Praxis Medical Insights

Uterine fibroids cause several distinct types of pain, including dysmenorrhea, chronic pelvic pain and pressure, and acute pain from complications, affecting women with fibroids 1, 2

Chronic Pain Presentations

Dysmenorrhea is a common symptom of fibroids, occurring alongside menorrhagia, in women with uterine fibroids 3, 4
Pelvic pain and pressure represent cardinal symptoms, often described as a sensation of bloatedness or fullness, in women with fibroids 3, 4
Bulk symptoms include pressure, pain, fullness affecting the pelvis, in women with uterine fibroids 5

Acute infarction or hemorrhage in a degenerating fibroid causes sudden severe pain, in women with degenerating fibroids 1, 2, 6
Torsion of pedunculated fibroids produces acute pain requiring urgent evaluation, in women with pedunculated fibroids 1, 2, 6
Prolapse of a submucosal fibroid through the cervix causes acute pain, in women with submucosal fibroids 1, 2, 6

Urinary urgency and frequency result from bladder compression, in women with fibroids compressing the bladder 3, 4
Constipation results from posterior fibroid pressure on the rectum, in women with posterior fibroids 3, 4

Fibroids become a significantly more common cause of acute pelvic pain in perimenopausal and postmenopausal women compared to premenopausal women, in the peri/postmenopausal group 1, 2
Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause, in women with uterine fibroids 3, 4
Uterine fibroids are the second most common cause of acute pelvic pain in postmenopausal women, accounting for more cases than in younger women, in postmenopausal women with fibroids 1, 2

Acute pain from fibroids warrants urgent imaging to exclude torsion, prolapse, or infarction/hemorrhage requiring intervention, in women with acute fibroid-related pain 1, 2
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, in women with fibroid complications 7
When fibroids coexist with adenomyosis, pain patterns may be more complex and treatment failure rates increase, in women with coexisting fibroids and adenomyosis 5
In postmenopausal women with fibroids and pain, maintain high suspicion for other gynecologic causes including ovarian cysts and ovarian neoplasm, in postmenopausal women with fibroids and pain 1, 2