Fibroid Pain

Fibroid pain is curable, read on to discover how to treat fibroid pain. Uterine fibroids are usually painless and do not normally cause symptoms, but this is not much consolation if your fibroids are painful. A fibroid is only painful for a reason. If one grows large enough then it can produce pelvic discomfort simply because of its size. A large fibroid will stretch uterine ligaments and press on other pelvic organs within the pelvis. Bodily movements and even simply walking around may cause a fibroid to produce pelvic pain if it is above a certain size.

image of woman with fibroid pain

Click here to discover how to shrink fibroids naturally

Fibroid pain

At the time of menstruation a fibroid may cause normal period pain to worsen (producing dysmenorrhoea). This is because a fibroid can distort the muscle of the uterus during a menstrual cramp and cause pain. A submucosal fibroid can cause a period to be heavier and make menstruation more unpleasant and painful. A myoma can produce low back (lumbar) pain. This occurs if the myomata press on the nerves, ligaments or muscles of the spine. A large leiomyoma which is present at the back (posterior aspect) of the uterus is much more likely to produce back pain than a fibroid that is small and confined to the wall of the uterus. Lumbar pain is very common, and other reasons for the discomfort should be investigated before putting it down to myomata.

Other sites for pain from a fibroid include: the hip, groin, pelvis, lower abdomen, thigh, ribcage (aching ribs) and flank. A large fibroid may press on the rectum and produce symptoms. These include: constipation, difficulty having a bowel movement, pain on opening the bowels or a sensation of rectal fullness. These symptoms are much more likely to be due to a problem with the bowel and should be investigated appropriately. A leiomyoma may press on the urinary bladder and in this way produce frequency of micturition (the need to pass urine very often) or urgency to pass urine. A fibroid may press on and even decrease the capacity of the bladder. If a myoma grows large enough it may impinge on the colon (large bowel) and cause pain or constipation.

A woman who has a large myoma may suffer pelvic discomfort. She will often describe this as an unpleasant heaviness or pressure sensation within the lower abdomen or pelvic region. She will often describe the feeling as a vague discomfort and not a sharp stab. A uterus that has grown large can make exercising or bending over uncomfortable. It can also make it unpleasant or difficult for a woman to lie on in a prone position on her stomach.

A fairly rare symptom is acute, extreme pain. If a fibroid undergoes what is known as red (or carneous) degeneration this may cause severe pain. With red degeneration the pain is felt in one spot in the lower abdomen and generally resolves over 2 to 4 weeks. The treatment is conservative with painkillers and rest.

Extremely rarely a fibroid may rotate on its stalk. This stops blood flowing to the fibroid and is called torsion. The result is extremely severe sudden lower abdominal pain. This is a gynaecological emergency and surgical treatment is necessary.

fibroid pain picture

Sometimes fibroids can cause chronic pelvic pain. This is difficult to manage and may require surgical treatment of the fibroids if it persists. Fibroids can cause pain or discomfort during sexual intercourse (dyspareunia). This may happen only in certain positions or at particular times of the menstrual cycle. Dyspareunia is an important symptom that is not always discussed, and if your doctor does not ask, then it is important to bring it to his or her attention. 

About fibroids

Fibroids are common, benign, firm, roundish tumours, enclosed in fibrous capsules, that form in the wall of the uterus (womb). The medical term for fibroids is leiomyoma (pleural leiomyomata or leiomyomas) or simply myoma (a type of mesenchymal tumour, the pleural is: myomas or myomata).

Fibroids are always benign (they are not cancerous, never invasive and never spread to other parts of the body). Fibroids can grow as a single tumour, or they can be multiple with many fibroids within the uterus. Myomas can be as so small that they can only be seen with a microscope, as tiny as an apple pip or as large as a melon. In extreme cases they can grow to be enormous. 

Fibroids usually cause no symptoms, but they can produce discomfort, heaviness, fibroid pain, pelvic pain or other unpleasant painful symptoms and referred pain. Women with problems from fibroids state that they can be difficult to have to live with. Leiomyomas can hurt and cause misery. It has been estimated that about 30% of women with fibroids have pain. Uterine fibroids are very common and it is estimated that somewhere between 25% to 80% of women by the age of 50, will have a fibroid if investigated thoroughly. A typical woman with fibroids will have several leiomyomata of varying sizes. Leiomyomata occur most commonly in women in their 40s and early 50s.

