How to Identify and Treat Fibroid Pain

Uterine fibroids (also called leiomyomas or simply myomas) are the most common gynecological condition, affecting up to 70% of women by the time they are 50 years old. Fibroids cause pain in some people, but not everyone who has fibroids will experience pain. Researchers estimate that 30% of women will seek treatment for fibroids because of pain and other symptoms.

Here is an overview of what you should know about getting treatment for painful fibroids.

What Are Fibroids?

A fibroid is a tumor made of muscle fibers that can develop in different areas of the uterus. Fibroids can be as small as a grain of rice or bigger than a baseball. A fibroid's size and location can affect how much pain it causes.

Large fibroids that obstruct the bladder or bowel can produce pelvic pressure and pain that may radiate down the back or legs. Fibroids can also compress or irritate a nerve, causing abdominal pain. A uterus that is enlarged by fibroids will also be heavier, and can produce pelvic pressure, pain, and bloating.

Pedunculated fibroids (which grow from the outer uterus on a stalk) may get twisted during sudden movements and can cause severe pain.

Fibroid Symptoms

Fibroids can be symptomatic or cause no symptoms (asymptomatic). A person with fibroids might experience symptoms related to fertility, bowel and bladder function, and menstrual bleeding, as well as abdominal, pelvic, and other types of pain.

It was long believed that fibroids could increase the chance of miscarriage because of how the tumors can distort the shape or size of the womb, and affect embryo implantation or uterine contractions.

However, a high-quality study published in 2017 challenged that belief, as it found that the presence of fibroids did not increase the chance of miscarriage.

Depending on their location and size, fibroids can also produce bowel or bladder symptoms, such as diarrhea, constipation, and urinary retention or urgency.

Even small fibroids, and particularly submucosal fibroids (which grow just beneath the uterine lining), can cause changes in menstrual bleeding, including heavy or excessive bleeding (menorrhagia) that may lead to anemia; midcycle bleeding; prolonged bleeding; frequent periods; and irregular periods.

The location and size of the fibroids will impact the type of pain a person has. For example, fibroids on the back of the uterus may put pressure on the rectum and cause pain during bowel movements. Fibroids that irritate pelvic nerves may cause radiating pain down the legs.

There are other pain-related symptoms that are associated with fibroids. A person with a fibroid may experience:

• Pain midcycle, after, or during menstrual bleeding
• Pain during sex (dyspareunia)
• Lower back pain
• Radiating leg pain
• Sudden, severe pelvic pain
• Abdominal bloating
• Pressure on the bladder
• Chronic pelvic pain

Diagnosing Fibroids

The first step in addressing fibroid pain and other symptoms is to make an appointment with your gynecologist. They will need to rule out other possible conditions that could be causing your pain, such as endometriosis and adenomyosis. These conditions, which have symptoms that overlap with fibroids, can only be definitively diagnosed from surgery with biopsy and pathology.

To definitively diagnose you with fibroids, your doctor will consider your personal health history, symptom profile, and family history. They might use imaging tests, such as transabdominal or transvaginal ultrasounds, as well.

Managing Fibroid Pain

Pain caused by fibroids can significantly affect a person's quality of life. In one study, over half of the participants with fibroids reported that their symptoms negatively impacted their life, including their sexual life, performance at work, and relationships and family.

It's important to talk to your doctor about medical treatment for fibroids. There are also some things you can try on your own that might help you manage your symptoms.

Home Remedies and Lifestyle

There is not much evidence to support home remedies specifically for fibroid pain, but you might find that they offer some relief.

Stretching, gentle yoga, meditation, and mindfulness may help you manage your fibroid pain, but not because the techniques alter or cure your fibroids. Instead, these methods can help change your perception of pain (through meditation). They can also help you correct muscle imbalances that developed because you have chronic pelvic pain (which you can do through stretching and yoga).

