Ask an Expert: How Can I Manage Uterine Fibroid Pain?

About three quarters of all women will experience uterine fibroids—growths in the muscular walls of the uterus. In many of these women, fibroids may not cause any problems at all. But others experience symptoms like painful cramps and heavy bleeding during periods that significantly interfere with daily life.

In some cases, the cramps that occur with fibroids cause pain in the lower back rather than in the lower abdomen, and may feel like a strained muscle. Some people have pain during sex because of fibroids.

Because fibroids tend to grow, a person who didn’t have symptoms initially may slowly start experiencing them. Cramps that were once "normal" and easy enough to cope with may become awful. But the change can happen so gradually people with fibroids just get used to the additional pain.

Fibroids usually start to shrink during menopause, which means that cramps may become less painful and then disappear completely when periods stop. But if you're experiencing pain now and menopause is not in your immediate future, how can you feel better in the meantime? Jessica Shepherd, MD, Chief Medical Officer of Verywell Health, discusses ways to manage painful cramps and the other discomforts caused by fibroids.

Verywell Health: Why do fibroids sometimes cause painful cramping?

Dr. Shepherd: Each month, a lining of tissue builds up in the uterus that then breaks down and is excreted in the form of menstrual flow. To help expel this blood and tissue, the levels of hormones called prostaglandins cause the uterus to contract. That is the cramping that most people feel during their cycle. Prostaglandins are involved in pain and inflammation and increase the amount of pain people feel.

When fibroids are present, more of this uterine lining forms. As a result, the uterus must contract more, and the cramps are more severe. The prostaglandins set up an inflammatory process.

Verywell Health: How do people with fibroids describe their pain? Is the pain of fibroids similar in most women who have them?

Dr. Shepherd: Pain is very subjective. No two people will feel pain from fibroids in the same way. Some cramps are felt low down in the pelvis while others are felt as lower back pain.

It's important to remember even though pain is subjective, it shouldn't be downplayed. Historically, there's been a perception in the medical community that Black women don’t feel as much pain as White women. Yet we know from research that Black women usually have bigger fibroids and heavier bleeding. The bigger the fibroid, the heavier the bleeding. This equates to more significant pain during cycles.

Verywell Health: What type of medications are safe to treat fibroid pain?

Dr. Shepherd: There are lots of different management tracks that healthcare providers may prescribe to fibroid patients.

Over-the-counter pain relievers like aspirin, ibuprofen (Advil or Motrin), acetaminophen (Tylenol), or naproxen (Aleve) can help many people with fibroid pain. Ibuprofen can inhibit the inflammatory cycle. If you can start taking that right at the beginning of menstruation, it can decrease the pain.

Hormonal types of birth control can be used to treat the pain of fibroids too. If you manipulate the body’s hormones so that there is less bleeding, then there should be less pain. If there is less for the uterus to excrete, then there should be less cramping.

More recently, medications called gonadotropin-releasing hormone antagonists (also called GnRH antagonists) are being used to treat fibroids. These drugs work by temporarily blocking the body from making hormones that cause buildup in the lining of the uterus.

GnRH antagonists cause the body to go into a state similar to menopause, which shrinks the fibroids. However, the fibroids start to grow again when the patient stops taking the medication. 

Verywell Health: Are there any home remedies that can help?

Dr. Shepherd: Yes. One method that is commonly used is a hot water bottle. Heat can be very helpful on the abdomen, or on the lower back if that is where the pain is.

Verywell Health: What about surgery for fibroids? When should that be considered?

Dr. Shepherd: If fibroids are causing extremely bad bleeding and cramps, and if medications are not helping, there are several surgical procedures that patients can consider with their doctors. These range from a minimally invasive procedure called radiofrequency ablation, which shrinks fibroids, to a hysterectomy, which removes the uterus completely. A procedure to remove fibroids falls somewhere in the middle, and is called a myomectomy.

Many women want to avoid a hysterectomy because it means the loss of their fertility. Ultimately, treatment is an individual choice. Factors like number of fibroids, their size, and where they are located will influence your treatment options.

Interview conducted by Valerie DeBenedette, health writer.