Clinical symptoms of uterine fibroids

Symptoms of uterine fibroids are common clinical phenomena such as uterine bleeding, breast tenderness, dull pain in the lower abdomen, irritation symptoms of adjacent organs, increased leucorrhea, infertility, a feeling of falling in the anus, increased or continuous menstrual flow, low back pain, facial pigmentation or chloasma, dark circles under the eyes, sallow complexion, anemia, hypofunction of heart function, and enlarged and hard uterus found during pelvic examination.

The symptoms of uterine fibroids vary with the location, size, growth rate, presence or absence of secondary degeneration and comorbidities of the fibroids. Common clinical phenomena are uterine bleeding, abdominal mass, pain, compression of adjacent organs, increased leucorrhea, infertility, anemia and heart function deception.

Symptoms and clinical manifestations of uterine fibroids - uterine fibroids

(I) Uterine bleeding is an important symptom of uterine fibroids, which occurs in half or more of the patients. Among them, cyclical bleeding (excessive menstrual flow, prolonged menstrual period or shortened menstrual cycle) is the most common, accounting for about 2/3; and non-cyclical (continuous or irregular) bleeding accounts for 1/3. Bleeding is mainly caused by intramural fibroids and submucosal fibroids. Cyclic bleeding is more common in intramural fibroids. The bleeding incidence rates of submucosal, intramural and subserosal fibroids are 100%, 74% and 36% respectively. The reasons for excessive bleeding caused by fibroids: 1. Patients with fibroids often have excessive menstrual flow due to excessive estrogen combined with endometrial proliferation and polyps; 2. Fibroids cause the uterus to increase in size, the endometrial area to increase, and the amount of bleeding is excessive and the bleeding is too long. 3. Submucosal fibroids, the mucosal surface is often ulcerated and necrotic, leading to chronic endometritis and causing continuous bleeding. 4. Intramural fibroids, which affect uterine contraction and instigate vascular function, or the endometrium of submucosal fibroids is exfoliated and cannot contract, all of which lead to heavy bleeding and prolonged duration. 5. Large fibroids can be combined with pelvic congestion, causing blood flow to be strong and heavy. 6. Menstrual irregularities during menopause

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

(II) Abdominal lumps Lower abdominal lumps are often the main complaint of patients with uterine fibroids, accounting for up to 69.9%. Sometimes, it may also be the only symptom of fibroids. Abdominal lumps are usually felt after uterine fibroids grow out of the pelvic cavity, and are often clearly seen in the morning when the bladder is full on an empty stomach. Because the uterus and fibroids are pushed upward, it is easy for the patient to touch them by himself. If the uterus is larger than 4-5 months of pregnancy, it can also be touched when the bladder is not full. Uterine fibroids are usually located in the middle of the lower abdomen, and a few may be located on one side of the lower abdomen. They are hard or have a swampy feeling. Larger ones are often degenerated, softer and smoother.

Clinical manifestations of uterine fibroids - (III) Pain manifests as abdominal pain in about 40% of cases, backache in 25% and dysmenorrhea in 45%; some also manifest as a feeling of heaviness in the lower abdomen or backache, but the degree is not very serious. The pain is caused by the tumor inciting the pelvic blood vessels, causing blood stasis, or inciting the nerves, or the pedunculated submucosal fibroids can stimulate the uterus to contract, and the cervical canal becomes open and painful due to the discharge from the uterine cavity to the outside, or the necrosis of the fibroids causes pelvic inflammation. Adhesions, traction, etc. If the individual uterine fibroids are red, the abdominal pain is more severe and accompanied by fever. Acute and severe abdominal pain also occurs when the pedicle of the uterine subserosal fibroids changes or the axis of the uterus changes. Large subserosal fibroids grow into the broad ligament, which can not only stimulate the nerves and blood vessels to cause pain, but also stimulate the ureter to cause ureteral or renal hydrops and cause back pain. Severe and progressively worsening dysmenorrhea is often caused by uterine fibroids with complications such as adenomyosis or endometriosis.

(IV) Indicative symptoms are often seen in cervical fibroids, or in the lower part of the uterine body where the fibroids enlarge and fill the pelvic cavity, causing irritation of the surrounding organs. If the bladder is affected, frequent urination or difficulty urinating, urinary retention, etc. may occur; if the ureter is affected, it may cause hydronephrosis and pyelitis. Fibroids growing on the posterior wall of the uterus may affect the rectum, causing constipation and even defecation difficulties. Compression of the pelvic veins may cause lower limb edema. Indicative symptoms are more obvious in the early stages of menstruation, which is due to the congestion and swelling of the uterine fibroids. If the subserosal fibroids are embedded in the uterine rectal fossa, bladder or rectal irritation symptoms may also occur. About 30% of cases are caused by fibroids.

(V) Leucorrhea

Clinical manifestations of uterine fibroids - (VI) Infertility and miscarriage 30% of patients with uterine fibroids are infertile. Pregnancy may be the reason for seeking medical treatment, and during the examination, it was found that there were uterine fibroids. There are many reasons for infertility caused by uterine fibroids. The miscarriage rate is higher than that of the normal population, with a ratio of 4:1.

(VII) Anemia: Long-term bleeding without timely treatment may lead to anemia. Severe anemia (less than 5 grams) can lead to anemic heart disease and myocardial degeneration.

(8) Hypertension Some patients with uterine fibroids are accompanied by hypertension. Many patients with fibroids and hypertension (and those with a history of hypertension) return to normal after the removal of the fibroids, which may be related to the elimination of ureteral insufficiency.

Clinical manifestations of uterine fibroids-submucosal uterine fibroids

(IX) Physical signs Myomas are usually not easy to touch through the abdomen if the uterus is larger than 3 months of pregnancy. Those that can be touched are usually in the middle of the lower abdomen, hard and often messy. Myomas on the anterior or posterior wall of the uterus are more difficult to touch. Multiple myomas can be felt on the uterus with multiple smooth, hard spherical masses. The uterus is obviously uniformly enlarged and hard, which may be a submucosal myoma hidden in the uterine cavity or cervical canal. If the cervical opening is loose, the smooth spherical tumor can often be touched by inserting a finger. Some are exposed at the cervical opening or even protruding into the vagina. The location of the myoma can also be related to the position of the uterine body and cervix.