Adopting a healthy diet and engaging in frequent low-impact exercise can promote your overall health and may help you feel better. Communicating about your pain to people you trust can also help you cope.

Over-the-Counter (OTC) Therapies

Over-the-counter (OTC) medications and therapies may help you manage your fibroid pain. Your doctor may recommend acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs, like aspirin, ibuprofen, naproxen), which you can buy at your local drugstore.

These medications won't treat your fibroids, but they might reduce your pain enough for you to carry on with your daily activities.

Iron Supplements

Your doctor may also recommend iron supplements if your fibroids cause heavy menstrual bleeding that has led to anemia.

While you can buy iron supplements without a prescription, you should take them only if your doctor tells you to, as there are side effects of iron supplementation. When iron supplements are taken under the guidance of your doctor to address anemia, you may feel more energized and stronger, and some of your pain may improve.

TENS Units

TENS (transcutaneous electrical nerve stimulation) machines can also be bought at a pharmacy and have been shown to reduce pelvic pain for some people.

Using a TENS unit involves placing electrodes on your abdomen. Through a battery-controlled unit, you can adjust the intensity of mild electrical impulses. Research indicates that TENS machines are effective at reducing pain caused by primary dysmenorrhea (menstrual pain), which many people with fibroids experience.

Complementary and Alternative Medicine (CAM)

You might choose to explore complementary and alternative medicine (CAM) to treat fibroids and the pain they cause. Of CAM techniques, the ones with the most evidence to support them are acupuncture and herbs from traditional Chinese medicine.

Acupuncture

Acupuncture involves a licensed practitioner sticking very thin needles into specific acupuncture points along your body that correspond with meridians or energy channels. The science of how acupuncture works is not fully understood, but theories include the release of endorphins and regulation of the autonomic nervous system to help regulate the pain response.

There is a lot of evidence to support the efficacy of acupuncture in treating gynecological conditions, but there is limited evidence specifically on acupuncture as a treatment for fibroids.

Currently, a systematic review (the highest level of research) is underway to assess the usefulness of acupuncture for fibroid pain.

Chinese Herbal Medicine

Current research evidence neither supports nor refutes the use of Chinese herbal medicine for fibroids. Most studies have focused on the impact of herbs on fibroid size and volume, rather than on a person's pain.

Medical Treatment

The two primary medical treatments for fibroids are medication and surgery. You will need to discuss your options with your doctor to figure out which treatment is the best fit for you.

Prescription medications are primarily used to manage symptoms, but they can have significant side effects. Surgery to remove fibroids does not always solve the problem permanently, as fibroids can come back. Procedures involving the reproductive organs can also impact fertility.

Both options have limitations and considerations, but if you have fibroid pain that is impacting your life, don't delay discussing treatment with your doctor.

Prescriptions

There are prescription medications that can help treat some of the symptoms of fibroids, including pain and heavy menstrual bleeding. Examples of medications prescribed to people with fibroids are antifibrinolytic agents (such as tranexamic acid) or oral contraceptive pills or intrauterine devices such as Mirena.

Medications may alleviate symptoms in some people, but they have side effects. Plus, they do not shrink the actual fibroids. In fact, progesterone-based contraceptives, such as the Mirena, may actually lead to the proliferation of fibroid cells.

GnRH Agonists

GnRH agonists and antagonists can shrink uterine and fibroid size, as well as reduce menstrual bleeding. However, GnRH agonists come with potentially severe menopausal symptoms and lifelong side effects, including bone density loss.

GnRH agonists can also be taken for only three to six months at a time, and fibroids can rapidly regrow after cessation.

Some doctors recommend treatment with a GnRH agonist, such as Lupron, before surgery to help reduce fibroid size. However, other doctors argue that giving patients these medications before surgery may shrink small fibroids so much that they are missed during the procedure, leading to symptom continuation and the need for additional invasive surgeries in the future.

