How to Identify and Treat Fibroid Pain

Uterine fibroids are a very common gynecological condition that can cause pelvic pain and heavy menstrual periods. Fibroids are non-cancerous tumors that grow in the walls of the uterus (womb).

Fibroid pain feels like pressure, heaviness, or a dull pain in your pelvis. Where you feel fibroid pain depends on the location of the fibroid, its size, and your anatomy. A very large fibroid can also cause low back pain, bladder and bowel problems, and painful intercourse.

This article discusses fibroid pain and other symptoms. It also explains how fibroids are diagnosed and treated.

What Are Fibroids?

A fibroid is a benign tumor made of muscle cells (myocytes) and collagen that can develop in different areas of the uterus. They can appear as a single tumor, or you can have multiple fibroids at once.

Fibroids, also called myomas or leiomyomas, commonly develop on the inside of the uterus. They can also grow on the outer uterus, known as pedunculated fibroids, which are attached by a stalk.

Fibroids can be as small as a grain of rice or bigger than a baseball. Fibroids can be symptomatic or cause no symptoms (asymptomatic).

Each fibroid has a unique life cycle. Some fibroids develop slowly, while others grow rapidly. Fibroids typically break down (degenerate) on their own over time, but new ones often develop.

Who’s at Risk for Fibroids?

Up to 70% of women will develop at least one fibroid before menopause. Factors that increase the risk of developing fibroids include:

• Age: Fibroids become more common during your 30s and 40s through menopause.
• Race: African-American women are more likely to develop fibroids than white women.
• Diet: Eating a lot of red meat may increase the odds of developing fibroids, while eating green vegetables may lower your risk.
• Genetics: Having a family member with fibroids increases your risk.
  
• Weight: Being overweight can double, or even triple, your risk of developing fibroids.
  

Fibroid Pain Symptoms

Uterine fibroids can cause symptoms related to bowel and bladder function, abnormal menstrual bleeding, or abdominal, lower back, pelvic, or groin pain.

A fibroid's size and location can affect how much pain it causes. Large fibroids can compress or irritate nerves, obstruct the bladder or bowel, or cause pelvic pain, pressure, and bloating.

Researchers estimate only about 30% of people with leiomyomas will seek treatment for fibroid pain and other symptoms.

Pelvic Pain

Fibroids do not always cause pain, but when they do, it may feel like:

• A vague discomfort in the lower abdomen
• Heaviness in the lower pelvis above the pubic bone.
• Pressure in the lower abdomen
• Sharp, sudden pelvic pain

The exact location and degree of pain will depend on its size, where it is in your uterus, the number of fibroids you have, and individual pelvic anatomy.

Fibroid pain can be cyclical (worsening during your menstrual period) or occur all month. Other characteristics of fibroid pelvic pain include:

• Pain midcycle, after, or during menstrual bleeding
• Pain during sex (dyspareunia)
  
• Sudden, severe pelvic pain
• Chronic pelvic pain

Heavy Vaginal Bleeding

Abnormal bleeding is a common problem with fibroids, even small ones. In particular, submucosal fibroids (which grow just beneath the uterine lining), are linked to changes in menstrual bleeding.

Fibroids can affect menstruation in the following ways:

• Heavy or excessive bleeding (previously called menorrhagia) that may lead to anemia
• Midcycle or breakthrough bleeding
• Prolonged menstrual periods
• Shorter menstrual cycles with more frequent periods
• Irregular cycles that are less predictable

Low Back Pain

Fibroid pain is often felt in the lower back. When this happens, it often flairs up when you have your period and can feel like menstrual cramps in your lower back, a general aching sensation, or stiffness.

Fibroids that are large or on the back of the uterus can irritate nerves in the pelvis and cause radiating pain down the legs.

Bowel or Bladder Problems

Depending on their location and size, fibroids can also produce bowel or bladder symptoms, such as:

• Bloating
• Constipation
• Diarrhea
• Frequent urination
• Painful urination or bowel movements
• Urge incontinence
• Urinary retention

Difficulty passing urine can lead to urinary tract infections as well.

Discomfort During Sex

Depending on their location, fibroids can also lead to painful intercourse. This is more common with large fibroids in the lower part of the uterus.

Diagnosing Fibroid Pain

The first step in addressing fibroid pain and other symptoms is to visit your gynecologist.

They will need to rule out other possible conditions that could be causing your pain, such as endometriosis and adenomyosis. These conditions, which have symptoms that overlap with fibroids, can only be definitively diagnosed from surgery with biopsy and pathology.

To definitively diagnose you with fibroids, your doctor will consider your personal health history, symptom profile, and family history. They might use imaging tests, such as a transabdominal or transvaginal ultrasound, as well.

How Is Fibroid Pain Treated?

