Dark skinned lady sitting cross legged on sofa in blue jeans grimacing with Uterine Fibroids Pain
19/01/2022 By AskAwayHealth

Benefits of Asking 7 Simple Questions About Painful Fibroids

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In my experience, one of the major problems of women who have painful fibroids is the absence of the right information. Understanding the condition and what is currently available to treat this condition can make a world of difference for many women with fibroids.

In this post, we’ve curated seven of the most common questions about uterine fibroids pain so that you can use these to speak with your primary care doctor or gynaecologist about your symptoms and treatment.

What are Uterine Fibroids?

Fibroids are benign growths of the womb muscle that affect one in 3 women worldwide.

Some interesting facts about fibroids:

  • They grow during your reproductive years but regress or diminish after menopause.
  • Fibroids can happen between menarche and menopause but are most common in women 35-49 years of age.
    • Many women who have fibroids do not have symptoms, so they do not even realize they have them and cause them no problems.
  • Thirdly, we are still not wholly sure WHY Fibroids happen. However, we know some situations that may increase your risk of developing fibroids:
    • being of African, Afro-Caribbean or African-American descent
    • eating few vegetables and lots of red meat
    • if close relatives like your mum and sister have fibroids
    • smoking and drinking excess quantities of alcohol (>14 U/week).

There’s a lot more to know about fibroids, so please check out the excellent playlist right here on our youtube channel.

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Do Fibroids Hurt?

 So while this may sound like a needless question given that we are talking about Painful Fibroids, the point is that not all fibroids are painful.

Several things can make fibroids painful, but not every woman will experience fibroid pain, and many do not even have symptoms from their fibroids.

To answer the question then: Not all Fibroids hurt, and those that can hurt do not do so all the time.

And that takes us nicely into discussing the features of fibroid pain.

Whether or not a fibroid is painful – and how bad the pain gets depends on many things like:

  • The type; that is: which part of the womb it is located
  • How big or small it is
  • How many fibroids are present
  • The natural growth of a fibroid

The more fibroids in the womb, then the more likely they can cause symptoms. However, let us look at the other factors in a bit more detail:

Growth

A fibroid is made of the same muscle as the womb. It relies on the blood supply to grow, but it begins to die when the Fibroid becomes too big for its blood supply.

 When that happens, it is called degeneration and the byproducts of fibroid degeneration (prostaglandins) cause pain in the abdomen and pelvis.

Location

If you have fibroids inside the womb, they can affect its shape, causing irregular menstrual bleeding and pain.

If the fibroids are outside the womb, they can press on organs like the bladder, rectum or the nerves around your spine. Doing so can cause pain or pressure in the abdomen, pelvis, and back.

Type

Subserosal fibroids grow under the outer layer of the womb. In this position, they can protrude outwards into the pelvis, pushing into or against nearby organs or tissues.

Intramural fibroids grow inside the wall of the womb. They can become very large and make the womb bulky so it exerts pressure on nearby organs.

Submucosal fibroids are the least common type. They grow under the womb lining (mucosa) and push into the womb’s inner cavity. They can make the womb lining irregular thus increasing the chance of irregular bleeding and pain. Doctors have found they are most often related to difficulties getting pregnant compared to the other types of fibroids.

Some fibroids located inside or outside the womb are painful because they are hanging by a stalk.  These are known as pedunculated fibroids.  If the stalk twists, it stops the blood supply to the fibroids, so the tissue dies, causing pain as it does so.

Do Small Fibroids Cause Pain?

We have seen that fibroids can cause pain.

Pain can happen by the bulk of the fibroid pressing on organs (or nerves) close by.

Uterine fibroids pain can also happen when they are degenerating.

Large fibroids are more likely to do so; however, small fibroids can also cause pain if they are pedunculated.

A small fibroid that is degenerating or located close to structures where they can cause pressure can also do the same.

What does Uterine Fibroids’ pain feel like?

Women with fibroid pain have different experiences.

For some, it can be mild or severe (comparisons to labour contractions included). Some women always have the pain (chronic pelvic pain), but it can be occasional (from time to time) for others.

It could be a dull ache or quite sharp, even stabbing.

