What symptoms do Fibroids cause?
Most women with fibroids (even large fibroids) do not have symptoms. Many women have fibroids diagnosed by imaging studies carried out for some other purpose. If the fibroids are not causing trouble, they can be ignored. Do not worry about them. A minority of women with fibroids have significant problems. These are for four main reasons:-
1. Pressure on nearby structures from the size of the fibroids.
2. Bleeding in the cavity of the womb
3. Distortion of the normal anatomy
4. Cosmetic problems from abdominal distension
The most common symptom caused by fibroids is menorrhagia (heavy periods). Other common symptoms are bladder irritation, altered bowel habit and pain. Less often, they can cause pain during sex, vaginal dryness, and lethargy from anaemia and painful periods.
Menorrhagia (heavy periods)
This may manifest as flooding or gushing of blood, passing large blood clots, having periods which last much longer than normal. If severe loss of blood can be so great that the woman cannot replace it fast enough and she becomes anaemic. This can cause dizziness and tiredness. Normally anaemia can be controlled by taking iron tablets and a good diet, with plenty of fresh vegetables, liver and maybe a glass or two of red wine!
The symptoms of menorrhagia and anaemia are most likely to be caused by fibroids which lie in the cavity of the womb (sub-mucosal). These stretch the lining of the womb leaving more to be shed at the time of each period. Bleeding during sexual intercourse can sometimes be caused by fibroids within the cervix.
Fibroids often cause pain, and it is thought that this is due to pressure on nerves, stretching of normal tissues, attempts by the uterus to expel large blood clots, pedunculated fibroids or the twisting of a pedunculated fibroid. The pain can be at the time or randomly throughout the menstrual cycle. The pain may be felt in the back, in the thighs or in the lower belly. It is usually a dull aching. Rarely a very sudden pain may be experienced in the lower belly or back, if a pedunculated fibroid twists and its blood supply gets strangled. Sexual intercourse can sometimes cause fibroids to be painful, especially if they are in the cervix area.
As the uterus and hence the fibroids lie just behind the bladder, it is not surprising that the bladder becomes irritated by the bulk of the fibroids. This can cause:-
1. Incontinence (leaking of urine)
2. Urgency (a sudden desire to pass urine)
3. Frequency (a need to urinate more often than normal)
4. Cystitis (infection of the urine caused by stagnation as the bladder does not empty completely)
5. Retention (an inability or difficulty to pass urine). This can be painful and is a serious problem. You need to talk to your doctor straightaway.
Pressure on the bowel lies just behind the uterus commonly causes symptoms. This can be constipation or an urge to empty your bowel but nothing comes. Piles may also occasionally be caused by the pressure in this area.
If the fibroids are very large, they may press on structures high up within the belly, causing indigestion and discomfort in the upper abdomen.
Many women are only aware of their fibroids because their belly swells. This can be most distressing causing them to be ashamed of their bodies and having to increase their dress size. If this is the only problem, then very careful consideration will need to be taken if the risks of treatment for it are undertaken.