Ten symptoms of uterine fibroids

Common clinical phenomena are uterine bleeding, abdominal mass, pain, compression symptoms of adjacent organs, increased leucorrhea, infertility, anemia and heart dysfunction. However, there are also many asymptomatic patients.

1. Uterine bleeding

It is the main symptom of uterine fibroids, occurring in half or more of the patients. Among them, cyclical bleeding (excessive menstrual flow, prolonged menstruation or shortened menstrual cycle) accounts for most, about 2/3; while non-cyclical (continuous or irregular) bleeding accounts for 1/3. Bleeding is mainly caused by intramural fibroids and submucosal fibroids. Cyclic bleeding often occurs in intramural fibroids, while submucosal fibroids often present as irregular bleeding. Subserosal fibroids rarely cause uterine bleeding. In some cases, the amount of menstruation actually decreases.

The reasons for excessive bleeding caused by fibroids: ① Fibroid patients often have excessive estrogen levels combined with endometrial hyperplasia and polyps, which lead to heavy menstrual flow; ② Fibroids cause the uterus to increase in size, the endometrial area increases, and the amount of bleeding is excessive and the bleeding lasts too long. Especially in the case of submucosal fibroids, the mucosal bleeding area can reach more than 225cm2 (normal is about 15cm2); ③ Submucosal fibroids, the mucosal surface is often ulcerated and necrotic, leading to chronic endometritis and causing continuous bleeding; ④ Intramural fibroids, affecting uterine contraction and clamping blood vessels, or submucosal fibroids endometrium exfoliation and unable to contract, all lead to heavy bleeding and prolonged duration; ⑤ Larger fibroids may be combined with pelvic congestion, making the blood flow vigorous and large; ⑥ Menstrual irregularities during menopause.

Excessive menstrual flow or prolonged menstruation may occur alone or in combination. If it occurs simultaneously with a shortened (too frequent) menstrual cycle, a large amount of blood may be lost in a short period of time, leading to severe anemia. Submucosal fibroids prolapse into the vagina and cause non-cyclical bleeding, which can be extremely heavy. Large polypoid fibroids also often cause persistent bleeding.

2. Abdominal mass

Lower abdominal mass is often the main complaint of patients with uterine fibroids, accounting for as high as 69.6%. Sometimes it may be the only symptom of fibroids. This situation often occurs with intramural fibroids that grow into the abdominal cavity and do not affect the endometrium, especially subserosal fibroids located at the fundus of the uterus or with pedicles. Abdominal masses are usually discovered after uterine fibroids grow out of the pelvic cavity and are often obvious in the early morning when the bladder is full and the stomach is empty. Because the uterus and fibroids are pushed upward, patients can easily touch them by themselves. If the uterus is larger than 4 to 5 months of pregnancy, it can be touched even when the bladder is not full. Uterine fibroids are generally located in the center of the lower abdomen, but in some cases they may be located on one side of the lower abdomen and may be hard or have an uneven feel. The larger ones tend to be degenerated, softer and smoother. Most do not grow quickly. According to data from the early days of liberation, some women did not seek medical treatment until they were 22 years old. This was mainly because working women were deeply oppressed in the old society and had no conditions for medical treatment. In rare cases, the tumor may grow rapidly or be accompanied by dull pain, and malignant transformation should be suspected.

About 40% of patients suffer from abdominal pain, 25% suffer from back pain and 45% suffer from dysmenorrhea. Some patients also suffer from a feeling of heaviness in the lower abdomen or back pain, but the degree of symptoms is usually not very serious. The pain is caused by the tumor compressing the pelvic blood vessels, causing congestion, or compressing the nerves, or the pedunculated submucosal fibroids can stimulate the uterus to contract and be discharged from the uterine cavity, causing the cervical canal to widen and cause pain; or the necrosis and infection of the fibroids can cause pelvic inflammatory disease, adhesion, traction, etc. If some patients have red degeneration of uterine fibroids, the abdominal pain will be more severe and accompanied by fever. Acute and severe abdominal pain can also occur when the pedicle of a subserosal uterine fibroid is twisted or the axial torsion of the uterus occurs. Large subserosal fibroids grow into the broad ligament, which can not only compress the nerves and blood vessels and cause pain, but also compress the ureters and cause hydroureteral or renal pelvis, resulting in low back pain. Severe and progressively worsening dysmenorrhea is often caused by uterine fibroids with complications such as adenomyosis or endometriosis.

