Fibroid pain during period

Free Yourself From Fibroid Pain

Compared to other women’s health issues, there is not a huge amount of research devoted to the study of uterine fibroids, probably because a fibroid is considered a benign growth. But don’t tell that to the women whose fibroids cause tremendous discomfort and excessive bleeding every month.

Benign as a fibroid might be as far as tumors go, the symptoms it can cause aren’t always so benign, especially around the time of menstruation.

Who’s affected by fibroids? Statistics show that at least 25 percent of all women have fibroids — and about one third of these women will experience pain and abnormal bleeding. The typical menstrual cycle lasts for three to seven days, starts off heavy, and gets lighter. Fibroids, however, can make your periods excessively heavy and longer lasting.

Signs that a fibroid or fibroids may be affecting your flow include bleeding for more than eight days with more than two to three days of heavy bleeding at the outset of your period, and having many blood clots in your flow. (If you haven’t yet been diagnosed with fibroids and experience this kind of heavy bleeding, see your doctor — fibroids are not the only cause of these symptoms.)

Fibroids’ Effects on Menstruation

Each month, your uterus goes through a cycle: It creates a thickened inner lining in case a pregnancy occurs. If pregnancy does not occur, your body sheds that lining — this is your period. But if you have fibroids within the uterine wall, or fibroids that protrude into the uterine cavity, more surface area is created. Consequently there is more thickened lining to shed when during your period. It’s not the size but the location of the fibroid, or fibroids, that has the most impact.

If your fibroids are big enough, you will feel a stronger sensation of pressure at the time of your period because of blood flow to the fibroids. Fibroids put more pressure on the uterine lining, also causing more bleeding and pain. In the days leading up to your period, you might feel more intense cramping as your uterus goes through its motions to force out the lining, and a stronger sensation of pressure when your period starts because of the heavier blood flow.

Besides heavier, longer periods, fibroids can cause bleeding at other times of the month, and all this blood loss can cause anemia — which occurs when you don’t have enough iron in your blood.

Ways to Ease Fibroid Pain

Your choice of treatment depends on the amount of bleeding and the level of pain you regularly experience.

  • Pain relief. Non-steroidal anti-inflammatory drugs, or NSAIDs, may help; popular choices include ibuprofen (Motrin and others) and combination products like Excedrin. These drugs are prostaglandin inhibitors — they cut down on the pain from cramps as they counter the production of chemicals called prostaglandins, which are produced naturally by the uterus for the contraction process that starts menstruation. You may also need to take an iron supplement to prevent or correct anemia.
  • Hormone therapy. Although it’s not clear what causes fibroids, they do seem to be affected by changes in hormone levels, particularly estrogen. When the estrogen level is high, like during pregnancy, fibroids may grow, and when it’s in decline, like at menopause, they often shrink. So your doctor may recommend hormone therapy that alters the production of estrogen.

    Birth control pills are often used to minimize the heavy bleeding and cramps that occur with fibroids, though they won’t reduce their size. Other hormone-based options to control heavy bleeding include progesterone-like injections (Depo-Provera) and an IUD that contains progesterone-like Mirena (levonorgestrel).

    Another class of drug, gonadotropin releasing hormone (GnRH) agonists such as Lupron (leuprolide), temporarily shrink fibroids. These drugs are often given before fibroids are surgically removed to reduce the risk of bleeding during surgery and to make surgery easier. In non-surgical situations, they are sometimes used to give you a break from heavy bleeding and a chance to recover from anemia. However, GnRH tricks your body into thinking you are in menopause, and it can have menopausal side effects like hot flashes and, over time, bone thinning, so it’s not a permanent solution, and is typically used for less than six months.

  • Other therapies. Some women have found fibroid relief from the low-tech application of heat on the abdomen and from complementary and alternative medicine approaches, like acupuncture.

The type of treatment you opt for will often depends on your age. If your symptoms are manageable with pain relief medication, you may decide to wait it out and not treat or remove the fibroids. If you are near menopause or premenopausal, strong medication that shuts down estrogen production may get you through until menopause officially starts and fibroids shrink on their own. But if you are younger, you may want to consider minimally invasive surgery or a new non-invasive procedure — focused ultrasound — that may help shrink a large percentage of fibroids and spare your reproductive organs.

March 1, 2011 — Women who sought treatment to relieve the pain, heavy bleeding, or other symptoms caused by uterine fibroids report a better quality of life after their procedure, a new study shows.

But several years after recovering from one of three different interventions — an abdominal hysterectomy, uterine artery embolization (UAE), or an MRI-guided focused ultrasound procedure, patients who had a hysterectomy said that, looking back, they might put off having that procedure almost two months longer than women who had the less invasive treatments.

