Do uterine fibroids cause pain?

In many cases, women with uterine fibroids do not experience any symptoms, but about 1 out of 3 will be symptomatic. If you do have pain symptoms, you are most likely to experience one or more of the following:

• Abdominal/pelvic pain
• Pain during sexual intercourse
• Lower back pain
• Painful periods
• Constipation, which may cause abdominal pain

Uterine fibroids may also cause abdominal pressure and bloating, heavy periods or abnormal bleeding.

Your pain symptoms depend on the size and location of your tumor. Some women experience intense pain in the exact area where the fibroid is located, and some have pelvic pain that is chronic, but milder. Fibroids can cause significant pressure on the bladder or abdomen, also causing continual discomfort.

In rare cases, fibroids growing near the back of the uterus can press on the nerves of the lumbosacral plexus (a network of nerves that supply feeling to your lower limbs and pelvic girdle), potentially causing constant leg and lower back pain and pressure that often becomes worse with movement. The bigger such tumors become, the more uncomfortable they are. While not considered a common pain symptom, there have been rare case reports of sciatica and hip pain related to fibroids.

Fibroids can intensify pain during menstruation, but women with fibroids are likely to experience pain outside of their menstrual window, too. It is common to experience more pain not only during your period, but after, as well as midcycle.

Some fibroids can cause pain during sex due to their location. This is most common with intramural fibroids (which grow in the muscle wall of the uterus) that are located in the upper region, or fundus, of the organ. Pain with sex can be mild to severe, and it can worsen with different sexual positions; painful sex occurs in approximately 1 in 5 women with fibroids.

Some fibroids, called pedunculated fibroids, are connected to the uterus by a branch-like piece of tissue. In severe cases, twisting of the branch that a fibroid is growing off of can cause extreme pain because it blocks the blood vessels supplying the tumor.

Pain management and treatment

If you are experiencing any form of pain from uterine fibroids, there are many steps you can take to help relieve your symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen and naproxen — can be useful in easing all types of fibroid-related pain. If your pain occurs only during menstruation, taking these over-the-counter drugs a day or two prior to the start of your period can be helpful. Intrauterine devices (IUDs) are sometimes recommended to help control pain.

Lifestyle changes may also help you to manage pain from uterine fibroids:

• If you have pelvic pain, taking a warm bath or applying a hot water bottle or a heating pad to the area of discomfort can help increase blood flow and soothe your muscles.
• If you are experiencing lower back or leg pain, using a pillow under your knees when you are laying down on your back may relieve some of the pressure, or you can try laying on your side with your knees pulled up to 90 degrees.
• Although you may not feel like being active when you’re in pain, exercise increases blood flow and boosts endorphins, the feel-good chemicals in your body that also help to decrease pain.
• Maintaining a healthy body weight and eating a healthy diet is also recommended, as these measures can boost your health in general.
• Holistic pain relief therapies such as acupuncture, yoga, muscle relaxation, meditation/visualization, biofeedback and deep breathing exercises may also be effective pain-reducing strategies.

Prescription medication or surgery may be recommended in cases of severe or persistent pain that is not helped by other methods.