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Symptoms
About 20 to 50 percent of women with fibroids experience symptoms. The two most common are bleeding and pelvic pressure. Reproductive problems like infertility and premature labor can also result from fibroids.
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Bleeding symptoms vary widely depending on the size and location of the fibroid. The most common problem is prolonged and/or profuse uterine bleeding, referred to as menorrhagia or hypermenorrhea. While normal menstrual periods typically last four to five days, women with troublesome fibroids may have periods lasting longer than seven days. They can have such heavy bleeding that they need to change sanitary protection as often as every hour and may curb their regular activities to avoid embarrassing social situations. Bleeding between periods is not usually associated with fibroids and should be investigated by a physician to rule out other problems. Although abnormal bleeding can occur with any of the three types of fibroids, women with submucosal fibroids, which bulge into the cavity, are particularly prone to this complication.
Pelvic pressure can result from the uterus expanding to accommodate a growing fibroid or from the location of a fibroid within the pelvic region. In some cases, fibroids can cause the uterus to expand to the size of a four- or five-month pregnancy. In addition to vague feelings of pressure, women can experience pressure on adjacent pelvic organs like the bowel and bladder. Pressure on these structures can result in constipation or diarrhea with bowel pressure, or in increased urination or incontinence with bladder pressure. Rarely, fibroids press against the ureter (the tube that carries urine from the kidneys to the bladder), which can lead to kidney problems.
Fibroids can also cause a range of reproductive problems including recurrent miscarriage, infertility, premature labor, breech birth, and labor complications. Although research is scant in this area, some evidence indicates that those fibroids that alter the shape of the uterus are the most likely to cause these problems. Women who have large or symptomatic fibroids who wish to become pregnant could opt to have a diagnostic test to assess the uterine cavity. If submucosal fibroids that distort the uterine cavity are detected, they should be removed since they can be a significant cause of reproductive problems. It is less clear whether fibroids in the wall of the uterus cause reproductive problems. Generally, if the uterus has remained normal in size, fibroids do not need to be removed in women contemplating or attempting pregnancy.
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