5 Symptoms of Fibroids and what they mean

The best way to study a fibroid is through a tomography or magnetic resonance imaging, but we know that many patients do not have the opportunity to undergo these types of studies, which is why today Dr. Arturo Valdés, Creafam fertility expert, explains the 5 main symptoms of fibroids and what each one means:

  1. Bleeding alterations
  2. Bulging
  3. Constipation or incontinence
  4. Infertility or abortions
  5. Anemia vs Polycythemia

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Before starting, I want to remind you that there are three types of fibroids depending on their location: subserosal fibroids, intramural fibroids and submucosal fibroids. In order not to get confused, you just need to remember that the uterus is covered with a layer similar to the skin but called serosa and that is why fibroids that are below this capula are called subserosal. Intramural are those that are within the walls of the uterus in the thick part full of muscle, finally, the uterus has a layer of moist mucosa inside, which is where the embryo will implant during pregnancy, it is also known as endometrium and there This is where submucous fibroids grow. Remember these locations because they are going to be very important in this video.

Symptom #1: Bleeding disorders

This is one of the most interesting symptoms since it can lean towards both sides of the scale: You may have excessive bleeding, which is called hemorrhage, or on the contrary, the bleeding disappears for months, which doctors call amenorrhea. Why does this happen? Well, fibroids don’t grow by magic, they need blood to grow. And where does that blood come from? Well, there are 3 main arteries: The vaginal artery, the uterine artery and the ovarian artery. Obviously the fibroid always tries to feed on the artery that is closest to it, for most fibroids it would be the uterine artery but there are cases of fibroids that grow in the cervix or cervix, for those it would be the vaginal artery and there are also fibroids that grow near the intraligamentary space, that is, between the uterus and the ovary. Let’s say that the uterus were my body and the tube were my arm, they would be fibroids that grow here in the armpit and they grow very quickly because they can feed on the uterine artery and the ovarian artery at the same time.

So let’s say that you are 30 years old, so you are still a long way from menopause but suddenly you start to notice that your bleeding has decreased too much, is reduced by half or even disappears in a few months. We could suspect that you have a fibroid and that it will grow very quickly. There are fibroids that can grow up to one centimeter per month, so the first month is very small but in less than a year it reaches 10 centimeters and is considered a fibroid with medium or large elements. But what happens when the opposite happens and the bleeding becomes more abundant? The fibroid is most likely submucosal or intramural but very close to the mucosa. Fibroids are an accelerated growth of the muscle cells of the uterus. When the fibroid is submucosal, it can invade the endometrial cells that are responsible for generating menstrual bleeding, so as the fibroid grows, the number of endometrial cells increases and even increases. They can generate leaks from the endometrium into the uterus and then in a few months we would have double or triple the number of endometrial cells and therefore much heavier bleeding. Then, when the bleeding disappears, we can suspect that the fibroid is intramural and close to the uterine artery.

When the bleeding becomes more abundant, it is likely to be a submucosal fibroid, but there are also cases in which the bleeding remains almost the same and the fibroid grows very slowly. This usually happens when the fibroids are located in the upper part of the uterus, far from the arteries and subserosaly, that is, outside the uterus, in those cases we would have to focus on the next symptom, which is the bulge.

Symptom #2: Bulging

As I just mentioned, when the fibroid is located near the intraligamentary area, it usually grows very quickly and alters bleeding so that in less than 6 months it is very obvious to the patient that something is wrong, but when the fibroid is of the subserous type and is located in the upper part of the uterus, it begins to grow very slowly and without altering the bleeding, so it takes the patient one or two years to realize that there is something strange, in addition, since the fibroid is outside the uterus, it begins to grow upwards, then the bulge is not down in the uterus but up in the belly, near the navel or even a little above the navel, which is why patients think that they are simply a little overweight or that they have a bowel inflamed.

These are patients who come to us up to two or three years later and are surprised when we discover that they have a fibroid measuring 15 or 20 centimeters, but hey, at least the patients realize the bulge when the fibroid grows above and in front of the uterus. . Everything becomes a little more complicated when the fibroid grows below or at the back of the uterus because then symptoms appear that we do not usually relate to the uterus, such as constipation or incontinence.

Symptom #3: Constipation or incontinence

The uterus is surrounded by organs, above it is the intestines, behind it is the rectum, below it is the bladder and if that were not enough on the sides are the ureters which are thin tubes that connect the kidneys with the bladder. Subserosal fibroids can then grow and crush these organs. When the patient suffers from constipation we can suspect that the fibroid is located on the posterior surface of the uterus, that is, behind. They are fibroids that are also detected up to two or three years later because when someone says “Constipation” we immediately think of intestines and laxatives, we do not think of uterus and fibroids.

