What to Know About Uterine Fibroid Pain — and How to Find Relief

For most women, a certain degree of menstrual pain is normal. As many as 75 percent of women experience period pain during their reproductive years, notes a study in the August 2019 Journal of Women’s Health. But it can also be a sign of something more serious, like uterine fibroids.

What Are Uterine Fibroids?

If you’re experiencing long-lasting period pain, or pain that worsens as you get older, it may be a sign of uterine fibroids.

“Uterine fibroids are benign smooth muscle growths of the uterus,” says Linda Bradley, MD, the director of the fibroid and menstrual disorders center at Cleveland Clinic in Ohio. These growths are rarely cancerous, and they’re very common — about 80 percent of women develop fibroids by age 50, according to the U.S. Department of Health & Human Services.

That said, they’re more common in some populations than others. Although fibroids can develop at any age, uterine fibroids are most common in women ages 30 to 40. Black women are more likely to develop uterine fibroids than white women; fibroids tend to develop at a younger age and grow more quickly in Black women, as well.

Common Symptoms of Uterine Fibroids

Some women who have uterine fibroids may not experience any symptoms. Others, however, may experience a range of symptoms that affect their period and beyond, such as:

• Abdominal or lower back pain
• Pelvic pain and cramping
• Painful sex
• Heavy menstrual bleeding
• Long, frequent periods
• Bleeding between periods
• Anemia (from blood loss)
• Bladder or bowel pressure
• Frequent or urgent urination
• Bowel movements that are difficult, frequent, or urgent
• Increased abdominal size
• Miscarriage
• Infertility

“Your symptoms generally depend on the location and number of uterine fibroids,” says Dr. Bradley.

Why Uterine Fibroids Cause Painful Periods

Each month, your uterus goes through a cycle: It creates a thickened inner lining in case a pregnancy occurs. If pregnancy does not occur, your body sheds that lining — this is your period.

During a normal period, your body releases hormones called prostaglandins. These hormones can cause pain and inflammation and can increase the intensity of uterine contractions, which may worsen menstrual cramping. And women who have elevated levels of prostaglandins may experience even more severe menstrual pain.

Fibroids can make this pain more intense: First, fibroids put pressure on the uterine lining. Then, if you have fibroids within the uterine wall, or fibroids that protrude into the uterine cavity, more surface area is created, which means more thickened lining for your body to shed during your period — that is, a heavier flow.

“For women who bleed a lot, large clots can form,” says Bradley. “As all of this blood and clotting is trying to come through the narrow cervix and be expelled from the body, the uterus is contracting more, which can cause pain.”

In the days leading up to your period, you might feel more intense cramping as your uterus goes through its motions to force out the lining, and a stronger sensation of pressure when your period starts because of the heavier blood flow.

If the uterine fibroids are large, you also may feel a stronger sensation of pressure at the time of your period due to blood flow to the fibroids.

Treatment Options for Uterine Fibroid Pain

Aside from uterine fibroids, period pain can be caused by health conditions like endometriosis or ovarian cysts. So if you’re dealing with period pain, it’s important to see your doctor or gynecologist to determine the underlying cause and recommend the proper course of treatment, says Bradley.

If you are diagnosed with uterine fibroids, a variety of treatment options can help you manage symptoms like heavy menstrual bleeding, pelvic pain, and pressure, and certain medications also treat the underlying uterine fibroids.

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can help alleviate period pain and decrease bleeding, but do not shrink the size of the fibroids themselves.
• Hormonal birth control, such as the pill, the ring, injections, and intrauterine devices (IUDs), decrease bleeding and alleviate menstrual pain and cramping, but do not shrink the size of uterine fibroids.
• Oral medications, including hormonal or nonhormonal options, used to treat heavy menstrual periods can alleviate uncomfortable uterine fibroid symptoms.
• Hormone injections, such as gonadotropin-releasing hormone (GnRH) agonists, can induce a temporary menopause-like state and help shrink the size of uterine fibroids while you’re taking the medication, which in turn can improve your symptoms — but once you stop taking the drug, the fibroids usually grow back, and these medications cannot be taken long-term.
• Complementary therapies, ranging from heating pads to regular exercise and diet alterations, to strategies like acupuncture and massage, may help you manage pain and other symptoms related to uterine fibroids.

“If it’s getting to the point where your quality of life is bad — you’re staying home and missing work, activities, and hobbies — your physician needs to look at other therapies, such as surgical procedures,” says Bradley.

Hysterectomy, which removes the entire uterus, remains the definitive procedure for treating uterine fibroids. But today there also are a range of surgical options that are significantly less invasive and have a shorter recovery time.

A noninvasive procedure called MRI-guided focused ultrasound surgery (FUS) is performed while a patient is in an MRI scanner; MRI images allow the doctor to see where fibroids are located and target them with sound waves that destroy the tissue, according to the Mayo Clinic. Minimally invasive procedures, like radiofrequency ablation or embolization, also aim to shrink or remove the uterine fibroids. It’s important to note that MRI-guided FUS has a high re-intervention rate, according to research published in January 2022 in the International Journal of Hyperthermia, and isn’t as readily available as uterine artery embolization.

“The No. 1 cause of hysterectomies in America is uterine fibroids with pain, heavy bleeding, or discomfort,” says Bradley. “But we have new options — you’re not relegated to a hysterectomy. There are many other procedures that are less aggressive or less invasive.”

Treatment is an individualized decision, and you need to see a physician who really looks at the whole patient, explains Bradley. The type of treatment you opt for should take into consideration your age, fertility plans, and the size and location of the uterine fibroids — and should be as minimally invasive as possible, she adds.