Procedures

Fibroids cause pain through their bulk and weight, or by pressing on other organs and nerves. The only way to completely remove a fibroid is with surgery. There are a few surgeries and procedures that your doctor may recommend.

• Hysterectomy: A hysterectomy is the surgical removal of the uterus. It is the definitive treatment for fibroids and can be performed laparoscopically. It also carries the lowest risk for needing future surgeries. However, a hysterectomy should be done only if the person does not want to have children.
• Myomectomy: A myomectomy is the surgical removal of fibroids. It used to require a large abdominal incision, but now it can be done laparoscopically. While a laparoscopic myomectomy is less invasive and comes with a shorter recovery time for patients, it's more challenging for surgeons. A myomectomy is the preferred surgical treatment for people who hope to have children. However, additional surgeries because of fibroid recurrence are required 20% to 30% of the time.
• Uterine artery embolization (UAE): UAE is a nonsurgical but still somewhat invasive procedure that is done in a doctor's office with intravenous pain relief. During UAE, a groin catheter is inserted, which sprays small particles to permanently limit blood flow to the uterus. Over a few months, this shrinks fibroids and will reduce pain, pressure, and cramping. UAE is not recommended for people who wish to become pregnant, although some pregnancies have occurred after UAE. About 15% to 32% of people who have UAE will require further surgeries.
• High-frequency magnetic resonance–guided focused ultrasound: This procedure is a thermal ablation technique that is directed at the fibroid, which uses heat to cause the death of the tissue. It is a newer technique that is expensive and not widely used. There is also no definitive evidence about the procedure's effect on fertility.

Frequently Asked Questions

What does fibroid pain during pregnancy feel like?

It is possible to have fibroids during pregnancy, either inside your uterus with the fetus or on the outside of your uterus. The experience of fibroid pain during pregnancy will be different for each person.

In rare cases, red degeneration may occur. Red degeneration refers to spontaneous hemorrhagic infarction (blockage of blood supply) of a fibroid. It occurs in about 3% of cases and is more common during pregnancy. The pain has been described as sharp, severe, and constant abdominal pain.

How long does fibroid pain last?

Fibroid pain lasts a different amount of time for every person, depending on the location and size of the fibroid. Some people develop chronic pelvic pain because of their fibroids and experience pain all month long. Some people may have worse pain during their menstrual periods.

Some people experience a sudden, sharp, shooting pain that is caused by the twisted stalk of a pedunculated fibroid. The pain may go away once they change position, or in some cases require an emergency room visit and myomectomy.

Where is fibroid pain located?

Like all other symptoms of fibroids, the location of the pain depends on multiple factors such as your individual anatomy and the location and size of your fibroid.

Many people feel pelvic pain, pressure, and heaviness where their uterus is. A fibroid that obstructs your bladder or bowel may cause pain in these areas during bowel movements or urination. Fibroids that compress nerves can also cause referred pain to other areas of the body, such as pain that radiates across your back or down your legs.

A Word From Verywell

Fibroids are the most common gynecological disorder, but your experience will be unique. If you are having pelvic pain, abdominal pressure and heaviness, irregular and heavy menstrual bleeding, or bowel and bladder symptoms, talk to your doctor.

Your doctor can look at your health history and perform imaging techniques to diagnose fibroids, and provide you with treatment options. It is important that you receive full informed consent when discussing your medical treatment options.

This includes making sure you understand the short- and long-term side effects. It also means that you consider your family planning goals, your values, and how your symptoms are impacting your life.

While you are waiting for surgery, if you have recurrence after surgery, or if you prefer not to have surgery, there are home remedies and lifestyle changes that might help you cope with fibroid pain.

Acupuncture and Chinese medicinal herbs are actively being studied as treatments for fibroid pain, but there is no definitive evidence of their effectiveness as of yet. Meditation, stretching, talk therapy, yoga, low-impact exercise, OTC medicines, TENS machines, and a healthy diet can help improve your overall wellness, which might help you cope better with living with fibroids.