Understanding the anatomy of the womb helps in comprehending myomata. The majority of the uterus is composed of smooth muscle which is called the myometrium. The outer layer of the myometrium is known medically as the serosa. The inner lining of the uterus is a layer named medically as the endometrium. The endometrium is the lining of the womb that is shed during a menstruation each month with a period. The endometrium is made up of the stroma and the glans. It does not contain muscle.

Frequency of Fibroid Pain

This varies enormously between women. The pain may be constant and present all day every day (this is unusual), or it may be random and very intermittent. It is often worse with a period. Other aggravating or precipitating causes are bending over, moving around, lying face down, jumping up and down, exercise, running, sexual intercourse and having a period.

Patterns of Pain

As mentioned above the pain may be constant or have a variable and random periodicity. It may last from a few seconds to minutes or hours. It may occur daily, weekly or monthly.

Types of Pain

The pain is usually described as a heaviness or discomfort. This is a mass effect due to a bulk-effect from an enlarged womb. Women often describe a sense of pressure pushing downward, sometimes bloating, as if trying to lift a heavy weight in their abdomen. Women have been known to describe having fibroids as: “like wearing a tool belt, with all the tools in it.” “I had absolutely no appetite and would even be sick sometimes after meals." "I looked like I was going to give birth soon!”

Many women feel that they are pregnant with all the fullness that goes with it. Some women describe "a sensation of hardness beneath their navel and feel that it's pushing all the other organs around." Some have problems taking in a full deep breath and described themselves as becoming winded easily.

Another said: "this chronic fibroid ache really wears me down and make me depressed." It is common for women to comment that they get: "that feeling of pain like before your period starts". One said: “It's that heavy, full, there's-somebody-standing-on-my-pelvic-bone feeling.”

woman with fibroid pain and the uterus with fibroids

Woman experiencing fibroid pain 

Another described the sensation of “aliens” in her abdomen with: “stabbing pains, pressure, protruding tummy, constant backache, constant trips to the toilet, constipation, stabbing pains down my right leg and, the worst, painful intercourse” When lying down she could “feel the little alien like an orange”. "My fibroid pain was dreadful".

Another: “feeling like stuff is squished in there” and “stabbing pains where my ovaries are located”.

Other women had to wear larger clothes and said that they looked bloated and pregnant.

Myomas do not tend to cause sensations that are described as "throbbing, burning, griping, smarting, pricking, stinging or tingling". Instead fibroid pain tends to be a heaviness or pelvic discomfort.

Referred Pain from Fibroids

Fibroids are located in the central pelvis, but they can cause referred pain in many different places, such as the spine, lumbar region, hip, groin, upper leg, abdomen, upper abdomen, chest, ribcage, vagina, cervix, bowel, bladder, ovary, umbilicus and buttock. Very rarely fibroids may lead indirectly to sciatic nerve pressure and the agonising symptom of sciatica. It is important to make the correct diagnosis if pelvic pain is present.

Fibroid pain can be confused with other pelvic diseases.

There are many causes of pelvic pain. These include: From the uterus – clot colic, adenomyosis and prostaglandin pain. Ovarian pain can be due to ovulation pain, ovarian cysts, ovarian remnant syndrome and ovarian cancer. Colonic pain may be secondary to bloating/wind, irritable bowel syndrome, constipation, inflammatory bowel disease (colitis and crohns disease) and food intolerance. From the urinary bladder, examples include: urinary tract infection, interstitial cystitis and bladder cancer. Discomfort and colic can arise from adhesions. Neuropathic pain arising in sensory nerve endings is difficult to treat. Pain arising in the pelvic venous system may be caused by conditions such as pelvic congestion syndrome and ovarian vein syndrome. The appendix may cause lower abdominal pain. Pelvic infections and pelvic inflammatory disease also cause pelvic pain. A rare cause of pain in the pelvic cavity is endosalpingiosis. 

fibroid pain images

Other Fibroid Symptoms

Heavy menstrual bleeding (menorrhagia) is a common symptom of fibroids. They do not normally lead to postmenopausal bleeding or bleeding between periods. These are symptoms that require investigation to rule out serious causes. Fibroids may also cause periods to be more prolonged, may cause irregular vaginal bleeding and the passing of blood clots, flooding and gushing. The bleeding may even be very painful. If the blood loss is heavy and/or prolonged bleeding then it may result in anaemia (low haemoglobin or red blood count level) and low iron stores in the bone marrow. This can lead to fatigue, exhaustion, pallor, shortness of breath, palpitations and tiredness.

