Pain and Bleeding from Uterine Fibroids: Causes and Solutions

Pain caused by uterine fibroids?

I have seven uterine fibroids and adenomyosis of varying sizes, with the largest measuring 4 centimeters.
For the past year, I have experienced intermittent pain on the left side of my abdomen during ovulation, accompanied by bleeding.
Initially, I thought it was due to a blocked fallopian tube, so I consulted three gynecologists and underwent both transvaginal and abdominal ultrasounds.
They all concluded that my pain is caused by the uterine fibroids and prescribed pain medication.
Could it really be solely due to the fibroids? Why do fibroids cause pain and bleeding during ovulation? Are they not related to the ovaries or fallopian tubes? Each time I experience pain, I can only take painkillers, which do not always provide complete relief, and this has been very distressing for me.
Additionally, due to the fibroids, I have been seeing a traditional Chinese medicine practitioner and taking herbal medicine.
However, my gynecologist mentioned that they have not heard of herbal medicine being effective.
I am unsure if the herbal treatment is the reason, but for the past two months, I have had two menstrual periods in one month, which means I am experiencing two ovulation periods monthly, resulting in pain twice a month.
This has severely impacted my quality of life.

Niming, 40~49 year old female. Ask Date: 2017/05/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have seven uterine fibroids and adenomyosis of varying sizes, with the largest measuring 4 centimeters.
For the past year, I have experienced intermittent pain in the area of my left ovary during ovulation, accompanied by bleeding.
Initially, I thought it was due to a blocked fallopian tube, so I consulted three gynecologists and underwent both transvaginal and abdominal ultrasounds.
All of them stated that my pain is caused by the uterine fibroids and prescribed painkillers.
Could it really be solely due to the fibroids? Why do fibroids cause pain and bleeding during ovulation? Is there no relation to the ovaries or fallopian tubes? Each time I experience pain, I can only take painkillers, which do not provide complete relief, and this has been very distressing for me.
Additionally, due to the fibroids, I sought treatment from a traditional Chinese medicine practitioner and have been taking herbal medicine.
However, my gynecologist mentioned that they have not heard of herbal medicine being effective.
I am unsure if it is related to taking the herbal medicine, but for the past two months, I have had two menstrual cycles in one month, effectively experiencing two ovulation periods, which means I have pain twice a month.
This has severely impacted my quality of life.
I have doubts about whether fibroids can indeed cause pain and bleeding during ovulation.

Reply Date: 2017/05/18

More Info

Understanding the pain and bleeding associated with uterine fibroids can be quite complex, especially when multiple factors are involved. Uterine fibroids, also known as leiomyomas, are non-cancerous growths of the uterus that can cause a variety of symptoms, including pelvic pain, heavy menstrual bleeding, and pressure symptoms. In your case, the presence of multiple fibroids, particularly the largest one measuring 4 cm, can indeed contribute to the discomfort you are experiencing, especially during ovulation.

Causes of Pain and Bleeding from Uterine Fibroids
1. Hormonal Influence: Fibroids are sensitive to hormonal changes, particularly estrogen and progesterone. During the menstrual cycle, especially around ovulation, hormone levels fluctuate, which can lead to increased fibroid activity. This can result in pain due to the fibroids expanding or causing pressure on surrounding structures.

2. Pressure Symptoms: As fibroids grow, they can exert pressure on nearby organs, including the bladder and rectum, leading to discomfort or pain. This pressure can also lead to changes in your menstrual cycle, causing heavier bleeding or irregular periods.

3. Degeneration: Sometimes, fibroids can undergo a process called degeneration, where the tissue inside the fibroid dies due to a lack of blood supply. This can cause significant pain and sometimes bleeding, particularly if the fibroid is large.

4. Associated Conditions: While your doctors have indicated that the pain is likely due to the fibroids, it is important to consider that other conditions, such as ovarian cysts or endometriosis, could also contribute to your symptoms. These conditions can coexist with fibroids and may require further evaluation.

Solutions and Management
1. Pain Management: Since you are currently relying on pain medications, it may be beneficial to discuss alternative pain management strategies with your healthcare provider. Options may include non-steroidal anti-inflammatory drugs (NSAIDs), hormonal treatments to regulate your menstrual cycle, or even more advanced pain management techniques.

2. Monitoring and Follow-Up: Regular follow-up with your gynecologist is essential. If your symptoms worsen or if you experience significant changes in your menstrual cycle, further imaging studies or evaluations may be warranted to rule out other potential issues.

3. Medical Treatments: Depending on the severity of your symptoms and the size of the fibroids, your doctor may recommend hormonal treatments, such as birth control pills or hormonal IUDs, to help regulate your menstrual cycle and reduce bleeding. In some cases, medications like GnRH agonists can be used to shrink fibroids temporarily.

4. Surgical Options: If your symptoms are severe and do not respond to medical management, surgical options may be considered. These can include myomectomy (removal of fibroids) or hysterectomy (removal of the uterus), depending on your reproductive plans and the extent of the fibroids.

5. Alternative Therapies: While your gynecologist may be skeptical about the effectiveness of traditional Chinese medicine, some patients find relief through acupuncture or herbal treatments. It is crucial to discuss any alternative therapies with your healthcare provider to ensure they do not interfere with your current treatment plan.

Conclusion
In summary, the pain and bleeding you are experiencing are likely related to your uterine fibroids, exacerbated by hormonal changes during your menstrual cycle. While pain management is essential, it is equally important to have a comprehensive approach that includes regular monitoring and potential medical or surgical interventions if necessary. Always communicate openly with your healthcare providers about your symptoms and treatment preferences to find the best approach for your situation.

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