Fibroid-Related Left Lower Abdominal Pain

Introduction to Fibroid-Related Pain

• Fibroids can cause several distinct pain presentations that can localize to the left lower abdomen, including chronic pelvic pain and pressure, dysmenorrhea, and acute severe pain from fibroid degeneration, infarction, hemorrhage, torsion of pedunculated fibroids, or prolapse of submucosal fibroids through the cervix, as noted by the American College of Radiology 1

Age-Specific Considerations for Fibroid-Related Pain

• Fibroids become significantly more important as a cause of pelvic pain in perimenopausal and postmenopausal women compared to younger women, according to the American College of Radiology 1, 2
• In postmenopausal women, fibroids are the second most common gynecologic cause of acute pelvic pain, accounting for more cases than in premenopausal women, as reported by the American College of Radiology 1, 2

Differential Diagnosis and Diagnostic Approach

• Acute diverticulitis of the sigmoid or descending colon is the most common cause of adult left lower quadrant pain overall, as stated by the American College of Radiology 3, 4
• For women of reproductive age with left lower quadrant pain where gynecologic pathology is suspected, transvaginal pelvic ultrasound is the initial imaging of choice, recommended by the American College of Radiology 3, 5
• For postmenopausal women with subacute or chronic pelvic pain, transvaginal ultrasound combined with transabdominal approach is the initial imaging study of choice, as suggested by the American College of Radiology 6
• For acute presentations with broader differential diagnosis or suspected complications, CT abdomen and pelvis with IV contrast is the most useful examination, according to the American College of Radiology 4, 5, 7

Diagnostic Performance and Pitfalls

• Contrast-enhanced CT demonstrates the best diagnostic performance for fibroid complications, with contrast enhancement of the fibroid showing 86% sensitivity and ascites showing 100% sensitivity, as reported by the American College of Radiology 1
• In postmenopausal women with fibroids and pain, it is essential to maintain high suspicion for other gynecologic causes, including ovarian cysts and ovarian neoplasm, as ovarian cysts are actually the most common gynecologic cause of postmenopausal pelvic pain, as noted by the American College of Radiology 1, 2