Uterine Fibroids: Symptoms, Diagnosis, and When to See a Doctor

Fibroids are common, non-cancerous growths that develop in or around the womb [1]. Some people never know they have them, while others live with heavy periods, pressure in the belly or bladder trouble that they had not linked to a fibroid. Knowing what they are and how they are usually found can make it easier to decide when to get checked.

What Fibroids Are

Fibroids are growths made of smooth muscle cells, fibroblasts and other material that grow in or on the wall of the womb, and they are the most common non-cancerous tumours in women of childbearing age [2]. They mainly affect women who have not been through the menopause, and anyone with a womb can get them [1].

Fibroids are grouped by where they grow [3]:

• submucosal fibroids grow just underneath the lining of the womb and into its cavity
• intramural fibroids grow in between the muscles of the womb
• subserosal fibroids grow on the outside of the womb
• pedunculated fibroids grow on stalks; some stalks grow out from the surface of the womb, and others grow into the womb cavity

Over time, fibroids can grow, shrink or remain a constant size [3].

Symptoms of Fibroids

Fibroids do not always cause symptoms, so you may not know you have them [1]. Many women have no symptoms of fibroids [4]. A person may have a single fibroid, and there can also be many, ranging from as small as an apple seed to as big as a grapefruit [5].

When fibroids do cause symptoms, these can include:

• heavy periods [1][4]
• painful periods [1][4]
• bleeding between periods [4]
• stomach pain [1]
• lower back pain [1][4]
• a feeling of fullness in the lower belly, sometimes called pelvic pressure [4]
• peeing more often than usual [1][4]
• needing to pee suddenly [1]
• not being able to control when you pee [1]
• problems pooing, such as bloating, not being able to poo and pain when you poo [1]
• pain during sex [1][4]
• difficulty getting pregnant [1]

Frequent urination can happen because a fibroid is pressing on the bladder [4]. Anaemia, when you do not have enough red blood cells, can also be part of the picture [4]. These are not all the symptoms fibroids can cause, and it is worth talking to a doctor if you are worried [1].

Several of these symptoms, especially painful periods and pelvic pain, are shared with other conditions.

Fibroids, Pregnancy and Fertility

Fibroids can be linked to reproductive problems such as infertility, multiple miscarriages and early onset of labour during pregnancy, and to an increased likelihood of caesarean section [4]. The UK National Health Service (NHS) describes being unable to have children or having miscarriages because of fibroids as possible, "although this is rare" [1].

Who Is More Likely to Get Fibroids

The exact cause of fibroids is unknown [1]. Researchers think more than one factor could play a role [5].

The NHS says you are more likely to get fibroids if you [1]:

• have not reached the menopause
• have never had a full-term pregnancy
• are overweight or obese
• have high blood pressure or diabetes
• are from a Black or Asian background
• have a close relative who has fibroids

The US Food and Drug Administration (FDA) says the factors that may play a role include age, having a family member with fibroids, race or ethnic origin, being overweight or obese, having high blood pressure, and certain dietary factors, hormones or both [5].

Fibroids are more common in Black women [6].

Possible Complications

Sometimes fibroids cause problems if they are not treated. Heavy bleeding can lead to iron deficiency anaemia [1]. Large fibroids pressing on the bladder can cause urinary tract infections, problems peeing and incontinence [1].

Fibroids may also lead to complications such as miscarriage [5][7].

How Fibroids Are Diagnosed

Unless you have symptoms, you might not know you have fibroids [5]. They are sometimes found during other tests or scans, such as a pregnancy scan [1], and a healthcare provider may find them during a routine pelvic exam [5].

If you have symptoms, a GP may ask about them and examine you. This may include checking your tummy and pelvic area and an internal vaginal exam [1]. If fibroids seem likely, you will usually be referred to a specialist for an ultrasound scan, which can show whether you have fibroids, how many there are, where they are and how big they are [1].

A provider may also order medical imaging like a pelvic ultrasound to see a picture of the fibroids [5]. Imaging tests might include [5]:

• ultrasound, which uses sound waves to make a picture, with the probe placed on the belly or inside the vagina
• saline ultrasound, which uses a small amount of salt solution placed in the womb to help see inside it on an ultrasound
• MRI, which uses magnets and radio waves to make a picture of the inside of your body
• CT, which scans the body with X-rays from many angles to form a more complete picture than a plain X-ray

Blood tests may also be ordered: a complete blood count checks for signs of anaemia (low red blood cell count), and a test of blood iron levels can confirm if iron-deficiency anaemia exists [5]. Surgery can confirm the ultrasound diagnosis of fibroids and provide additional information, like where the fibroids are [5].

When to See a Doctor

The NHS gives this non-urgent advice [1]:

See a GP if:

• you have symptoms of fibroids
• your symptoms are affecting your everyday life, work and relationships

The FDA advises [5]:

Contact your healthcare provider if you have any of the following symptoms:

• Heavy bleeding or bleeding between periods
• Significant cramping or pain with periods
• A full or heavy feeling in or near your belly
• Frequent urination or difficulty with urination

If you plan on having children, talk to a doctor about your options. Some treatments can stop you having children, or increase the risk of problems during pregnancy [1].

Treatment Overview

Fibroids do not always need to be treated, but they can be if they are causing problems [1]. If you have fibroids but no symptoms, you may not need medical intervention, and your provider can check during regular exams and with imaging to see if your fibroids have grown [5].

When fibroids do cause symptoms, the choices a healthcare professional may discuss include having no treatment, "waiting and watching", medical treatment and surgery [6]. For moderate or severe symptoms, a provider may recommend medical treatment, surgery or other procedures, depending on your symptoms and history [5]. The type of surgery or procedure depends on how many fibroids are present, where they are located and whether you want children in the future [5].

Living with Fibroids

People who have symptoms may find fibroids hard to live with [5]. Before deciding on any treatment, your healthcare team can talk through your situation and answer your questions, so that together you can choose the option that is right for you [5][6]. It can help to write a list of the questions you want answered and take it to your appointment, and you may also want to talk over your options with your family or friends [6].

Clinical trials can help doctors learn more about safe treatments for fibroids [5].

Conclusion

If your periods have become heavier, or pressure and bladder changes have crept up on you, it is reasonable to ask whether fibroids could be the reason. Going in with a clear account of your symptoms and your plans for pregnancy gives you and your doctor a better basis for choosing between watching and treating.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.