The commonest symptoms which occur with uterine fibroids, are heavy menstrual bleeding and pelvic or lower abdominal pressure or discomfort. Heavy menstrual bleeding is also known as menorrhagia. The term menorrhagia refers to periods that are heavy or excessively long. A normal menstrual period will last for about 4 to 5 days. Menstrual bleeding which lasts for seven or more days is considered to be menorrhagia. There are some women who have quite short periods ( lasting 2 to 3 days) but these periods can be excessively heavy, and this is also referred to as menorrhagia.
There is no formal medical classification system to describe or classify heavy periods. However the following symptoms commonly take place in women who have fibroids and menorrhagia.
Flooding is a term which is often used for loss of control of menstrual flow. Even if women are using plenty of pads or tampons, when flooding happens,women may still have been menstrual accidents, which result in staining of their clothes.
Needing to change a tampon or pad more frequently than every two hours
Needing to use double sanitary protection. In other words needing to use a tampon and a pad, or two tampons and two pads frequently.
With heavy periods, women typically need to get up at night to change their sanitary protection.
Wearing adult diapers or nappies for menstrual control.
Many women have to change their work or social schedule in order to deal with their heavy periods.
Any change in your normal schedule because of your heavy periods suggests that you have significant menstrual flow.
If you have heavy periods and you consult your doctor, then it is quite likely that he or she will request a blood test to check for anaemia. Having periods that are heavy enough to result in anaemia also confirms that you are suffering from menorrhagia. A normal haemoglobin ( in other words not being anaemic) does not rule out heavy periods. There are many women who are able to maintain a normal blood count by taking iron, vitamins and eating a good diet, despite having menorrhagia. On the other hand there are some women who do not feel that they’re having heavy periods, but they become anaemic as a result of their monthly blood loss.
The other common symptom which is associated with fibroids is pelvic pressure or discomfort (fibroid pain). The discomfort or pain is not typically sharp or disabling, but tends to be a discomfort based on the size of the uterus, and the pressure that the uterus causes on adjacent organs. It is similar to the discomfort pregnant women experience, because fibroids result in a uterus which enlarges to sizes which are commonly seen in pregnancy.
Women with fibroids may experience other symptoms such as: urinary frequency, constipation, difficulty emptying the urinary bladder, abdominal distension, sciatica and bloating. These are all symptoms which can also occur in pregnancy. The uterine fibroids can become fairly large before a women is aware of the symptoms. This is probably because fibroids develop slowly over time. When a woman is six months pregnant, then she can tell fairly easy lead that her symptoms are different from before she was pregnant. However a woman who has a six-month sized fibroid uterus may have had this develop slowly over time period of 5 to 10 years. She therefore mistakenly puts the symptoms down to other processes such as ageing.
Severe pain and sudden pain can occasionally happen with fibroids. This fibroid pain typically happens in two situations. The first is if the fibroid grows more rapidly than its blood supply and the centre of the fibroid degenerates or dies. This may happen to any type of fibroid. The second cause of acute fibroid pain occurs with a fibroid which is on a stalk (a pedunculated fibroid). If a pedunculated fibroid twists on its stalk, it can cut off the blood supply to the fibroid and cause sudden fibroid pain. Because sudden severe pain is uncommon with fibroids, it is important to investigate this type of pain. The pain may not be due to fibroid pain but may be due to other causes such as an ovarian cyst or endometriosis.
Uterine artery embolisation is a relatively new treatment for fibroids, and some of the feedback and information coming from studies about women undergoing uterine artery embolisation suggests that pain with fibroids may be more prevalent than previously thought by doctors specialising in this area.
Other problems that can occur with fibroids include: infertility, miscarriage and pregnancy complications. However, most women with fibroids are able to fall pregnant without difficulty and go on to have uncomplicated pregnancies and childbirth. It is important, before blaming a fibroid on reproductive difficulties, to thoroughly investigate a woman and her partner to exclude other more common causes. Infertility (difficulty getting pregnant) or problems with early miscarriages are seen most commonly with the type of fibroid that distorts the endometrial cavity. These are known as submucosal fibroids. It is fortunate that these fibroids are the ones which are most readily treated with a hysteroscope. This is a minimally invasive way of treating uterine fibroids.
Fibroids do sometimes cause problems during pregnancy and these complications of pregnancy are more likely with fibroids which are located directly under the the placenta, and with larger fibroids. The pregnancy complications that are known to be associated with uterine fibroids include:
- First trimester menstrual bleeding.
