Understanding Uterine Fibroids

March 7, 2023

Uterine fibroids are muscular tumors that grow in the wall of the uterus. Don’t let the word “tumor” scare you, though—fibroids are almost always non-cancerous! It’s estimated that uterine fibroids affect 80% of people with uteruses by the age of 50. While that number is quite high compared to other chronic pelvic pain conditions (endometriosis affects approximately 30% of vulva owners and adenomyosis about 20%), it’s possible that you have these benign bumps, but don’t know it since they often don’t show any signs or symptoms.

However, these tumors can grow quite large, causing pelvic pain and heavy periods. In fact, there are different types of fibroids, each with a unique set of symptoms dependent on where they grow in the uterus.

Different Types of Fibroids

Uterine fibroids may be medically referred to as leiomyomas, myomas, uterine myomas, or fibromas. There are four types of fibroids that have their own unique symptoms.

Intramural fibroids are the most common type of fibroid. They grow within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb and are more likely to cause painful bleeding.

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your uterus (or womb) appear bigger on one side.

Pedunculated fibroids Subserosal tumors can develop a stalk, or slender base that grows out from the surface of the uterus or into the uterine cavity that makes the tumor look like a mushroom. When they do, they’re known as pedunculated fibroids, which can cause pressure and constipation.

Submucosal fibroids are less common and develop in the middle muscle layer, or myometrium, of your uterus. May cause heavy menstrual bleeding and trouble conceiving.

What Causes Fibroids?

Like most other chronic pelvic pain conditions related to vulvovaginal health, the science is severely lacking and it’s unclear why fibroids develop. There are, however, several identified factors may influence their formation, namely hormone fluctuations, genetic predisposition, and whether or not you are or have been pregnant. Fibroids have been found to grow rapidly during pregnancy when hormone levels are high, and often shrink during menopause, or when anti-hormone medication is taken.

While chronic pelvic pain conditions don’t discriminate, and can affect anyone of any age, race, gender, or weight, people with periods are at greater risk for developing fibroids if they are pregnant, 30 years or older, African-American, at a higher body weight, or have a family history of fibroids.

Illustration of pelvic pain points of uterine fibroids on abdomen, pelvic region, and lower back

Pain Areas & Symptoms of Fibroids

Fibroid symptoms depend on the number of tumors one has as well as their location and size. If your tumor is very small, or you’re going through menopause, you may not experience any symptoms. In fact, fibroids can shrink during and after menopause when estrogen and progesterone levels drop. Common symptoms include:

heavy bleeding between or during your periods that includes blood clots
pain in the pelvis or lower back
increased menstrual cramping
increased urination
pain during intercourse
menstruation that lasts longer than usual
pressure or fullness in your lower abdomen
swelling or enlargement of the abdomen

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How Can I Diagnose Fibroids?

For a proper diagnosis, you’ll need to get a pelvic exam to check the condition, size, and shape of your uterus. You may need an ultrasound or pelvic MRI which allows your doctor to see if any fibroids are present and to help diagnose what type of fibroids you have. Once diagnosed, you have several treatment options, depending on pain points and severity.

You know your body best, so if and when you make an appointment with your doctor, be sure to advocate for yourself: be specific, don’t under-state your pain, and demand further testing if you think you need it. If you feel your doctor is not giving you the information you need to feel confident in your diagnosis, don’t be afraid to ask for a second opinion, and do your own research as well. The only real way to end the myth that fibroid symptoms are “normal” or "just period cramps" is to challenge the way things are done in the medical community. Don't be afraid to push for more research, more tests, and more answers. It’s likely going to be a long and frustrating process but you—and your reproductive and sexual health—are worth it.

Treatment Options for Fibroids

Lifestyle changes We always encourage evaluating your lifestyle and environment to see what you can control to live a balanced life and manage pain. A varied diet of whole foods fuels our bodies and regular movement promotes healthy blood flow and regeneration. Some people consider alternative treatments for their symptoms including physical exercise, diet changes, and even acupuncture, and herbal remedies for natural pain management.

Anti-Inflammatory Medication Analgesic painkillers (like ibuprofen) reduce blood flow during your period while relieving severe cramps, which can help you cope with the pain, but do nothing to prevent the disease from progressing.

Anti-hormonal Drugs Lowering estrogen and progesterone levels helps provide symptom relief and may help slow the growth of fibroids, but you should be wary of altering your natural hormonal balance.

Myolysis During a myolysis, a needle is inserted and the fibroids are destroyed by an electrical current or freezing method.

Uterine Fibroid Embolization (UFE)or Uterine Artery Embolization (UAE) Tiny plastic or gel particles are injected into the blood vessels, effectively blocking the blood supply to the fibroid and causing it to shrink. Studies suggest fibroids are not likely to grow back, but not all fibroids can be treated with UFE or UAE.

Radiofrequency Ablation Heat is applied directly to the fibroid to destroy the rogue tissue without harming surrounding normal uterine tissue. The fibroids remain inside the uterus but shrink in size.

Endometrial Ablation If you experience very heavy bleeding, you might want to consider endometrial ablation. The lining of the uterus is removed or destroyed with a laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. It sounds scary (boiling water?) but this procedure is usually considered minor surgery and can be done on an outpatient basis or even in a doctor's office. While complications can occur, they’re uncommon and most will have a speedy recovery. About halve of those who get an endometrial ablation will no longer menstruate and about 3 in 10 experience much lighter bleeding and cramps. However, you should only consider this surgery if you do not plan on having children.

Hysterectomy The only permanent cure for fibroids is getting a hysterectomy, which is the complete removal of the uterus. This is a major surgical intervention, however, and is only used as a last resort for people who do not plan to have children.

Myomectomy If you wish to remove your fibroids without permanently removing the healthy tissue of the uterus or wish to have children in the future, a myomectomy may be a better option. Just note that new fibroids can regrow and cause trouble later.

Meet the Fibroids Queen

Registered nurse, certified fitness coach, and fibroids advocate Phyllis Frempong (she/her) of @fibroidqueen shares her journey of her own diagnosis and helping others live their best beyond fibroids. Continue reading to learn more about early signs, symptom management, and how to improve your fibroid fitness with Phyllis.

What would you recommend to someone who is trying to find the source of their discomfort?

Through my journey with fibroids, I was able to find relief of my symptoms via a customized holistic regimen I created which entails fitness, yoga, and nutrition. I currently run fibroid fitness challenges where I coach women through their pain to find relief. I address sources of discomfort with a regimented diet change, pelvic floor exercises, and mindfulness techniques.

What products or methods have you used to help alleviate your pain?

Castor oil regimen, healing exercises, changing diet, mindset shift, warm packs, and massage.

How does chronic pain affect your day to day life?

It is no longer an issue for me with the regimen I created for myself. I get many people inquiring about how to deal with chronic pain due to fibroids everyday.

Can you speak to the diversity of symptoms/treatments for fibroids depending on where they are?

As a nurse, fitness-yoga coach, and one who has once suffered, I can speak to a wide range [of diversity], but the main triggers are bloating, painful cramps, anemia, and heavy bleeding. Depending on the person and location of their fibroids, I can get an idea of what symptoms they will experience. Those with intramural fibroids/inside the uterine cavity can have more pain and bleeding versus pedunculated fibroids, which can cause more pressure and constipation. There are a lot of different factors, but that is the basics of it.

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