Fibroids are almost never associated with mortality, but they may cause morbidity and significantly affect quality of life (44). Women who have hysterectomies because of fibroid-related symptoms have significantly worse scores on SF-36 quality-of-life questionnaires than women diagnosed with hypertension, heart disease, chronic lung disease, or arthritis (44).
Of 116 women with fibroids larger than 5 cm on sonographic examination and uterine size greater than 12 cm on pelvic examination, 42% were satisfied with their initial level of symptoms, including stress, bleeding, and pain (45). Most of the 48 women who chose to have treatment within 1 year were more likely to have higher scores on bleeding and pain scales and be more concerned about their symptoms. Most women chose myomectomy (n = 20), hysterectomy (n = 15), or hysteroscopic myomectomy (n = 4), and symptoms scores improved markedly during the 7.5 months (mean) of follow-up.
Abnormal Bleeding The association of fibroids with menorrhagia is not clearly established. Therefore, other possible etiologies, including coagulopathies such as von Willebrand’s disease, should be considered in a woman with heavy menstrual bleeding (46).
A random sample of women aged 35 to 49 was evaluated by self-reported bleeding patterns and by abdominal and transvaginal sonography to determine the presence, size, and location of fibroids (47). Of the 878 women screened, 564 (64%) had fibroids and 314 (36%) did not. Forty-six percent of women with fibroids reported, “gushing blood” during menstrual periods, compared with 28% without fibroids. Gushing blood and length of periods were related to the size of fibroids but not to the presence of submucous fibroids or multiple fibroids.
Another study found that women with fibroids used 7.5 pads or tampons on the heaviest day of bleeding compared with 6.1 pads or tampons used by women without fibroids (48). Women with fibroids larger than 5 cm had slightly more gushing and used about three more pads or tampons on the heaviest day of bleeding than women with smaller fibroids.
Pain Women with fibroids are only slightly more likely to experience pelvic pain than women without fibroids. Transvaginal sonography was performed on a population-based cohort of 635 non-care-seeking women with an intact uterus to determine the presence of uterine fibroids (49). Dyspareunia, dysmenorrhea, or noncyclic pelvic pain was measured by visual analog scales. The 96 women found to have fibroids were only slightly more likely to report moderate or severe dyspareunia or noncyclic pelvic pain and had no higher incidence of moderate or severe dysmenorrhea than women without fibroids. Neither the number nor the total volume of fibroids was related to pain. However, women who present for clinical evaluation for fibroid-associated pain may be different from those in the general population (49).
Fibroid degeneration may cause pelvic pain. As fibroids enlarge, they may outgrow their blood supply, with resulting cell death (50). Types of degeneration determined both grossly and microscopically include hyaline degeneration, calcification, cystic degeneration, and hemorrhagic degeneration. The type of degeneration appears to be unrelated to the clinical symptoms (50). Pain from fibroid degeneration is often successfully treated with analgesics and observation. Torsion of a pedunculated subserosal fibroid may produce acute pelvic pain that requires surgical intervention (51).