Fibroids and Pelvic Pain

Pelvic pain is one of the most common symptoms that brings women to the attention of a gynaecologist, and fibroids are frequently implicated. However, the relationship between fibroids and pain is not always straightforward — some women with large fibroids experience no pain at all, while others with smaller fibroids may have significant discomfort. Understanding the mechanisms behind fibroid-related pain can help you recognise when your symptoms may warrant investigation and treatment.

For a comprehensive overview of fibroid symptoms, visit our symptoms page.

How Fibroids Cause Pain

Fibroids can cause pain through several different mechanisms, and the type of pain experienced often depends on the size, location, and behaviour of the fibroid:

Pressure-Related Pain

As fibroids grow, they can press on surrounding structures in the pelvis. This pressure can produce a dull, constant ache or a feeling of heaviness in the lower abdomen or pelvis. Large fibroids may press on the bladder, causing urinary discomfort, or on the bowel, causing a sensation of fullness or constipation. Pressure on nerves in the pelvis or lower back can cause referred pain to the legs, back, or hips.

Menstrual Pain (Dysmenorrhoea)

Many women with fibroids experience more severe period pain than women without fibroids. This is particularly true for submucosal fibroids (those growing into the uterine cavity) and larger intramural fibroids. The pain typically occurs during menstruation and may be accompanied by heavy bleeding. The mechanism involves the uterus contracting more forcefully to expel blood past or around the fibroid.

Degeneration

Fibroids can outgrow their blood supply, leading to a process called degeneration. When the centre of a fibroid does not receive enough oxygen, the tissue begins to break down, causing sudden, severe pain. This is sometimes called red degeneration and is particularly common during pregnancy but can occur at any time. The pain typically lasts several days to a couple of weeks and is managed with rest and pain relief.

Torsion

Pedunculated fibroids — those attached to the uterus by a stalk — can occasionally twist on their stalk. This torsion cuts off the fibroid's blood supply and causes acute, severe pain that may require urgent medical attention. This is a relatively uncommon complication but one that is important to be aware of.

Pain During Intercourse

Fibroids positioned near the cervix or in the lower portion of the uterus can cause deep pain during sexual intercourse (dyspareunia). This can have a significant impact on relationships and quality of life and is a symptom that many women are reluctant to discuss, despite the fact that effective treatments are available.

Differentiating Fibroid Pain from Other Causes

Pelvic pain has many potential causes, and it is important to establish an accurate diagnosis. Other conditions that can cause similar symptoms include:

Endometriosis — a condition where tissue similar to the uterine lining grows outside the uterus
Adenomyosis — endometrial tissue growing into the muscular wall of the uterus (this can also coexist with fibroids)
Ovarian cysts — fluid-filled sacs on the ovaries
Pelvic inflammatory disease — infection of the reproductive organs
Musculoskeletal pain — pain originating from the muscles, bones, or joints of the pelvis

A thorough clinical assessment, including imaging, is essential to determine the cause of your pain and ensure you receive the right treatment.

Managing Fibroid-Related Pain

The management of fibroid-related pain depends on the underlying cause and severity:

Over-the-counter pain relief — paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be effective for mild to moderate pain
Hormonal medication — treatments that reduce oestrogen levels can help shrink fibroids and reduce associated pain
Uterine Fibroid Embolisation (UFE) — by cutting off the blood supply to fibroids, UFE can significantly reduce pain and pressure symptoms
Surgical options — myomectomy (removal of fibroids) or hysterectomy may be appropriate in certain cases

When to Seek Help

You should seek medical advice if your pelvic pain is persistent, worsening, affecting your daily activities, or accompanied by other symptoms such as heavy bleeding, urinary problems, or pain during intercourse. Sudden, severe pelvic pain should be assessed urgently to rule out complications such as fibroid torsion or degeneration.

If pelvic pain is affecting your quality of life, our team can help identify the cause and discuss effective treatment options. Book a consultation at the North London Fibroid Clinic today.

Pelvic Pain and Fibroids: Understanding the Connection