- Increased risk of placental abruption.
- Increased risk of preterm labour.
- Increased risk of Caesarian section.
A rare complication of very large fibroids is kidney problems, caused by a very large fibroid pressing on the ureter. The ureter is the tube that carries urine from the kidney to the bladder. Prolonged, severe pressure on the ureter can lead to back pressure on the kidney and result in a condition known as hydronephrosis. This is a rare complication of fibroids. The classical symptom of hydronephrosis is a sensation of pain or discomfort in the kidney area (in the loin) which is relieved by passing urine. If hydronephrosis is left untreated it can eventually lead to permanent kidney damage and renal failure. If a fibroid is causing hydronephrosis then surgical treatment is required.
Uterine fibroids, how common are they?
Medical studies have shown that up to 80% of women have fibroids present in their uterus. This rather high figure comes from studies of uteri (uteruses) under the microscope which have been removed surgically or uteri which have been removed and examined in women who have died from non-gynaecological causes. It is therefore likely that most women have some microscopic fibroids in their uterus. However, the percentage of women with medically significant uterine fibroids is generally reported to be about 25%. Medically or clinically significant uterine fibroids are those that are large enough to be felt on a pelvic examination or seen on ultrasound. This figure of 25% means that an estimated 23 million women in the United States between the ages of 19 and 64 may have clinically significant uterine fibroids. It is known that black women have an increased risk of developing fibroids and they are thought to develop fibroids at a rate three times that of Caucasian women. There is also some medical evidence that black women with fibroids develop more severe fibroid disease and do so at an earlier age. One study estimated that up to 80% of African American women in the United States will develop fibroids which are detectable on an ultrasound scan. Although large scale studies have not taken place in Africa, it appears that African women have a similar risk of fibroids to African American women. The medical studies that have taken place so far, also suggest that this increased incidence and prevalence are not due to other confounding factors. In other words factors that would vary between Caucasian women and African American women, and factors which would not account for this difference such as height, weight and age at first pregnancy.
What increases the risk of a woman developing fibroids?
As mentioned above being an African American woman leads to an increased risk of developing fibroids. Studies have shown that Asian and Hispanic women appear to have a similar risk of fibroids to Caucasian women. There seems to be a genetic component to the risk of developing fibroids. Having close relatives with fibroids seems to increase the risk of developing fibroids. Having a baby leads to a reduced risk of fibroids. It is not known why pregnancy reduces the risk of fibroids formation, but some medical researchers suggest that the remodelling of the uterus that occurs after pregnancy may clear newly formed fibroids.
Medical studies have suggested that taking the oral contraceptive pill may also reduce the risk of developing fibroids. It is debated amongst doctors, whether women with fibroids should take the oral contraceptive pill. Some medical textbooks state that women with fibroids should not take the oral contraceptive pill. This is because of a worry that the fibroids may grow rapidly. Although this may happen, many fibroids do not grow over time in women taking the contraceptive pill. The difference in findings may be explained by the fact that once established, the fibroids can respond to the hormones in the pill; on the other hand the steady state of hormones in the contraceptive pill may prevent cells from forming fibroids or fibroids from starting to grow. It is thought that the timing of starting the birth control pill may be important. In a large study involving nurses most women taking the contraceptive pill had a decreased risk of fibroids, but women who started taking the pill between the age of 13 and 16 had an increased risk of developing fibroids.
Smoking is also thought to reduce the risk of fibroids. This may be because of differences in the oestrogen levels between smokers and non-smokers. However it is very important to state that the benefit from reduced risk of fibroids, certainly does not outweigh the severe health risks of smoking.
Diet also has an effect on fibroid risk. Women who eat a diet which is rich in vegetables and fruit are known to have a reduced risk of developing fibroids. It is also known that women who eat a diet which is high in red meat have an increased risk of developing uterine fibroids.
It is also known that consumption of alcohol, in particular beer, also increases the risk of fibroids.
Caffeine is not thought to affect the risk of fibroids.
The progesterone only contraceptive known as Depo-Provera also seems to reduce the risk of developing uterine fibroids. This effect has been most clearly shown in African American women.
Weight also has an effect on the risk of developing fibroids. Women who have a greater body mass index (BMI) and who are overweight or obese have a greater risk of having fibroids.