But if constipation has been going on for several months and is not resolved with medication, it is clear that it is not a metabolic problem but rather that the problem is one of compression, the intestines or rectum are being crushed. Now, when the fibroid grows below the uterus, it puts pressure on the bladder and can cause urinary urgency, that is, the patient feels like going to the bathroom all the time. The same thing happens to pregnant women, the uterus grows so much that it crushes the bladder, but in this case even a relatively small fibroid can cause urinary urgency, and when they grow a lot, incontinence occurs, that is, the patient inadvertently becomes a little pee because the bladder is so crushed that it cannot contain any liquid.

On the other hand, we have fibroids that grow on the sides of the uterus, these can put pressure on the ureters and then the urine does not flow well from the kidneys, this causes difficulty when urinating, frequent infections and pain in the kidneys begin, which they are more or less here on either side of the lower back. At Creafam we are dedicated to everything that has to do with women’s health, but it is true that we focus mainly on fertility, which is why many of our patients come to see us for the following symptom.

Symptom #4: Infertility or abortions

As we already saw, when fibroids are subserous they affect the organs of the abdomen but when they are submucosal they affect fertility and pregnancy. It is quite logical when we realize that the fibroid and the embryo are competing for the same space inside the uterus, However, here comes the real problem for patients who have fibroids and have suffered infertility or abortions and this is what they always ask us: What do I do now? Should I have surgery or try to get pregnant again? Honestly, in cases of infertility and abortions, I would ask you to do everything possible to have a tomography or MRI because that will help us know exactly what is happening and evaluate options. In general, if the fibroid is subserous, you could try to get pregnant again. , we have already had several patients with small subserosal fibroids to whom we recommend seeking pregnancy and even after giving birth we operate on the fibroid, but if it is intramural or submucosal, an important question would have to be answered: At how many weeks did the abortion occur? ?

If it occurred in the first 12 weeks of pregnancy, it is most likely that the fibroid is submucosal and that the embryo implanted on the fibroid or very close to it and never managed to fully develop the placenta to feed. The advantage with submucosal fibroids is that they are easy to operate, they are entered vaginally and the patient can be discharged the same day. However, if they decide not to have surgery, in theory the mother should recover soon and could try to get pregnant again. in about 2 or 3 months. The possibility of a repeat abortion varies in each case but ranges from 25 to 50%, so there will be patients who manage to get pregnant and give birth in one or two more attempts, but others could try five or six times and never be successful.

If the answer is that the abortion occurred after week 12, we can rule out a submucosal fibroid because they are usually small and the placenta should already be well formed by this time. Then we can suspect that it is a very large intramural fibroid and that it is absorbing many nutrients from the uterine artery, so the effect was able to grow well at the beginning of pregnancy but when it was already large it had problems continuing to grow due to the lack of nutrients or even due to lack of space inside the uterus, we call this intrauterine growth restriction. In these cases it would definitely be better to operate on the fibroid, firstly because after each loss of the mother it will take six months or up to a year to recover and secondly because it is very likely that she will have a pregnancy loss again if she becomes pregnant.

Symptom #5: Anemia vs Polycythemia

Anemia is when the blood has too few red blood cells and polycythemia is when there are too many. If you have anemia, you are likely to feel fatigued, experience dizziness or vertigo from time to time, and be unable to make any effort or tire quickly when doing household chores. Obviously they will not realize when they have polycythemia, but if they suspect that they have a fibroid, they can have a blood chemistry test to check how their red blood cells are.

Statistically, anemia is usually closely related to submucosal fibroids of medium elements. Let us remember that submucosal fibroids generate a lot of bleeding, while polycythemia is very rare, but if it does occur, it is most likely that the fibroid will be of the intramural or subserous type and here comes a Fun fact: One might think that if the mother has subserous fibroids and at the same time has too many red blood cells, she could give the fetus more nutrients and it would grow better, but polycythemias linked to subserosal fibroids have a higher rate of abortion. We are not sure why, but it is most likely that when the fibroid first appears, the red blood cells go down, so the body begins to produce more red blood cells but they are of no use because the fibroid keeps absorbing the nutrients before they arrive. to the fetus.

The advantage of having elevated erythrocytes or red blood cells is that surgery becomes a little easier because the body has many nutrients. The opposite occurs when there is a lot of anemia since we will usually have to give iron supplements and blood cells to the mother. before and after surgery.

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Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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