Uterine Fibroids – Pain in Pelvis, Lower back and Legs

Uterine fibroids are non-cancerous growths in the muscular tissue of the uterus which may vary in size, location, and shape. These benign lesions are also called Leiomyomas. Prolonged, painful periods are one of the most commonly associated symptoms with Fibroid Uterus.

Location of pain

The pain due to uterine fibroids is generally felt in the pelvis, lower back, and legs.

Duration of pain

The pain usually lasts throughout the menstrual period.

Symptoms

Most females with fibroid uterus remain asymptomatic, however, larger fibroids may cause a variety of symptoms, some of which include:

  • Prolonged, heavy bleeding during your period
  • Intermenstrual bleeding
  • Dysmenorrhea and a feeling of fullness in the lower abdomen
  • Dyspareunia is pain during sex
  • Pain in the lower back and legs
  • Anemia due to excessive blood loss
  • Abnormal vaginal discharge
  • Abdominal distension
  • Constipation
  • Urinary incontinence and frequent urination

Types of Fibroids

Fibroids are further classified into two types on the basis of their location, shape, and size:

  • Submucosal: Lie on the mucosa and are present inside the uterine cavity. It may be pedunculated (joined by a stalk) or non-pedunculated.
  • Subserosal: Extend from the uterine wall into the pelvic cavity. May be pedunculated or non-pedunculated
  • Intramural: These are located in the muscular tissue of the uterus.
  • Cervical: These lie on the cervix. If pedunculated they may hang in the vagina and are then called a vaginal fibroid.

Causes of uterine fibroids

The exact cause of why fibroids may develop in the uterus is still unknown. However, some of the suggested theories are:

  • Hormonal: Progesterone and estrogen are responsible for an increase in the thickness of the endometrium during the menstrual cycle and may also affect fibroid growth. This also explains the shrinkage of fibroids after menopause.
  • Other growth factors: Several other growth factors in our body such as insulin-like growth factors may also promote tissue growth.
  • Extracellular matrix: Fibroids have higher levels of the extracellular matrix which allows them to hold growth factors for longer durations thus, causing an increase in their size.
  • Genetic causes: Fibroids follow a pattern of inheritance and thus may have genetic associations as well.

Risk factors

There are several risk factors that may make a female prone to develop fibroids:

  • Obesity
  • The age group of the 30s and 40s
  • Females who had early menarche or late menopause
  • Nulliparous women
  • Sedentary lifestyle
  • A family history of fibroids

Complications associated with Uterine Fibroids

  • Excessive bleeding during menstruation may lead to anemic conditions.
  • Large fibroids that extend in the uterine cavity may interfere with the implantation of a zygote and thus make it hard for the female to conceive.
  • Increased risk of miscarriage.

Uterine fibroids and cancer

Fibroids are benign lesions and rarely develop into cancer. Only 1 in 1000 females may develop a cancerous condition called leiomyosarcoma. However, doctors believe that leiomyosarcoma is an entirely different condition and does not arise from an existing fibroid (leiomyoma).

Diagnosis

Diagnosis of the fibroid uterus is made after conducting a series of tests:

  • Beginning with a detailed history of symptoms given by the patient.
  • Pelvic examination
  • Ultrasound of the pelvis can help in early detection.
  • Hysteroscopy is done to determine the size and location of submucosal fibroids.
  • Laparoscopy is done for fibroids located outside the uterus.
  • Medical resonance imaging gives detailed information regarding fibroids.
  • CT Scan is another test to formulate a definite diagnosis.

Treatment

Uterine fibroid is managed medically as well as surgically depending upon the severity of symptoms experienced by the patient.

Medical treatment:

  • Birth control pills are employed to control heavy menstrual bleeding and dysmenorrhea associated with the fibroid uterus.
  • An intrauterine device is another option that may help reduce heavy menstrual bleeding and also provide contraception.
  • Anemia is managed by giving iron supplements.
  • Gonadotrophin-releasing hormone agonists are given before surgical intervention, they shrink a fibroid before surgery, which allows its easy removal.

Surgical treatment:

There are a number of surgical options available for fibroid removal. Size, location, number of fibroids, and desire to convince affects the choice of surgery. Therefore, the surgical options available are as follows:

  • Myomectomy: This method involves the removal of fibroid without causing any damage to the uterus and allowing the patient to conceive in the future.
  • Laparoscopy: Fibroids that lie on the outer walls of the uterus are removed by this procedure.
  • Hysteroscopy: A scope is inserted into the uterine cavity through the vagina which will cut away the fibroids that are located inside the uterus.
  • Radiofrequency ablation: This is an effective method for ablation of symptomatic Fibroids using radio-waves.
  • Embolization of uterine fibroids: The blood flow towards uterine fibroids is blocked which results in shrinkage of fibroids and thus relieving the symptoms.
  • Hysterectomy: For people who have completed their families and do not wish to conceive in the future, hysterectomy is the best option available as this relieves the symptoms completely and there are no chances of recurrence.

When to consult a doctor?

Most females with fibroids remain asymptomatic throughout their life. However, for some, the symptoms may begin to worsen at some point in life and require medical intervention as soon as possible. Some of the conditions which require immediate medical attention are:

  • Fibroids that cause excessive bleeding
  • A rapid increase in growth of the mass
  • Debilitating pelvic pain
  • Bleeding in between consecutive periods
  • Development of pressure symptoms like urinary incontinence and constipation.

FAQ

What happens when Fibroids go untreated?

Fibroids don’t require treatment if they are asymptomatic. However, symptomatic fibroids may cause infertility.

What size of Fibroids is dangerous?

Fibroids larger than 10 cm are known to distort the shape of the uterus and are potentially dangerous as they begin to cause symptoms.

Are Fibroids a type of cancer?

No, Fibroids are benign lesions and rarely develop into cancers.