Uterine Fibroids Symptoms and Risk Factors

The clinical presentation of uterine fibroids is highly variable. Approximately 50% of women are asymptomatic, with the condition discovered incidentally during routine pelvic exams or imaging. For symptomatic women, the manifestations are debilitating and are classified into three primary categories: Abnormal Uterine Bleeding, Bulk/Pressure Symptoms, and Reproductive Dysfunction.

1. Abnormal Uterine Bleeding (AUB-L)

This is the most frequent indication for medical or surgical intervention. In the FIGO classification of bleeding, this is termed AUB-L (Leiomyoma).

• Menorrhagia (Heavy Menstrual Bleeding): Defined as prolonged (>7 days) or heavy menstrual bleeding (>80mL per cycle). The mechanisms by which fibroids cause bleeding are complex:
  • Surface Area: Fibroids distend the uterine cavity, increasing the total surface area of the endometrium that sheds during menstruation.
  • Vascular Abnormalities: Fibroids induce angiogenesis (the formation of new blood vessels). The venules overlying a submucosal fibroid are often dilated, fragile, and lack the normal vasoconstrictive ability.
  • Contractility Interference: Normal menstruation cessation relies on the myometrium contracting to compress the spiral arteries. Intramural fibroids disrupt this muscular architecture, preventing adequate hemostasis.
• Iron Deficiency Anemia: Chronic heavy blood loss depletes iron stores (ferritin), leading to systemic anemia. Patients present with chronic fatigue, dyspnea (shortness of breath), palpitations, pica (craving ice or dirt), hair loss, and pallor. Severe anemia (Hemoglobin <7 g/dL) can lead to high-output heart failure if untreated.
• Dysmenorrhea: Severe cramping caused by the uterus trying to expel the fibroid or large clots.
• Intermenstrual Bleeding: Spotting or bleeding between periods is less common but can occur, particularly with submucosal fibroids that ulcerate the overlying endometrial lining