As mentioned above, they may produce urinary frequency, urgency, urinary incontinence, constipation, tenesmus (sensation of incomplete emptying of rectum – needs investigation), varicose veins or swollen lower legs (if they press on pelvic veins), rarely they may cause retention of urine (inability to pass urine), increase in waist size and alteration in contour of the abdomen.

A fibroid may have no symptoms and simply be discovered during a routine physical, abdominal or pelvic examination by a health professional, or be diagnosed on a routine scan or investigation carried out to investigate unrelated symptoms.

An often neglected issue is that of the psychological and emotional state of the sufferer. Often the physical problems are given priority and the emotional or mental issues are neglected. Fibroids may cause emotional problems in various ways. Firstly, having chronic discomfort is emotionally draining, secondly, the awareness that there is a problem with the womb and that all is not normal, is upsetting, thirdly the associated hormonal imbalances can lead to mood changes. In addition there is the stress of coping with the pain, heavy bleeding, prolonged periods and painful cramps. So myomata may even cause anxiety and/or depression.

Very, very rarely a fibroid can lead to pressure one or other ureter. These 2 important tubes pass down from each kidney into the bladder. They carry urine to the bladder. Pressure on a ureter can obstruct the free flow of urine and lead to back pressure in the kidney. If untreated this is serious. It results in a condition known as hydronephrosis. This may be asymptomatic, it may cause renal failure and the typical symptom of hydronephrosis is one of loin discomfort relieved by passing urine and emptying the bladder.

Treatment of pain from fibroids

If you are experiencing fibroid pain the best treatment in the short term is painkillers (analgesics) such as acetaminophen (paracetamol, Tylenol) or ibuprofen (Advil, Nurofen). These work well for mild to moderate pain. For more severe pain stronger analgesics requiring a doctor’s prescription are needed. Examples include stronger NSAIDS like diclofenac, mefenamic acid and naproxen or opiates such as codeine, dihydrocodeine, pethidine or morphine.

There are other ways of relieving pain from fibroids.

These include: Gentle therapeutic massage, the careful use of thermal heat pads, or ice-packs to the site of the pain, poultices, TENS machines, acupuncture, and hypnosis. Caution: there is a risk of burns when using heat pads or ice-packs (ice-burns). Prolonged or incautious use may result in skin burns, permanent colour changes to the skin (erythema ab igne) and skin damage. Always follow the manufacturer’s instructions.

fibroid pain - smiling woman who has cured her painful fibroids

It is possible to relieve pain from fibroids

Risk Factors for Myomata include:

  • Age. They are more common as women get older, particularly from the age of 30 to 55. After the menopause the uterus and therefore also the fibroids tend to shrink.
  • Genetics. If there is a family member who is affected then your risk increases. If your mother had fibroids then your risk is increased to about three times the average risk.
  • Ethnic origin. African-American women are considerably more at risk of developing fibroids than white women.
  • Being obese. Those women who are overweight have a greater risk, and those who are obese have approximately a two to threefold increased risk.
  • Diet. It has been discovered that diet high in red meat and ham is associated with a greater rate of getting myomata. It has also been found that eating lots of green vegetables actually reduces the risk.

fibroid pain - diet can help to treat fibroids

Diet can help fibroids

Main fibroid section on this website: Fibroids

Types of Fibroids

Uterine fibroids (also called fibroma, fibromyoma, myoma or leiomyofibroma) are the most common female pelvic tumour, occurring in an estimated 20-40% of women in reproductive age. They develop from microscopic nests of uterine muscle cells and have been documented to be composed of numerous copies of the same or very few cells (monoclonal expansion). They are benign growths of smooth muscle and connective tissue anchored in the muscular wall of the uterus, whose growth rate is influenced by oestrogen, growth hormone, and progesterone.

Intramural fibroids (are entirely within the wall of the uterus).There are four types of fibroid:

  1. Submucosal – these grow on the inside of the uterine cavity (are immediately adjacent to, or protrude into, the uterine cavity)
  2. Intramural – these form inside the muscular wall (myometrium) of the womb. This type is the most common.
  3. Subserosal – these develop on the outer aspect of the uterus (they distort the contour of the outer surface of the uterus).
  4. Pedunculated – these grow on stalks out from the outer lining of the womb or into the internal cavity of the womb.

picture of types of uterine fibroids and their location in the uterus

Aetiology or Causes

It is not known for certain why certain women and not others develop myomata. It is likely there are several factors. These include:

  • Hormones – growth of leiomyomata is affected by levels of oestrogen and progesterone. They can grow quickly during the first three months of pregnancy (especially the initial 10 weeks) and shrink when hormone levels fall after the menopause. They also shrink when anti-hormone drugs are prescribed.
  • Genetic Factors – The tendency runs in families.