Pain caused by fibroids can significantly affect a person's quality of life. In one study, over half of the participants with fibroids reported that their symptoms negatively impacted their life, including their sexual life, performance at work, and relationships and family.

It's important to talk to your doctor about medical treatment for fibroids. There are also some things you can try on your own that might help you manage your symptoms.

Home Remedies and Lifestyle

There is not much evidence to support home remedies specifically for fibroid pain, but you might find that they offer some relief. To help manage fibroid pain, try:

• Gentle yoga
• Meditation
• Mindfulness
• Stretching

These techniques will not alter or cure your fibroids, but they can help change your perception of pain and correct muscle imbalances that developed due to pelvic pain.

Other lifestyle changes that can promote your overall health and may help relieve fibroid symptoms include:

• Adopting a healthy diet
• Engaging in frequent low-impact exercise
• Communicating about your pain to people you trust

Over-the-Counter (OTC) Treatments

Over-the-counter (OTC) medications that can help manage fibroid pain include:

• Acetaminophen (Tylenol)
• Advil (ibuprofen)
• Aleve (naproxen)
• Aspirin

While these treatments will not help the fibroids themselves, they can relieve fibroid pain enough for you to carry on with your daily activities.

Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine (CAM) may help to treat fibroids, though the evidence is lacking. CAM treatments that may help fibroids include:

• Acupuncture: This treatment involves a licensed practitioner sticking very thin needles into specific acupuncture points along your body that correspond with meridians or energy channels. Evidence supports the use of acupuncture for several gynecological conditions, but there is a lack of research proving it can treat fibroids.
• Chinese herbal medicine: Current research evidence neither supports nor refutes the use of traditional Chinese herbal medicine for fibroids. Most studies have focused on the impact of herbs on fibroid size and volume, rather than on a person's pain.
• Transcutaneous electrical nerve stimulation (TENS): This therapy involves placing electrodes that deliver mild electrical impulses on your abdomen, which are adjusted using a battery-controlled unit. TENS has been shown to reduce pelvic pain caused by primary dysmenorrhea (menstrual pain). TENS machines can be bought at a pharmacy or online.

Prescription Medications

Prescription medications are primarily used to manage symptomatic fibroids, but they can have significant side effects.

Types of medications used to treat fibroid pain and heavy bleeding include:

• Antifibrinolytic agents, such as tranexamic acid
• GnRH agonist, such as Lupron
• Oral contraceptive pills, patches, rings, or intrauterine devices (IUD)

Procedures

Fibroids cause pain through their bulk and weight, or by pressing on other organs and nerves. The only way to completely remove a fibroid is with surgery. There are a few surgeries and procedures that your doctor may recommend.

• Hysterectomy: A hysterectomy is the surgical removal of the uterus. It is the definitive treatment for fibroids and can be performed laparoscopically. It also carries the lowest risk of needing future surgeries. However, a hysterectomy should be done only if the person does not want to have children.
• Myomectomy: A myomectomy is the surgical removal of fibroids. It used to require a large abdominal incision, but now it can be done laparoscopically. While a laparoscopic myomectomy is less invasive and comes with a shorter recovery time for patients, it's more challenging for surgeons. A myomectomy is the preferred surgical treatment for people who hope to have children. However, additional surgeries because of fibroid recurrence are required 20% to 30% of the time.
• Uterine artery embolization (UAE): UAE is a nonsurgical but still somewhat invasive procedure that is done in a doctor's office with intravenous pain relief. During UAE, a groin catheter is inserted, which sprays small particles to permanently limit blood flow to the uterus. Over a few months, this shrinks fibroids and will reduce pain, pressure, and cramping. UAE is not recommended for people who wish to become pregnant, although some pregnancies have occurred after UAE. About 15% to 32% of people who have UAE will require further surgeries.
• High-frequency magnetic resonance–guided focused ultrasound: This procedure is a thermal ablation technique that is directed at the fibroid, which uses heat to cause the death of the tissue. It is a newer technique that is expensive and not widely used. There is also no definitive evidence about the procedure's effect on fertility.

Summary

Fibroids are the most common gynecological disorder. Fibroids can cause pelvic pain, abdominal pressure and heaviness, irregular and heavy menstrual bleeding, or bowel and bladder symptoms, but your experience will be unique.

Fibroids are diagnosed by a gynecologist based on your health history, symptom profile, family history, and ultrasound. Fibroid pain can usually be managed with OTC pain relievers and lifestyle additions like meditation, stretching, talk therapy, yoga, low-impact exercise, OTC medicines, TENS machines, and a healthy diet.

Fibroids that are problematic can be treated with prescription medication, including antifibrinolytic agents, hormonal birth control, and GnRH agonists. If fibroids are causing severe symptoms, invasive treatments may include uterine artery embolization, uterine ablation, surgery to remove fibroids (myomectomy), or hysterectomy.