Fibroids cause symptoms in 20 to 50 percent of women. The most common symptoms are heavy uterine bleeding, pelvic pressure, frequent urination, constipation, painful periods and painful intercourse, infertility, and pregnancy complications.
Normal menstrual periods typically last four to five days. Women with fibroids often have periods lasting longer than seven days that can be very heavy, requiring changing sanitary protection frequently (perhaps every hour). Bleeding between periods is not usually due to fibroids and should always be evaluated by a physician. Although abnormal bleeding can occur with any type of fibroid, women with submucous fibroids are more likely to experience abnormal bleeding.
Pelvic pressure results from an increase in size of the uterus or from a particular fibroid. Most women with fibroids have an enlarged uterus; in fact, doctors describe the size of a uterus with fibroids as they would a pregnant uterus, for example, as a 12 week-size fibroid uterus. It is not unusual for a uterus with fibroids to reach the size of a four to five month pregnancy. Women can experience pressure on the bowel and/or bladder due to fibroids. This can cause constipation, frequent urination and incontinence. In some rare cases, fibroids can press on the ureters (tubes which carry urine from the kidneys to the bladder), leading to kidney dysfunction.
Women with fibroids also may experience reproductive problems including recurrent miscarriage, infertility, premature labor, abnormal presentation of a fetus (such as a breech presentation), and complications during labor.
Many doctors believe these reproductive complications most often occur when fibroids change the shape of the uterine cavity. Thus fibroids on the inside the uterus (submucous fibroids) which distort the uterine lining should be removed.
In general, fibroids only need to be treated if they are causing symptoms or affecting a woman’s fertility or ability to carry a pregnancy. Treatment for uterine fibroids should be based on a woman’s medical history, surgical history and goals of therapy.
Fibroids can generally be felt by your doctor during a general gynecological examination, however diagnosis is made based on imaging tests such ultrasound, MRI (magnetic resonance imagery), and CT (computed tomography). Currently, ultrasound is the most common method used to diagnose uterine fibroids, but MRI may prove more useful because it can often distinguish fibroids from other growths in the uterus.
In patients experiencing menorrhagia (profuse and/or prolonged menstrual flow) or recurrent pregnancy losses, careful examination of the uterine cavity is important because the presence of a submucous fibroid can be missed on traditional ultrasound.
Hysterosalpingography, sonohysterography, and hysteroscopy are used to diagnose fibroids inside the uterus. Hysterosalpingography and sonohysterography use X-ray pictures and ultrasound pictures, respectively, to visualize the uterine cavity after fluid is injected into the uterus. Hysteroscopy allows your physician to look inside the uterine cavity by inserting a small camera on the end of a long tube (hysteroscope) into the uterus through the vagina and cervix.