Uterine fibroids: symptoms and when to see a gynecologist

“Uterine fibroids are benign tumors of the uterus, typically nodular in shape, composed of smooth muscle cells and fibrous tissue,” explains the professor.

Their number, location, and size can vary greatly from one woman to another. They are more common in women of reproductive age, with incidence increasing over time and peaking between the ages of 40 and 50, just before menopause.

They may also be detected during menopause, as many remain asymptomatic and are discovered incidentally during routine examinations.

The symptoms associated with uterine fibroids can vary and are often nonspecific, including:

Menstrual changes: heavy, painful, or absent periods

Fibroids frequently cause heavy menstrual bleeding because they alter uterine blood supply and contractility, making the uterus less effective at stopping bleeding. Stronger contractions, sometimes associated with inflammation and compression of surrounding tissues, may also lead to painful menstruation.

More rarely, when fibroids alter the uterine cavity, affect endometrial vascularization, or are associated with hormonal imbalances, they may cause irregular or absent menstrual cycles.

Spontaneous bleeding

Fibroids may also cause bleeding outside of menstruation. This occurs particularly when fibroids deform the uterine cavity or alter endometrial blood supply, making blood vessels more fragile.

This bleeding often appears as spotting or intermittent bleeding between cycles and represents a reason to consult a gynecologist.

Abdominal swelling and pelvic pain

As fibroids grow, they may cause a sensation of abdominal heaviness, bloating, or pelvic pain.

Bowel and urinary symptoms

Pressure on the bladder or intestines may lead to frequent urination, difficulty emptying the bladder, or constipation.

Pain during sexual intercourse

When fibroids deform the uterine cavity or compress nearby pelvic tissues and nerves, they may cause pain during intercourse, especially when located in the lower uterus or near the cervix, or when large enough to compress the vagina, bladder, or rectum.

Infertility

In some cases, fibroids may affect fertility, for example by altering the shape of the uterine cavity, interfering with embryo implantation, or compressing the fallopian tubes and preventing egg passage.

Fibroids located near the endometrium may also impair its function, making implantation more difficult.

Anemia

Heavy and prolonged bleeding may lead to iron deficiency and anemia, resulting in fatigue and weakness.

Leg pain

Large fibroids may sometimes compress nerves and blood vessels, causing radiating pain or a feeling of heaviness in the legs.

It is important to consult a gynecologist for medical evaluation if the following occur:

• very heavy bleeding or bleeding between menstrual cycles;
• persistent pelvic pain;
• unexplained abdominal enlargement;
• anemia or chronic fatigue;
• difficulty urinating or recurrent bowel problems;
• difficulty conceiving.

“A gynecological examination represents the first and fundamental step in identifying uterine fibroids or possible abnormalities,” explains the professor.

During the consultation, the specialist reviews the patient’s personal and family medical history, evaluates symptoms, and performs a transvaginal or abdominal ultrasound to detect possible irregularities or masses such as fibroids.

Early assessment allows monitoring of disease progression and helps identify the most appropriate therapeutic strategy.

Additional diagnostic tests

If necessary, the physician may also perform or prescribe:

• magnetic resonance imaging (MRI) in more complex cases;
• hysteroscopy;
• other specific diagnostic tests.

Treatment depends on several factors:

• symptoms;
• age;
• fibroid size;
• desire for pregnancy;
• overall health conditions.

Management options may include:

• periodic monitoring in asymptomatic cases or when fibroids are small;
• medical therapy to control bleeding and pain;
• endoscopic or surgical procedures, including myomectomy, which removes fibroids while preserving the uterus and fertility, as well as minimally invasive techniques such as laparoscopy and hysteroscopy, which reduce pain and recovery time. In more complex cases, or when preservation of the uterus is not necessary, hysterectomy — complete removal of the uterus — may be performed.

A personalized evaluation with a gynecologist is essential to choose the treatment pathway best suited to a patient’s needs and quality of life.