Where

The pain often starts in the pelvis and lower abdomen but could travel down your leg.

You might experience discomfort in the abdomen when the heavy womb with a fibroid presses on the bowels or bladder.

Women with fibroids more often experience pressure on the bladder or inside the abdomen.

Many women often ask: can fibroids cause back pain?

Fibroids can most certainly cause back pain. Think of where fibroids are located.

There are large nerve networks all over the body and in the pelvis (and abdomen) where fibroids grow.

Therefore, if your fibroid presses on a nerve in your lower back area (spinal nerves), your legs, hips, and back could all be affected.

This is in addition to the heavy bulk of fibroids placing pressure on the ligaments and other tissues that make up the back.

Fibroids pressing on the lower part of your spine can cause similar pain to sciatica. If you have sciatica, there is a pain in your back that travels down your leg and into the foot.

Usually, sciatica happens because the sciatic nerve, the thickest nerve in humans is irritated.

The sciatic nerve travels from around your buttock on either side and continues all the way down into the leg and foot.

Very large fibroids or several smaller ones in that same area can result in similar pain.

Timing

If you have fibroids you may suffer more often from pain around the middle of your cycle. You may also get more pain during and after your menstrual period.

Pain during sex (dyspareunia) is a symptom that women with fibroids may have and it can be embarrassing to describe this. However, providing this to your doctor can be a helpful clue about the cause of your symptoms.

Doctor's gloved hand pointing at a woman's pelvis indicating where Painful Fibroids may be located

Does Fibroid Pain come and go?

Now we’ve looked at how fibroid pain can develop; it’s clear that fibroid pain may not be present all the time.

In other words, the pain symptoms can come and go.

In addition, certain activities trigger fibroid pain, including:

  •  during your periods
  •  when exercising
  •  opening your bowels
  •  while having sex

As fibroids grow, pain can develop because they are degenerating or, if they are pedunculated, have grown to the extent where their stalk begins to twist.

What does Fibroid Pain during Pregnancy feel like?

Many women with fibroids do not have any problems when they are pregnant. And yes – you can have fibroids and still fall pregnant.

Only a small percentage of women with fibroids do experience infertility – often related to the size and location of the fibroid.

However, while fibroids can co-exist with pregnancy, many women can have significant challenges:

  • Miscarriage
  • Preterm Labour
  • An abnormally placed placenta (placenta praevia); and premature separation of the placenta (placental abruption)
  • Bleeding after delivery (Postpartum bleeding/haemorrhage or PPH)
  • Breech birth
  • C-section birth
  • Death of the baby

Therefore careful monitoring throughout your pregnancy and during/after your delivery is essential to prevent, promptly identify these complications and treat them.

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Early Pregnancy (First Trimester)

At this stage of pregnancy, your estrogen levels are elevated. You also have a higher blood volume as your body prepares your womb to grow and carry your baby.

These two factors also affect any fibroid you have, making them grow larger.

Studies tell us that not all fibroids grow in pregnancy, but one out of 3 women will find their fibroids do increase in size when they are pregnant.

The changes in size affect both large and small fibroids – but usually not more than a quarter of their original size.

But what about pain? Abdominal cramps and pain commonly happen from fibroids when you are pregnant.

Studies tell us nearly 6 out of 10 pregnant women experience pain from their fibroids – from their abdomen, pelvis, lower back, buttocks, hips and legs.

Later Pregnancy (Second/Third Trimester)

At this stage of your pregnancy, your womb is growing larger as your baby grows within it. This means effects like pressure and challenge to the blood supply will affect the fibroid more.

As a result, pain is often reported from fibroids during later pregnancy.

Large fibroids can place pressure on the other organs within the pelvis and abdomen. If their position is on the back of the womb, they can place pressure on the nerves in the back (spinal nerves) leading to back and leg pain like sciatica.

If you have a pedunculated fibroid, it may have grown in your pregnancy. It can thus twist very suddenly causing severe sharp pain or cramps in your abdomen or pelvis. This is Fibroid Torsion and is an emergency requiring prompt medical attention.

