Signs of Fibroids Breaking Down and What to Do

Fibroids, also called leiomyomas, are benign (noncancerous) tumors that grow inside or on the outer wall of the uterus. Up to 80% of people with uteruses will develop fibroids by the age of 50.

Fibroid degeneration is the breakdown of a fibroid through cell death. This is caused by ischemia (a lack of adequate blood supply) in the fibroid.

This ischemia is usually the result of a fibroid growing too large for its blood supply, but it can also be caused by mechanical compression (blockage) of the feeder arteries.

Fibroid degeneration can occur during pregnancy when the growth of the pregnancy compromises the blood supply of the fibroid, or when a pedunculated fibroid (a fibroid attached by a thin stalk to the uterus) becomes twisted (torsion) and cuts off the fibroid's blood supply.

Degeneration or secondary changes can be found in 65% of uterine fibroids.

Close-Up of a woman laying on a couch, holding her pelvis in pain.


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Types of Degenerating Fibroids

The type of degeneration appears to depend on the degree and rapidity of onset of the vascular insufficiency (lack of adequate blood supply).

Types of degenerating fibroids include:

Hyaline Degeneration

  • Accounts for 63% of cases
  • The fibroid’s normal connective tissue and smooth muscle fibers are replaced by hyaline tissue (the most common type of cartilage, which has a glossy and smooth appearance)
  • Caused by a fibroid outgrowing its blood supply

Myxoid Degeneration

  • Accounts for 19% of cases
  • Gelatinous appearance (looks like it's melting) under a microscope
  • Has clear and mucus-like connective tissue
  • No mitotic activity (its cells are not dividing and growing as normal cells do)
  • Can have similar features as some leiomyosarcomas (rare cancer), so it is important that a pathologist takes the time to make the distinctions between the different types of fibroid degenerations

Calcification

  • Accounts for 8% of cases
  • Calcium deposits form when a fibroid is dying
  • Transforms some of the tissue into a hard mass

Cystic Degeneration

  • Accounts for 4% of cases
  • Seen more often after menopause
  • Presents in a liquid, honeycomb pattern under a microscope
  • May mimic an ovarian cyst

Red Degeneration

  • Accounts for 3% of cases
  • Also called "carneous"
  • Usually occurs during pregnancy, but can happen in people who are not pregnant, particularly those using contraceptive drugs
  • Turns almost completely red due to massive internal hemorrhaging (bleeding)
  • Usually from a ruptured blood vessel inside the fibroid
  • Fibroid degeneration during pregnancy is called necrobiosis
  • Fibroids occur in up to 12.5% of all pregnancies
  • Can cause abnormal bleeding and severe abdominal pain
  • Can be caused by fibroid tissue outgrowing its blood supply
  • Can be caused by the growing uterus causing distortion and kinking of the blood vessels, interfering with the blood supply to the fibroid
  • Pain may also be caused by the prostaglandins (hormones that influence pain levels and inflammation) produced by damage to the cells in the fibroid

Pedunculated fibroids (fibroids attached to the uterus by a thin stalk) are more prone to degeneration because they can become twisted and cut off the blood supply to the fibroid. They can be more painful and last longer than regular degeneration.

Symptoms 

Typical symptoms of fibroids can include:

  • Menstrual periods lasting longer than seven days
  • More frequent menstrual periods
  • Heavier than normal bleeding during menstrual period
  • Painful menstrual periods
  • Irregular bleeding between periods
  • Pelvic pain
  • Abdominal pain
  • Sudden or severe abdominal pain
  • Abdominal bloating and/or cramping
  • A feeling of fullness or heaviness in the pelvis/lower abdomen
  • Fever
  • Pain during sex
  • Lower back and/or thigh pain
  • Anemia
  • Urinary incontinence
  • Frequent urination
  • Difficulty urinating or other bladder symptoms
  • Constipation
  • Rectal pressure
  • Difficulty with bowel movements, or other bowel symptoms

In addition to the symptoms of fibroids, signs that fibroids may be degenerating include:

  • Acute pain: Most common symptom. A sharp pain in the abdomen that may be accompanied by swelling. May be acute pelvic pain focused on the site of the fibroid. Can last from a few days to a few weeks.
  • Chronic pain: Less severe, lasting pelvic pain
  • Fever: Often during pregnancy. May be mild.
  • Bleeding: May be severe. Seek immediate care for abnormally heavy bleeding, including during menstrual periods.
  • Temporary elevation in the white blood cell count

Are Fibroids Always Symptomatic?

Fibroids do not always cause symptoms. Many people with fibroids experience few or no symptoms and may not realize they have fibroids. It is possible for degenerating fibroids to also be asymptomatic, but they tend to cause more, and more severe, symptoms than fibroids alone. For many people, degenerating fibroids are their first indication that they have fibroids at all.

Your Symptoms May Go Away

When a fibroid degenerates, it shrinks. Once it has reduced to a size that can once again be supported by its blood supply, it can stop degenerating. This often causes the pain to decrease or subside.

Though symptoms may have gone away, it is still important to see a healthcare professional and address the problem. Fibroids will begin to grow again once they start receiving adequate blood supply, and will eventually reach the point they start degenerating again, causing a painful cycle.

When to See a Doctor

Any symptoms of fibroids or degenerating fibroids warrant a visit to a healthcare provider. While fibroids themselves are not usually life-threatening, they can cause discomfort and complications such as anemia, and put stress on surrounding organs.

In addition to the fibroids themselves, symptoms of degenerating fibroids can mimic more serious conditions, and can also be harder to diagnose with imaging equipment.

Seek immediate medical attention if:

  • You have severe vaginal bleeding.
  • You have new or worse belly or pelvic pain.

Preventing Degeneration

The best way to prevent fibroids from degenerating is to treat the fibroids before they degenerate and take measures to stop them from recurring.

Fibroid Treatment

Treatment for fibroids and fibroid symptoms include:

Medications such as:

Surgeries such as:

  • Hysterectomy (removal of the uterus)
  • Myomectomy (removal of the fibroids)

Medical procedures such as:

  • Uterine fibroid embolization: A catheter is placed through the groin into the uterine artery, where small coils or pellets are released to block the blood supply to the fibroids.
  • Radiofrequency ablation: High-energy waves are used to generate heat that destroys fibroids.
  • Magnetic resonance imaging (MRI)–guided focused ultrasound: High-intensity ultrasound waves are used while the person is in an MRI scanner to heat and destroy the uterine fibroids.
  • Endometrial ablation: Heat is used to destroy the endometrium (the lining of the uterus).

Frequently Asked Questions

How long does fibroid degeneration take?

The pain from a degenerating fibroid can last from a few days to a few weeks, but everyone experiences fibroids differently.

It is still important to seek medical care after the symptoms subside, as fibroids are likely to grow and degenerate again.

How do you help fibroid degeneration pain?

In the short term, pain from a degenerating fibroid can be managed by taking an NSAID medication, such as ibuprofen (Advil, Motrin), or naproxen (Aleve).

For long-term, and often permanent, relief, the fibroids need to be treated and/or removed.

What happens to a fibroid after degeneration?

Fibroids shrink during degeneration until they are small enough to reestablish an adequate blood supply.

Once this happens, the fibroids begin to grow again until they get too big and start the process of degeneration again.

For this reason, it is important to seek medical care for degenerating fibroids, even if symptoms subside.

A Word From Verywell

Fibroid degeneration can be painful and may cause unpleasant symptoms, but it can be managed and even go away completely with treatment.

If you notice any signs of fibroids or fibroid degeneration, see your healthcare provider.

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11 Sources
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