Do all fibroids cause symptoms?
Fiboids are very common and most fibroids do not cause any symptoms. In fact most women with fibroids (often quite large) may not even know of their presence. Some fibroids (approximately 40%) will cause some symptoms. These symptoms depend on location of fibroids, their size, changes within the fibroids and pregnancy status. Submucous fibroids are often likely to cause bleeding problems while intramural and subserous fibroids tend to cause pressure symptoms. Fibroids tend to grow during pregnancy due to presence of oestrogen and consequently fibroids are more likely to cause symptoms during pregnancy.
What are the common symptoms?
Abnormal Uterine Bleeding: Fibroids (often submucous) can cause bleeding problems such as heavy periods (menorrhagia) or bleeding in between periods. Sometimes the bleeding is associated with heavy clots and spasmodic pain. Blood loss can also lead to iron deficiency and anaemia.
Pressure symptoms: Fibroids can press on the surrounding organs such as bladder and bowel. This can lead to urinary frequency and constipation. Occasionally, pressure on the bladder neck can lead to urinary retention. Large fibroids can cause pressure on pelvic blood vessels which can lead to swelling of legs, deep vein thrombosis and back pressure on kidneys.
Pain: Fibroids can cause heaviness and fullness in the pelvic area. Large fibroids can cause mass and pressure effects. Sometimes the fibroids can outgrow their own supply and can undergo central degeneration and become extremely painful. Some of the fibroids can cause dyspareunia (pain during sex) because of their position.
Infertility: Fibroids usually do not lead to fertility issues and most women with fibroids will achieve pregnancy without any difficulty. In fact, many of the fibroids are diagnosed on ultrasound scans performed during pregnancy. Submucous fibroids can obstruct the uterine cavity and prevent implantation very similar to an Intrauterine Device (IUD). Some fibroids can obstruct the fallopian tubes and cause difficulty in conceiving. There is some evidence that myomectomy can improve fertility rates by approximately 50%. Removal of fibroids larger than 6cm and submucous fibroids will improve fertility rates and risk of complication during pregnancy.
Pregnancy and Fibroids: Most women with fibroids will have straight-forward course in pregnancy. However, the fibroids tend to grow in size in pregnancy due to high levels of oestrogen. Occasionally, they will outgrow their own blood supply and become painful due to a condition called ‘red degenration’. Submucous fibroids can occasionally cause early pregnancy complications such as bleeding and pregnancy loss due to implantation on a fibroid and not enough blood supply. Later on in pregnancy, if the fibroids are low in the uterus, malpositions such as breech and transverse lie can occur or indeed slow progress in labour and a caesarean section may be necessary. Caesarean section sometimes can be complex if the fibroids are in the way. They can also interfere with uterine contractions and lead to excessive bleeding after delivery.