Fibroid degeneration which we describe earlier can also happen in the latter part of your pregnancy. Here, larger fibroids (usually more than 5 cm) outgrow their blood supply. As a result, they degenerate/die while releasing by-products in large amounts. These by-products are prostaglandins. They are responsible for painful menstrual cramps, but also the contractions during labour.

What helps Fibroid Pain?

Fortunately, there are several measures you can take to help with uterine fibroids’ pain.

Short term measures to deal with acute pain include:

  • A heating pad or hot water bottle; a warm bath may also help relax your back muscles and soothe back pain
  • Changing position from sitting/standing to lying down
  • Over The Counter drugs like Paracetamol, Ibuprofen, Naproxen.

Medium-term, you could have hormone treatments including combined contraceptive drugs, hormone injections or sprays, more potent pain killers available only with a doctor’s prescription and uterine fibroid embolization, UFE.

UFE is a non-surgical method of removing fibroids by shrinking them after shutting off their oxygen supply. 

You can also learn about more of these methods in these videos on my playlist.

When it comes to more permanent approaches, surgical options you may consider are Myomectomy – cutting the Fibroid out of the womb; or Hysterectomy, which means the removal of the womb.

Surgeons holding a large fibroid just removed in an operating theatre to measure the size - both large and small sized fibroids can cause Fibroid Pain
Surgery to Remove Fibroids – Image Credit @Adobe Stock

Natural Pain Relief for Fibroids

Natural remedies are an essential aspect of Fibroids care and can be short, medium and long term.

Though we have limited studies, evidence suggests diet and micronutrients play a part in the development of Fibroids. Make sure you check out this video on my channel, where I talk extensively about natural fibroids remedies. However, to summarise:

  1. A healthy diet. We believe that your diet makes a difference in the growth of fibroids. In particular, cutting down foods high in sugars, carbohydrates and red meat. Taking more dairy products can also help improve micronutrients like calcium and magnesium levels. Low fat and high protein diets that are low in plant and animal oestrogen, in particular, may be helpful, as Oestrogen seems to play a role in developing fibroids.
  2. Vitamin D supplements can help if you have low vitamin D levels. A study of African-American women suggested that they are three times more likely than white women to develop Fibroids because, thanks to their genes, they produce less vitamin D.
  3. Stress. Studies show that being under stress makes you more likely to develop Fibroids. Stress reduction has multiple benefits – you relax more and may experience less impact of some symptoms; you may also find you rely less on drugs and some of their side effects. 1. Simply lying down and resting may relieve some of the symptoms. Add a pillow under your knees to take some pressure away from your back area for backache. 2. Try relaxation techniques such as relaxing your muscles and deep breathing. Yoga and Acupuncture can also help with managing stress and fibroid pain.
  4. As I’ve just mentioned, physical activity like Yoga and other types of exercise, including swimming, can help you maintain a healthy weight and prevent stress. Maintaining a healthy weight can also help control some of the pain from Fibroids.

What is the Best Pain Relief for Fibroids?

Unfortunately, there is no exact, perfect or single answer to this question (as you commonly find in medicine). 

Instead, you may find a method that seems to remove the pain but comes with several side effects or is only temporary. 

The method you choose may also depend on your age, whether you have kids or not. Often, it’s a combination of things. 

For example, if you are yet to start a family and not keen on surgery, using OTC pain medicines or the combined pill may be suitably combined with natural measures of healthy eating and keeping active.

For someone else, Acupuncture may do the trick in addition to Yoga or other forms of regular exercise.

The best pain relief for you is what works best, with minimal side effects, and you can use it for short or more extended periods depending on your needs. 

You can address this best with your doctor, and you may not get it right the first time, but please don’t give up.

Getting The Best Treatment for Fibroid Pain

Many women whose fibroids cause troublesome symptoms often feel as if no one is listening to their specific problems. Many times it feels as if the only option they have is surgery to remove the womb or the fibroids.

This is far from true – and if you suffer from Fibroids’ pain, please take make a list of the questions in this post you feel are most relevant when next you have a doctor’s appointment.

By discussing the available options, you and your doctor may be able to come up with a solution that best suits your needs.

Let us know in the comments section if you have questions related to painful fibroids.

More Reading:

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are reviewed by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

Image Credits @Canva

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