Uterine Fibroids

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Signs and Symptoms

Uterine fibroids often are asymptomatic (i.e., do not cause symptoms), especially in women younger than 30 years of age. When symptoms do occur, they usually depend on the location of the fibromata. For example, growths located in the bladder region may cause urinary symptoms, and those that affect the lining of the uterus (endometrium) may cause problems with menstrual periods.

Signs and symptoms of uterine fibroids include the following:

• Abdominal and/or pelvic pain
• Bowel problems (e.g., painful bowel movements)
• Infertility
• Feelings of "fullness" in the lower abdomen
• Low back pain
• Menstrual problems (e.g., bleeding between periods, painful periods [dysmenorrhea], heavy menstrual bleeding [menorrhagia])
• Pain during sexual intercourse
• Pregnancy complications (e.g., miscarriage, early labor)
• Urinary symptoms (e.g., frequent urination, painful urination [dysuria])

Uterine fibroids may increase in size during pregnancy. After menopause, they often shrink in size or stop growing. Uterine fibroids do not increase the risk for uterine cancer (e.g., endometrial cancer, uterine sarcoma). Very rarely (in fewer than .1% of cases), uterine fibroids can become malignant (cancerous).

Diagnosis

In some cases, uterine fibroids are diagnosed upon physical examination when the physician feels an enlarged uterus during a routine gynecologic (pelvic) exam. If fibromata are suspected, imaging tests may be performed to confirm the diagnosis.

Imaging tests that can be used to diagnose uterine fibroids include the following:

• Computed tomography (CT scan or CAT scan; uses x-rays from different angles to create three-dimensional images of tissues and organs)
• Magnetic resonance imaging (MRI scan; uses electromagnetic radio waves to create detailed images of tissues and organs)
• Ultrasound (uses sound waves to create images of tissues and organs)
• X-rays (use electromagnetic radiation to create and record images)

When the results of physical examination and imaging tests are not conclusive, surgery may be necessary to confirm the diagnosis. Types of surgery that may be performed include laparoscopy and hysteroscopy.

Laparoscopy usually is performed in a hospital or an outpatient surgical center, under general anesthesia. In this procedure, a small incision is made in the abdomen and carbon dioxide is passed into the abdomen to move aside the abdominal wall and allow the physician to see the area better. Then, a tube containing a tiny video camera and light (called a laparoscope) is inserted into the abdominal cavity. Using this device, the physician is able to see into the abdomen and pelvis and detect uterine fibroids.

In hysteroscopy, an instrument (called a hysteroscope) is inserted into the uterine cavity through the vagina and used to look for fibroids. This procedure can be performed under general, regional, or local anesthesia with sedation, in a hospital, outpatient surgical center, or physician's office.

Risks associated with these procedures include adverse reaction to anesthesia, bleeding, damage to an organ, and infection. Hysteroscopy may cause cramping and minor vaginal bleeding. Heavy bleeding, fever, and severe pain should be reported to a physician immediately.

In most cases, laparoscopy and hysteroscopy do not require overnight hospitalization. After surgery, over-the-counter or prescription pain relievers and antibiotics often are administered to relieve pain and reduce the risk for infection. In most cases, patients are advised to take it easy for a week or two following the procedure.

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