That ranking, something doctors call a waiting trade-off, is a way to measure how long someone might opt to continue to live with their symptoms, rather than go through a procedure involving some discomfort, risk, and healing.

“Basically, we asked patients that knowing what they now know about the treatment that they had, how long would they put off having it?” says study researcher Fiona M. Fennessy, MD, MPH, a radiologist at Brigham and Women’s Hospital in Boston.

The 62 women in the study who had abdominal hysterectomies, in which the uterus is removed through an incision on the stomach, said they put off having that procedure an average of 21 weeks.

The 74 women who’d had a UAE, in which a catheter is threaded through the arteries to the fibroid and particles are injected that starve the fibroid of blood, said they’d put off having that procedure for about 14 weeks.

The 61 women who had an MRI-guided focused ultrasound procedure, in which a patient lies on an MRI table while ultrasound waves are used to pinpoint and destroy the fibroids, said they’d also wait an average of about 14 weeks.

The study will be published in the May issue of the journal Radiology.

“I think the study’s good because in some ways it quantifies for us kind of the risk-benefit analysis that patients do when we present them all the options for their fibroids,” says Catherine A. Sewell, MD, MPH, an assistant professor of gynecology and obstetrics and director of the Johns Hopkins Fibroid Center, in Baltimore.

“The results are pretty clear that people prefer to do the least invasive thing possible to get the biggest benefit,” says Sewell, who was not involved in the study. “And for most people, unless they’re really having a lot of trouble with their fibroids or have dealt with them for a long time, for most people, hysterectomy will be their last choice.”

Fibroids

Medically reviewed by Drugs.com. Last updated on Feb 6, 2019.

  • Health Guide
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  • Care Notes
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What Is It?

A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea to as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus.

About 30% of women older than 30 years have fibroids, and they usually appear between the ages of 35 and 45. Some women are more likely to get fibroids, including black women, women who have never been pregnant and women who have a mother or sister with fibroids.

The cause of fibroids is unknown. However, the female hormone estrogen seems to play a role in stimulating the growth of some fibroids.

Symptoms

Some women never realize that they have fibroids because they have no symptoms. In other women, uterine fibroids are discovered either during a routine gynecologic exam or during prenatal care.

When symptoms of fibroids occur, they can include:

  • Pelvic pain or pressure

  • Heavy menstrual bleeding

  • Bleeding or spotting between menstrual periods

  • Unusually frequent urination

  • Abdominal swelling

  • Low back pain during intercourse or during menstrual periods

  • Fatigue or low energy from heavy periods and excessive bleeding

  • Infertility, if the fibroids are blocking the fallopian tubes

  • Constipation

  • Repeated miscarriages

Diagnosis

Usually, a woman doesn’t realize that she has a fibroid until her gynecologist feels it during a pelvic exam. If your gynecologist thinks you have a fibroid, several tests can confirm the diagnosis:

  • Pelvic ultrasound — In this radiology test, a wand-like instrument will be moved over your lower abdomen or may be inserted in your vagina to view the uterus and other pelvic organs more closely. The instrument produces sound waves that create an image of your pelvic organs.

  • Hysterosalpingogram — In this X-ray procedure, a dye is injected into your uterus and fallopian tubes to outline any irregularities.

  • Hysteroscopy — During this procedure, a narrow instrument that looks like a telescope is inserted through your vagina into your uterus. This lets the doctor look for abnormal growths inside your uterus.

  • Laparoscopy — In this procedure, a thin tube-like instrument called a laparoscope is inserted through a small incision in your belly so the doctor can look inside the abdomen.

Expected Duration

The number of fibroids, their size and how fast they grow varies among women. Female hormones encourage fibroids to grow, so they continue growing until menopause. Some fibroids shrink after menopause. However, larger fibroids may change little or become only slightly smaller in size. If a woman has had fibroids removed surgically, new fibroids can appear any time before she enters menopause.

Prevention

There are no proven measures you can take to prevent fibroids from developing. Studies show that athletic women seem to be less likely to develop fibroids than women who are obese or who don’t exercise.

Treatment

If fibroids are small and are not causing any symptoms, they do not need to be treated. Your gynecologist may do a pelvic examination every six months to a year to make sure that your fibroids are not growing rapidly. In some cases, medications can be prescribed to control any abnormal bleeding and temporarily shrink the fibroids.

Medications used to shrink fibroids, such as leuprolide (Lupron), create a temporary menopause by stopping the ovaries from making the female hormone estrogen. While estrogen levels drop and menstrual periods stop, menopausal hot flashes appear and fibroids stop growing and slowly shrink. This helps to stop blood loss from heavy, prolonged periods. However, when the medication is stopped periods return, hot flashes disappear and fibroids that have not been removed will start growing again. These medications usually are given by needle injection in a large muscle.

