Pelvic Pain Caused by Uterine Fibroids

Uterine fibroids can be a cause of women's pelvic pain. Uterine fibroids are abnormal tissue masses that grow in or on the wall of the uterus. While they are tumors of the muscle tissue, they are almost always benign, with less than one in 1,000 being cancerous. Having fibroids doesn't increase your risk of developing a cancerous fibroid or getting another form of cancer of the uterus. They are very common. About 70% of women will have had one by age 45, but most are small and have no symptoms. 

The cause of uterine fibroids is largely unknown though they occur more frequently in women in their 30s and 40s, especially those with a family history of fibroids. They are also more common in black women. A diet high in red meat and obesity may increase a woman's risk of developing uterine fibroids.

While some women never know they have fibroids, those who do have symptoms commonly experience:

• Pelvic pain
• Dysmenorrhea (painful menstrual period)
• Pain during sex
• Abnormally heavy menstrual flow
• Urinary urgency
• Low back pain
• Infertility (usually only in severe cases)

For some women, symptoms of uterine fibroids are mild and easily treated. For others, uterine fibroids cause chronic pelvic pain that can interfere with their quality of life.

Uterine fibroids can be detected by ultrasound, sometimes performed by filling the uterus with water (sonohysterogram). Other scans for uterine fibroids include x-rays, MRIs, and CT scans. Your doctor may also order a hysterosalpingogram, in which the uterus is filled with dye before x-rays are taken.

Sometimes, a more invasive procedure is required to accurately diagnose uterine fibroids. In a hysteroscopy, a scope with a small camera is inserted into the uterus. In a laparoscopy, it is inserted through a small incision in the abdomen. Each can be used to diagnose uterine fibroids, as well as to remove them.

If your uterine fibroids are problematic or if they cause chronic pelvic pain, you may receive any of the following:

• Pain medications such as over-the-counter or prescription NSAIDs can control mild to moderate pelvic pain caused by uterine fibroids.
• Gonadotropin-releasing hormone agonists (GnRHas) can sometimes shrink fibroids though fibroids may return again.
• Hormone treatments such as birth control pills or progesterone injections can decrease fibroid growth.
• Surgery, such as a myomectomy, hysterectomy, endometrial ablation or uterine fibroid embolization may be performed if other approaches are not effective. Myomectomy might be preferred over hysterectomy if you want to be able to become pregnant, but hysterectomy is regarded as the only true cure.
• Expectant management: If you are perimenopausal, your doctor may decide to watch and wait as fibroids often shrink in size after menopause.

The prognosis for pelvic pain caused by uterine fibroids is variable. Some women find that their pain can be controlled effectively with medications such as NSAIDs and/or hormonal treatments. In some women, however, surgery is the only option. While surgery is often very effective at treating uterine fibroids, some options (such as hysterectomy and endometrial ablation) may leave a woman infertile. If you are infertile due to fibroids alone, myomectomy can restore fertility about half of the time.

Uterine fibroids decrease in size and symptoms are usually diminished once menopause begins.