of the uterus and may protrude into the uterine cavity as they grow.
- Growth – just beneath the uterine lining in the muscle
- Symptoms – heavy bleeding, prolonged menstruation,clots during menstruation
- Fertility – prevention of embryo implantation into the lining for growth of the baby, less likely blocking the fallopian tubes. If fertility is desired, submucosal fibroids need to be surgically removed2
Pedunculated fibroids develop on stalks attached to the uterus.
- Growth– Into the cavity of the uterus (pedunculated intracavitary fibroid) or from the outside of the uterus (pedunculated subserosal fibroid)
- Symptoms – pain and pressure, sometimes worsened if fibroids begin twisting on the stalk
Delay in Care: Fibroid Complications
If allowed to grow, fibroids can have serious complications. OBGYN “watching and waiting” is a bad practice, and leads to large fibroids that need removal. The following are common symptoms and complications that occur as fibroids grow.
Anemia is the result of heavy blood loss from fibroids during the cycle, which can cause fatigue, weakness, pale skin, dizziness, headaches and cognitive problems. This condition can quickly turn into a life-threatening situation. Severe anemia can lead to fainting, accidents while driving or at work, stroke, heart attack, and many other problems.
Chronic pain is a common complication of untreated fibroids. In many cases, chronic pain occurs in the pelvic region, but patients may also feel pain in the lower back, abdomen and down the legs. Period pain can be severe in many patients with fibroids and occurs around and during the menstrual cycle. This type of pain can be incapacitating, with many patients unable to work or leave the house.
Infertility occurs when growing fibroids distort the regular shape and function of the uterus.
- Fibroids in or near the uterine cavity – submucosal fibroids – can cause infertility by preventing implantation of the embryo.
- Fibroids that grow in the uterine muscle – intramural fibroids – can obstruct fallopian tubes, which prevents conception, and restricts fetal growth, sometimes to the point that vaginal delivery is no longer an option, and a preterm birth is more likely.
- Any type of fibroid can contribute to infertility and pregnancy complications, but research2 suggests submucosal fibroids have the greatest impact on fertility.
Bladder compression by fibroids decreases the capacity of the bladder and leads to urinary frequency. Urinary frequency can become a serious problem if a patient is getting up multiple times a night to urinate, causing fatigue from loss of sleep and dysfunction in everyday activities. Fibroids can press on the urethra, the tube that drains the bladder, causing urgency and urinary retention – can’t pee. As fibroids become larger, they can also compress the ureter – the tube that drains urine from the kidney to the bladder. This can cause hydronephrosis, or swelling of the kidney, which can lead to kidney damage.
Abdominal problems can occur such as distension, bloating, swelling, constipation, and diarrhea. The larger the fibroids the more serious the problems that occur. , leading to abdominal distension. Bloating and swelling results, with many patients looking like they are 20 weeks pregnant, or more.
Mental Health and Social Complications from the physical complications of untreated fibroids can be debilitating and negatively impact a person’s quality of life. This can severely affect mental health5 and lead to higher occurrences of conditions like depression and anxiety. While fibroids and the symptoms they cause cannot be treated by psychotherapy alone, seeking therapy in addition to surgical removal of fibroids can help to support a patient’s mental state when dealing with fibroids and undergoing treatment.
Fibroids Treatment and Specialists
For a full review of Fibroid Treatment and the role of CIGC Hyper-Specialists, please go to the section on Treatment Options and click on Fibroids.
The Hyper-Specialists at CIGC are experts in diagnosing and treating fibroids through advanced minimally invasive surgical procedures.
Our experts have performed more than 25,000 GYN surgeries with just two small incisions, no hospital stay and a quick recovery. If you have been diagnosed with fibroids and you’re looking for the most effective treatment option for your case, schedule an appointment today to talk through all available options.
Fibroid Causes
Estrogen
Fibroids are dependent on estrogen to grow. Because ovulation increases the amount of estrogen in the body, hormonal medications like birth control that stop ovulation can also help to decrease estrogen production. Decreasing estrogen production will not stop fibroid growth altogether, but it may help slow down the growth rate in some patients.
Genetics
Some women are more genetically predisposed to fibroid growth than others. All women are at risk for fibroids, but African American women have fibroids two to three times more than other races. African American women can develop problems at an earlier age, with the tumors growing faster, becoming larger and causing more bleeding and anemia than for women of other races. Patients with a family history of fibroids need special care and counseling to ensure any potential fibroid growth is being closely monitored and, when necessary, treated.
Age and Ethnicity
By age 50, about 80% of women will have fibroids. As patients get older, their risk of developing fibroids increases. But for women who are past menopause, their risk declines in accordance with decreasing estrogen production. Routine ultrasounds should be performed regularly to check for fibroid growth. If fibroids are diagnosed, patients should work with a fibroid specialist to explore potential treatment options and keep symptoms under control. This is especially important for patients interested in fertility.
Risk Factors for Fibroids
All women are at risk for fibroids, but there are particular risk factors that may have a small impact on the likelihood of developing fibroids. Unlike potential causes, risk factors are often under the control of the patient. Controlling risk factors may not only decrease the chance of developing fibroids, but it can also lead to a healthier life in general.
- Obesity. Any risk factor that increases the production of estrogen will cause increased fibroid growth. Obesity is one of the commonly cited risk factors for fibroids. In women with an elevated BMI, higher fat levels allow for more conversion of male hormones to female hormones through an enzyme in the fat cells, aromatase.9 Higher levels of aromatase therefore increase the production of estrogen, which causes increased fibroid growth.
- Estrogen related diet. To a much lesser extent, higher intake of foods high in estrogen derivatives, such as tofu, yams, and other foods may increase estrogen levels enough to cause fibroid growth. However, it would take a very high intake of these foods to see growth of fibroids.
- Vitamin D deficiency – Studies5-7 have identified vitamin D deficiency as a notable risk factor for fibroids. Supplementing your diet with added vitamin D may help to slow fibroid growth.
The following factors may have some relationship to fibroid growth.
- Not eating enough fruit – Adding additional servings of fruit into your diet may help to lower the risk of developing fibroids. Studies have shown this is especially apparent with increased servings of citrus fruits.4
- High diet of red meat – Some research9 shows women who report eating higher amounts of red meat in their diet are more likely to have fibroids. Decreasing the amount of red meat and replacing it with additional servings of fruits and vegetables may have a protective effect against fibroid growth.
- Using hair relaxers – One study10 found a correlation between frequent use of hair relaxers (and associated burns on the scalp) and a higher incidence of fibroids. The researchers hypothesized that burns on the scalp may cause chemicals to enter the body and increase fibroid risk.
- Stress – Increased levels of stress can cause changes in hormone levels that may affect fibroid growth. Reducing stress may help to decrease fibroid risk.11
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References:
1 Downes E, Sikirica V, Gilabert-Estelles J, et al. The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol. 2010;152:96-102.
2 Baird D, Dunson D, Hill M, et al. High Cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1): 100-7.
3 Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Human Reproduction Update. 2016;22(6):665-686.
4 Eltoukhi H, Modi M, Weston M. The health disparities of uterine fibroids for African American women: a public health issue.AJOG. 2014;210(3):194-199.
5 Stewart E, Cookson C, Gandolfo R, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501-1512.
6 Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95–114.