Fibroids may need to be removed if they cause significant symptoms or are large enough to interfere with fertility. Growths in your uterus also may need to be removed if it is difficult for your doctor to tell whether they are fibroids or cancer. There are several options for removing fibroids:

  • Myomectomy — This means cutting the fibroids from the uterine wall. Myomectomy allows a woman to keep her entire uterus in case she wants to have children. However, because this surgery can leave the uterine wall weakened, future babies may have to be delivered by Caesarean section. Surgery to remove fibroids sometimes can be done by laparoscopy, which is surgery through several small incisions in the lower abdomen. When fibroids are too large or too abundant to perform a laparoscopic procedure, then a traditional approach through a larger incision in the lower abdomen is preferred.

  • Hysteroscopic resection — In this procedure, a viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope are used to remove fibroids growing inside the uterus. This procedure sometimes is done in combination with laparoscopy, depending on the number and location of the fibroids.

  • Uterine artery embolization — In this X-ray-guided procedure, material is injected into specific blood vessels to plug them and stop blood flow to a fibroid or fibroids. It is an option for a woman who may not be medically cleared for surgery or who does not plan to have more children, but prefers not to have her uterus removed.

  • Hysterectomy — In this procedure the uterus is removed including all fibroids within it. Though other options are available to treat or remove fibroids and the patient’s needs and goals must be fully considered, in some cases hysterectomy is the preferred treatment. This may include situations in which fibroids are too numerous, too large, or cause heavy prolonged bleeding and severe anemia. Some patients may prefer hysterectomy so they can be assured the fibroids will not grow back.

When To Call a Professional

You should call your doctor if you have any of the following symptoms:

  • Unusually heavy or prolonged bleeding during your period (menstruation)

  • Bleeding from your vagina after intercourse

  • Bleeding from your vagina or blood spots on your underwear between menstrual periods

  • Unusually frequent urination

  • Pelvic or low back pain during intercourse or during menstrual periods

Call your doctor immediately if you experience severe pelvic pain, or if you develop severe bleeding from your vagina.

Prognosis

Fibroids often shrink after menopause because they need female hormones to grow. Many women have small- to moderate-size fibroids throughout their childbearing years that cause them few or no problems. Several medical and surgical options are available to treat or remove troublesome fibroids without having to remove the uterus.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Fibroid & Menstrual Disorders

Washington DC Gynecologists

Whether you’ve had multiple prior surgeries, are overweight, or have very large fibroids, there is an answer. A hysterectomy may not be your only option. You may qualify for a less invasive procedure to treat your fibroids.

The George Washington University Medical Faculty Associates Fibroid and Menstrual Disorder Center will review your case with you and discuss your options.

Comprised of a team of gynecologic surgeons, high-risk obstetricians, oncologists, and interventional radiologists, doctors at The GW MFA Fibroid and Menstrual Disorder Center are committed to helping you make an informed decision on a treatment plan that is right for you.

Uterine Fibroids

Uterine fibroids—also known as fibroid tumors, leiomyomas, or myomas—are benign, non-cancerous lumps that grow in a woman’s uterus. Fibroids may grow on the inside, outside, in the wall of the uterus, or in the tissue that holds the uterus in place. They can be common in women in their 30s and 40s. Although it is not known what causes the formation of fibroids, the presence of estrogen and progesterone can cause existing fibroids to grow.

It is not uncommon for fibroids to shrink after a woman has experienced menopause and the natural production of these hormones is lessened. In many cases, fibroids will not cause symptoms, or they may only cause mild symptoms. Severe symptoms of fibroids can include:

  • Lower back pain
  • Frequent urination
  • Painful intercourse
  • Pressure in the abdomen
  • Long periods of painful cramping

The presence of fibroids can lead to further complications such as anemia caused by excessive bleeding, or difficulties with pregnancy: achieving pregnancy, early labor, or miscarriage. Because most fibroids cause no or mild symptoms, many women many choose not to do anything to treat them.

In severe cases, there are two surgical options for a woman who would like to remove her fibroids:

  • Myomectomy – If a woman hopes to someday become pregnant or would like to keep her uterus, a surgery known as myomectomy can remove only the fibroids. This procedure does not guarantee that a woman will be able to achieve pregnancy later, and the fibroids may eventually return.
  • Hysterectomy – The second surgical option for removing fibroids is the hysterectomy, in which a woman’s entire uterus is removed. Pregnancy is not possible after a hysterectomy.

Dysmenorrhea

Dysmenorrhea, also known as menstrual cramps, is a condition that includes pain right before and during menstruation that can range from mild to severe. The types of pain that are associated with dysmenorrhea include sharp, burning, throbbing, dull, burning, or shooting in the hips, lower back, or inner thighs. Other symptoms that can accompany dysmenorrhea include vomiting or diarrhea.

