Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Part 2 of 9 in Benign Growth in Uterus Causing Gynaecological Problems
What Are Uterine Fibroids? Risk Factors and Symptoms
August 25, 2024
Fibroids are not cancer. They are rounded growths on or inside the uterus, and among the most common problems seen in young women. Risk factors include high hormone levels, an age range of 30 to 40 years, obesity, high blood pressure, and a family history of fibroids.
How fibroids present
Patients most commonly present with a growing lower abdomen or a palpable mass, constipation from pressure on the bowel, or burning and throbbing pain during intercourse. Anaemia from chronic blood loss is a common complaint, along with urinary or bowel symptoms depending on which direction the fibroid is growing. Fibroids can also cause infertility by blocking the fallopian tubes or distorting the uterine cavity so an embryo can't implant, and during pregnancy they can raise the risk of miscarriage, preterm labour and heavy bleeding after delivery.
Why the throbbing, burning pain happens
One doctor asked directly, live during the session, how fibroids cause the throbbing and burning pain some patients report during urination, and whether it predisposes them to UTIs. Dr. Lal's answer: since the bladder sits anterior to the uterus, a fibroid growing on the front surface of the uterus can press into and separate the bladder, causing difficulty passing urine and the resulting pain sensation.
This article is based on a Jivo Masterclass session conducted by Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a gynaecology consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Suman Lal taught doctors across Africa on August 25, 2024.
FROM THE LIVE Q&A
Moderator
What are some of the symptoms of a high-risk pregnancy if it can be detected only with the fibroid?
Dr. Suman Lal
Pelvic pain out of proportion to a normal pregnancy, urinary symptoms from an anterior fibroid pressing on the bladder, rectal or pelvic pressure from a posterior fibroid, and localised pain when the uterus is touched, which often signals degeneration within the fibroid. Any of these should prompt an ultrasound.
Frequently Asked Questions
How exactly do fibroids cause throbbing and burning pain during urination, and does it predispose patients to UTIs?▼
Since the bladder sits anterior to the uterus, a fibroid growing on the front surface of the uterus can press into and separate the bladder, causing difficulty passing urine and the resulting pain sensation.
Can tranexamic acid be used in treatment, like reducing the size of a myoma?▼
No. Tranexamic acid doesn't reduce the size of a fibroid. It works by promoting clot formation, so it reduces heavy bleeding caused by a fibroid, but has no effect on the fibroid's size.
How far can progesterone hormone reduce the size of a fibroid?▼
Progesterone reduces fibroid size by only around 20%. It's given to women waiting for surgery or unable to have surgery who have heavy bleeding, not routinely to patients without symptoms.
What is the management of fibroids using medication without surgery, and what are the possibilities?▼
If bleeding is heavy and the fibroid isn't inside the cavity, medical management with painkillers, oral contraceptive pills, and GnRH agonist injections is possible. GnRH injections reduce fibroid size but the effect reverses within six months to a year of stopping, so medical management is generally a one-to-two year bridge, not a permanent solution, and is most useful pre-menopause, pre-surgery, or pre-pregnancy attempts.
What is the role of the gonadotropin agonists used in India, Lupron and Goserelin?▼
Both are effective at reducing fibroid size, by around 40-50%. Different centres use different ones, but either can be used.
What are the risk factors for uterine fibroids?▼
High hormone levels, age 30-40 years, obesity, high blood pressure, and a family history of fibroids.
Why do fibroids cause burning pain during urination?▼
A fibroid on the front (anterior) surface of the uterus, next to the bladder, can press into and separate the bladder, causing difficulty passing urine and the resulting pain.
In This Series: Benign Growth in Uterus Causing Gynaecological Problems
- 1.Uterine Fibroids
- 2.What Are Uterine Fibroids? Risk Factors and Symptoms
- 3.Diagnosing and Classifying Fibroids by Location
- 4.Fibroids, Fertility, Pregnancy Risk and Menstrual Pain
- 5.Medical Management: Painkillers, Progesterone and GnRH Agonists
- 6.Uterine Artery Embolization: When It Works and When It's Contraindicated
- 7.Surgical Removal: Hysteroscopic, Laparoscopic and Robotic Myomectomy
- 8.Beyond Fibroids: PCOS, Endometriosis and Infertility
- 9.Preventing Adhesions After Myomectomy: What Actually Works