Pelvic Discomfort
Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.
Pelvic Pain
A less common symptom is acute, severe pain. This occurs when a fibroid goes through a process called degeneration. Usually, the pain is localized to a specific spot and improves on its own within two to four weeks. Using a pain reliever, such as ibuprofen, can decrease the pain significantly. However, chronic pelvic pain can also occur. This type of pain is usually mild but persistent and confined to a specific area.
Bladder Problems
The most common bladder symptom is needing to urinate frequently. A woman may wake up several times during the night to empty her bladder. Occasionally, women are unable to urinate despite a full bladder.
These symptoms are caused by fibroids pressing against the bladder, reducing its capacity for holding urine or blocking the outflow of urine. Treatment for bladder problems can provide great relief.
Low Back Pain
Rarely, fibroids press against the muscles and nerves of the lower back and cause back pain. A large fibroid on the back surface of the uterus is more likely to cause back pain than a small fibroid within the uterine wall. Because back pain is so common, it is important to look for other causes of the pain before attributing it to fibroids.
Rectal Pressure
Fibroids also can press against the rectum and cause a sensation of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Sometimes, fibroids can lead to the development of a hemorrhoid.
Discomfort or Pain With Sexual Intercourse
Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue. If your doctor doesn't ask you about this symptom, make sure you mention it.
Pain & Pressure
How do fibroids cause infertility?
While uterine fibroids can cause a variety of symptoms, they may not cause any symptoms at all. Some women may not even know that they have one. When a woman has fibroids pressing on the uterus, it can prevent normal attachment of a fertilized egg to the inner lining of the uterus. Or, if a embryo does attach to the uterus, the fibroid can limit the embryo's growth and cause loss of the pregnancy. Both of these effects from fibroids lead to infertility.
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Uterine fibroids are common, and they are found in up to 75% of the general female population, and 5-10% of infertile women. Certain types of fibroids are known to decrease fertility more than others. The most common fibroid to cause infertility are the ones that are inside the uterine cavity. The other type of fibroids that can cause infertility are very large fibroids (>6 cm in diameter) that are located within the wall of the uterus. Because most women with fibroids will have normal fertility, they should have a thorough evaluation by a fertilty doctor to detect other problems that can decrease fertility. That fertility specialist can help determine if fibroids might be hampering their ability to conceive.
How do fibroids cause infertility?
There are several explanations for why uterine fibroids may reduce fertility.
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Changes in the position of the cervix (the vaginal opening to the womb) due to fibroids located above it may affect the number of sperm that can travel through the cervix.
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Changes in the shape of the uterus can interfere with sperm movement.
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Blockage of the fallopian tubes by the fibroids.
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Affecting the blood flow to the uterine cavity where the embryo would implant.
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Changes in the uterine muscle that prevents movement of the sperm or the embryo.
What happens to fibroids during pregnancy?
Fibroids are found in 2% to 12% of pregnant women. Not all fibroids will increase in size and complicate a pregnancy. If a fibroid grows, it will typically do so in the first 12 weeks of pregnancy and sometimes shrink as the pregnancy continues.
What can happen if a fibroid does grow during pregnancy?
In some instances, fibroids can possibly outgrow their blood supply and cause severe pain that might lead to hospitalization. Also, fibroids can change the baby’s presentation (position at birth), increase the risk of a cesarean section, miscarriage and preterm delivery. The management of uterine fibroids depends on your doctor’s recommendations. Rarely is surgery necessary or performed during pregnancy.
Summary of Fibroids and Fertility
Uterine fibroids are common and can affect fertility in many ways. They can affect ovulation, fertilization and implantation. Treatment options vary, but treatment will help to address the gynecologic symptoms of fibroids and improve overall fertility. The management of uterine fibroids will depend upon the severity of your symptoms and your doctor’s recommendations.
Infertility
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