The term primary dysmenorrhea is used to describe menstrual cramps that occur without an identifiable cause other than menstruation, while secondary dysmenorrhea is caused by something other than menstruation. Secondary dysmenorrhea can be caused by endometriosis, ovarian cysts, fibroids, cervical or uterine polyps, pelvic infections, or structural problems in a woman’s uterus, cervix, or vagina.

Premenstrual Syndrome (PMS)

PMS is a common condition that most women experience to some degree as their bodies prepare for menstruation. The symptoms of PMS may appear a week or two before menstruation and may include:

  • Cravings for sweet or salty foods
  • Bloating, constipation or diarrhea
  • Loss of appetite
  • Acne
  • Back pain
  • Headaches
  • Sore breasts
  • Clumsiness
  • Nausea
  • Mood swings
  • An inability to concentrate
  • Worsening of symptoms from other conditions such as asthma, depression, or migraines

Some symptoms of PMS can be mitigated through exercise, eating a diet high in B vitamins, and through avoiding foods such as salt, caffeine, sugar, and alcohol. Additionally, many women find relief from the pains associated with menstruation by taking pain relievers such as aspirin, acetaminophen, ibuprofen, or naproxen. For severe PMS symptoms, a doctor may prescribe the usage of birth control pills or other hormones to make periods lighter and reduce symptoms overall.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a condition very similar to PMS, however in PMDD the symptoms are heightened. An individual suffering from PMDD may experience panic attacks, crying spells, suicidal thoughts, insomnia, disinterest in activities or relationships, fatigue, or feeling out of control. Treatments meant to provide relief from the symptoms of PMS can also be used to minimize the symptoms of PMDD. In addition to exercise and changes in diet, doctors may prescribe hormonal therapies, anti-depressants, or other medications to treat the extreme symptoms of PMDD.

Abnormal Uterine Bleeding (AUB)

Menorrhagia: Menorrhagia is a condition in which a menstrual bleeding is exceptionally heavy or long. In an average menstrual cycle, a woman will lose approximately 70 mL of blood. If a woman bleeds more than approximately 80 mL or for longer than 7 days in a period, she may be experiencing menorrhagia. A woman who has menorrhagia may experience this excessive blood loss during every period to the degree that she is incapacitated and unable to perform usual activities.

Menorrhagia can be caused by:

  • A hormonal imbalance
  • Dysfunction of the ovaries
  • Fibroids
  • Polyps
  • Adenomyosis
  • The use of an IUD
  • Pregnancy complications
  • Medications
  • Cancer

Menorrhagia can cause complications such as anemia and severe pain. Treatment for menorrhagia can include medications such as ibuprofen to minimize pain and bleeding, or hormonal therapies (such as oral contraceptives) to regulate menstrual cycles. In severe cases, surgical options such as the destruction of the lining of the uterus or the removal of the uterus itself can reduce menstrual flow or cease menstruation entirely.

Amenorrhea

Amenorrhea is the absence of menstruation, usually for three or more menstrual cycles (secondary amenorrhea), or the lack of beginning menstruations by age 16 (primary amenorrhea). Amenorrhea can be cause by pregnancy, breast feeding, menopause, certain types of contraceptives, or certain medications. Additional factors that can influence the lack of a menstrual cycle include stress, body weight, excessive exercise, a hormonal imbalance, or a structural abnormality of a woman’s reproductive system. A woman experiencing amenorrhea may have difficulty conceiving. Treatment for amenorrhea varies, depending upon the underlying cause, but may include medication, contraceptives, or surgery.

What causes uterine fibroids, and why do they (sometimes) cause unusually heavy bleeding?

— Kristin Estabrook from Boston

Short Take

Uterine fibroids, known medically as leiomyomas, are benign growths of uterine muscle. Genetics, race, hormones and previous pregnancies can all have a role in creating fibroids. There are several ways that these benign tumors can contribute to heavy menstrual periods.

Tell Me More

Fibroids are benign tumors of the muscle of the uterus, also called the myometrium. They are very common — by 50 years of age 70 percent of white women and 80 percent of black women will have at least one fibroid. For many of these women, fibroids are very small and/or cause no symptoms. They are often found incidentally — most commonly on an ultrasound, CT scan or M.R.I. that was performed for symptoms unrelated to fibroids.

For other women, fibroids can cause heavy or prolonged menstrual periods. Other symptoms may include:

  • Irregular bleeding — meaning bleeding not during the menstrual cycle.

  • Pelvic pressure and urinary incontinence, especially when fibroids are larger.

  • Complications in pregnancy such as miscarriage, preterm labor and even obstruction of labor, necessitating a cesarean section.

Fibroids are hormonally responsive. They are influenced by the reproductive hormones estrogen and progesterone and as such are not seen before puberty, typically shrink with menopause and can grow rapidly during pregnancy

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