What symptoms can be associated with fibroids?

The majority of fibroids are small and cause no problems. Fibroids may be present in 50% of women so that the fact that they co-exist with a symptom such as pelvic pain does not necessarily prove cause and effect (Q4.3).

Heavy periods are often associated with fibroids. In one study, 30% of women presenting with heavy periods had fibroids seen on hysteroscopy (Q 24.8). There was, however, no difference in the incidence of fibroids in the group with heavy periods and another group who did not have heavy periods. Many women who present with heavy periods are found to have fibroids but proof that the fibroids are the cause of the problem is lacking. There have been very few studies to confirm that removing fibroids reduces heavy periods.

Bleeding between periods (intermenstrual bleeding IMB) can be related to a submucous fibroid (Figure 23.1).

Figure 23.1

Pelvic pain, like heavy periods, is a frequent problem and may co-exist with fibroids. They are not usually the cause of pain unless they are being squeezed out through the cervix or they are attached to the outer surface of the uterus and start twisting (torsion). If there is any doubt, it may be helpful to undertake a pelvic examination at the time that the pain is present. On occasion, a fibroid may lose part of its blood supply resulting in degeneration and acute pain. Degeneration of a fibroid is more common during pregnancy but can occur at other times.

Infertility and recurrent miscarriage investigation frequently demonstrate fibroids. It should not be assumed that the fibroids are the cause of the problem.

Bladder symptoms including increased Frequency of bladder emptying may be due to large fibroids pressing on the bladder (Q 29.9)

Occasionally abdominal enlargement may be the presenting symptom of large fibroids.

The risk of malignant change of a fibroid is extremely small. The figure often quoted is one in a thousand but this is probably derived from examination of fibroids that have been removed and excludes the majority of fibroids that have not been removed. Rapid enlargement of a fibroid could indicate the possibility of malignant change.

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