Symptoms of Uterine Fibroids and When to See a Doctor

Talk to your healthcare provider if you're experiencing heavy, painful periods or pelvic pain.

Illustration by John Muñoz

Uterine fibroids are noncancerous tumors that grow from the walls of the uterus. They affect 20 percent to 80 percent of women in their reproductive years, according to the U.S. Department of Health & Human Services' Office on Women's Health.

Of course, some fibroids are very small. Having one doesn't necessarily mean you'll have symptoms.

"Most cases of fibroids do not cause issues," said Monte Swarup, M.D., a board-certified gynecologist in Arizona and founder of HPD Rx. "But complications can arise."

Though most fibroids are not dangerous, some can grow large and cause problems such as anemia and infertility. If your periods have become significantly heavier or you're experiencing pain during sex, talk to your doctor. You may have one or more fibroids.

Symptoms of fibroids

Not everyone with fibroids has symptoms. For those who do, the most common symptom is pain. This includes general pelvic pain, painful periods and pain with sex, according to Swarup.

Pain, however, does not always indicate fibroids. Pelvic pain and painful periods can be caused by several conditions, including endometriosis, pelvic inflammatory disease (PID), pelvic floor dysfunction and more.

Here's a closer look at the types of pain and other symptoms linked to fibroids:

Pelvic or abdominal discomfort. "Fibroids that are attached to the uterus can cause pain and nausea," Swarup said. This typically feels like pressure, heaviness and vague discomfort rather than a sharp, stabbing pain, according to UCSF Health, part of the University of California San Francisco.
Abdominal fullness. "Large fibroids can swell the abdomen," Swarup explained. You might experience fibroid-related swelling as chronic fullness or pressure rather than occasional bloating.
Pain with sex. An internal, aching pain during penetrative sex is called deep dyspareunia. Fibroids were significantly associated with deep dyspareunia in a 2014 analysis of data from the Uterine Fibroid Study published in the Journal of Sexual Medicine.
Heavy, painful periods. Fibroids can cause heavy, painful or long-lasting periods. Tell your doctor about changes in your periods because these symptoms can also signify endometriosis or other health conditions.
Difficulty getting pregnant. Between 5 percent and 10 percent of infertile women have fibroids, according to research published in Obstetrics and Gynecology Clinics of North America. Sometimes both issues are caused by another underlying condition, but Swarup said fibroids do cause infertility in some cases.

Risk factors

The main risk factor for fibroids is being born female. Next is being of reproductive age.

Beyond that, Swarup said there are a few factors linked to an increase in your chance of developing fibroids:

Genetics. Fibroids might be genetic. If your mother had fibroids, you might have a heightened risk of developing them, too.
Race. Black women are more likely to develop fibroids than women of other races.
Lifestyle factors. Experts have found diets high in red meat or low in vegetables can increase your risk for fibroids. Vitamin D deficiency, obesity and early period onset (age 11 or younger).

Tests to diagnose fibroids

If you're experiencing symptoms of fibroids, tell your gynecologist. Fortunately, most fibroids do not cause urgent complications and can be attended to at your next appointment.

Seek immediate medical attention if you have heavy vaginal bleeding (especially between periods) or sudden, sharp pelvic pain. These symptoms can indicate a medical emergency that might or might not be related to fibroids.

Your doctor might be able to diagnose fibroids during a pelvic exam. However, additional tests might be necessary depending on the location and size of the fibroid.

Pelvic exam

A pelvic exam is the most common way fibroids are found, Swarup said. It involves a full external and internal evaluation of your genital region.

Before the exam, you lie on your back on an exam table and put your feet in stirrups. During the exam, the doctor inserts a finger or two into your vagina to feel for lumps and bumps that might be fibroids. Next, your doctor inserts a metal tool called a speculum into your vagina. Once inserted, the device is opened to press against the vaginal walls so the doctor can do a visual check for anything abnormal.

Additional tests to diagnose fibroids

According to Swarup, if you're experiencing symptoms of fibroids, your doctor might also recommend one or more of the following tests:

Ultrasound. An ultrasound uses sound waves to create an image of your uterus and other internal organs. This scan can help your doctor pinpoint and measure each fibroid.
Hysteroscopy. In this test, your doctor inserts a thin, illuminating device into your vagina, through your cervix and into your uterus. This procedure allows the doctor to see fibroids inside the uterus.
Hysterosalpingogram (HSG). For an HSG, your doctor injects contrast dye into your uterus before an X-ray to detect abnormalities in the uterus and fallopian tubes.
Sonohysterogram (SHG). In this test, your doctor uses a thin catheter to put saltwater in your uterus before a vaginal ultrasound. This allows the doctor to check the uterus and its lining.
Laparoscopy. This outpatient surgical procedure involves inserting a thin, camera-like device inside your abdomen through a cut near your belly button. A laparoscopy can be used to find fibroids that have developed outside the uterus, Swarup said.
Magnetic resonance imaging (MRI). This detailed imaging test can help your doctor track fibroids' growth.

Next steps

Not all fibroids require treatment. But if uterine fibroids are causing symptoms or fertility problems, there are treatments that can help. Talk to your doctor about the best treatment options based on any plans to become pregnant and the size and placement of each fibroid.