Compression symptoms

It often occurs in uterine cervical fibroids, or is caused by the enlargement of fibroids in the lower part of the uterine body, which fills the pelvic cavity and compresses the surrounding organs. Compression of the bladder can cause frequent urination, difficulty urinating, urine retention, etc.; compression of the ureter can cause hydronephrosis and pyelonephritis. Fibroids growing on the posterior wall of the uterus can compress the rectum, causing constipation or even difficulty in defecation. Compression of the pelvic veins may cause lower limb edema. The compression symptoms are more obvious in the early stage of menstruation, which is due to the congestion and swelling of uterine fibroids. If the subserosal fibroids are incarcerated in the uterorectal fossa, bladder or rectal compression symptoms may also occur.

About 30% of patients suffer from compression symptoms caused by myoma, including 20% ​​frequent urination, about 10% dysuria, 3.3% urinary retention, 5% urinary pain, 5% constipation, 6% lower limb edema.

5. Leucorrhea

Increased leucorrhea accounted for 41.9%. Enlargement of the uterine cavity, increase in endometrial glands, accompanied by pelvic congestion or inflammation can all increase leucorrhea; when submucosal fibroids ulcerate, become infected, bleed, or necrotize, bloody or purulent leucorrhea will occur, and the amount can be large.

6. Infertility and miscarriage

30% of patients with uterine fibroids suffer from infertility. Infertility may be the reason for the visit, and uterine fibroids may be discovered during the examination. There are many reasons why uterine fibroids can cause infertility. Please see the special section on uterine fibroids and pregnancy.

The spontaneous abortion rate is higher than that of the normal population, with a ratio of 4:1.

7. Anemia

Long-term bleeding without timely treatment may cause anemia. Before liberation, the majority of working women suffered from persistent uterine bleeding due to the pressure of life, but were unable to seek treatment, which caused anemia. A document about uterine fibroid patients in the early days of liberation introduced that 45.25% of the patients had hemoglobin levels between 5 and 10 grams. Those with hemoglobin levels below 5 grams accounted for 12.4%, most of whom were submucosal fibroids. Severe anemia (less than 5 grams) can lead to anemic heart disease and myocardial degeneration.

8. Hypertension

Some patients with uterine fibroids have hypertension. Some statistics have shown that most patients with fibroids and hypertension (excluding those with a history of hypertension) return to normal after the fibroids are removed, which may be related to the relief of ureteral compression.

IX. Physical signs

If the fibroid is smaller than the size of the 3-month gestational uterus, it is generally not easy to palpate it through the abdomen. The palpable ones are usually in the middle of the lower abdomen, are hard and often uneven. In patients with thin abdominal walls, the outline of the tumor can be clearly felt and even its shape can be seen. Gynecological bimanual examination can usually clearly feel the outline of uterine fibroids. If the fibroids are located on the front or back wall of the uterus, the front or back wall will be more prominent; if there are multiple fibroids, multiple smooth, hard spherical lumps can be felt on the uterus; a hard lump protruding from the side wall of the uterus may be a broad ligament fibroid; if the cervix is ​​significantly enlarged and a normal uterus can be felt on it, it indicates a cervical fibroid; if the uterus is obviously and uniformly enlarged and relatively hard, it may be a submucosal fibroid hidden in the uterine cavity or cervical canal. If the cervical opening is relaxed, a smooth spherical tumor can often be felt by inserting a finger; some are already exposed at the cervical opening or even protruding into the vagina, and can be seen at a glance; but some are secondary to infection, necrosis, or are so large that the cervix cannot be touched, which can easily be confused with cervical malignant tumors, uterine inversion, etc.

The location of the fibroid growth can also affect the position of the cervix in the uterine body. For example, if the fibroids are on the posterior wall of the uterus, the uterine body and cervix can be pushed forward. If the fibroids on the posterior wall of the uterus develop towards the rectouterine fossa, the uterus can even be squeezed to the upper and posterior side of the pubic symphysis. The outline of the uterus can be felt in the lower abdomen, and the cervix also moves upward. The posterior wall of the vagina bulges forward, and the cervix cannot be felt during vaginal examination. If it is a broad ligament fibroid, the uterine body will often be pushed to the opposite side.

When myoma undergoes degeneration, except for changes in the characteristics and size of the lump felt by palpation, its relationship with the uterine body and cervix remains the same as described above.

10. Changes in the patient's general condition

For example, nutrition, anemia, heart function, and urinary system status are related to the duration of the disease, the amount of bleeding, or other complications.