Fibroids and Cancer

Fibroids are benign. They are not cancerous because they do not invade into surrounding tissues and do not spread (metastasise) to other parts of the body. Very rarely a fibroid may change (like any tissue of the body) into a cancer (carcinoma). If this happens then the cancer is known as a leiomyosarcoma. The risk of this occurring is usually quoted as being less than 1 in 1000 and is in reality much less than this. Having myomas is not a risk for developing uterine cancer or endometrial cancer.

Diagnosis

A doctor may diagnose fibroids during a routine pelvic examination. The doctor may be able to palpate the fibroids, which on examination feel like a painless lump or swelling on the womb. The doctor may explain the size of the fibroid by making a comparison with a familiar object such as a peanut, apple, melon, tennis ball or basketball. The diagnosis can be confirmed with imaging investigations such as ultrasound scanning.

Examples of investigations used for diagnosis are:

  • Ultrasound Scan. This uses sound waves to produce an image of internal organs. The ultrasonographer or radiologist will use a probe which is placed on the abdomen or inside the vagina to produce an image.
  • Magnetic resonance imaging (MRI) scan. This uses radio waves and large magnets to produce a very clear and detailed picture.
  • X-rays. These use a type of radiation which passes through the body and produces pictures of bones and internal organs.
  • Computerised axial tomography (CAT or CT) scan. This uses multiple images using X-rays from different angles, usually in slices, to construct a more detailed and better image than plain X-ray.
  • Hysterosalpingogram (HSG). This test involves an injection of dye, which shows up with X-rays, and then taking pictures using X-ray.
  • Sonohysterogram. In this test water is injected into the cavity of the womb and then images are produces using an ultrasound scanner.

Fibroid pain - diagnosis of uterine fibroid symptoms with ultrasound

Above: ultrasound picture of fibroids 

Other investigations involve surgical techniques to directly examine the uterus.

Currently there are two surgical ways of examining the uterus.

  1. Hysteroscopy. During this investigation the gynaecologist will pass a long thin tube, which has a light and telescope at the end, into the vagina and through the cervical canal into the uterine cavity. No incision or cut is necessary. Local anaesthetic (ideally paracervical local anaesthetic injection) is used to numb the cervix. The gynaecologist can directly visualise the inside of the womb and look for polyps, fibroids or other problems. Pictures and tissue samples can be taken.
  2. Laparoscopy. A tiny incision (cut) is made below the umbilicus (navel). The surgeon then passes a long thin telescope through the incision. The tube has a light and telescope at the end. The gynaecologist can then directly examine the organs of the lower abdomen and pelvis. The outside of the uterus and ovaries can be examined. Picture and tissue samples can be taken.

Questions to ask your gynaecologist.

  • How many fibroids do I have?
  • How large are my fibroids?
  • Where are the fibroids located in the womb? For example: inside the cavity, in the wall or on the outer surface.
  • Do you think the fibroids will get larger?
  • How quickly are they growing?
  • If they have previously been diagnosed and are being monitored. How can I tell if the fibroid is enlarging?
  • What medical problems may the fibroid cause?
  • What symptoms can I expect?
  • Which investigations can be used to monitor the fibroids?
  • Is treatment necessary?
  • What are the treatment options?
  • What is your opinion about the various treatment options?
  • For example what is your opinion about surgical treatments (like myomectomy or hysterectomy) compared with other types of treatment?

If your questions have not been answered to your satisfaction, then a second opinion from another gynaecologist may be worth seeking.

Treatment

It is not always necessary to treat leiomyomata. The majority of women with leiomyomata have no symptoms and their fibroids cause no problems. Leiomyomata are benign (not cancerous) and can safely be left untreated. Those leiomyomata that produce symptoms are causing problems can be treated. You should discuss your therapy options with your family doctor or gynaecologist. Your medical advisor will consider numerous factors before helping you decide on the ideal therapy.

Some of these factors include:

  • The symptoms that you are experiencing.
  • The size of the myomata
  • The location of the myomata within the uterus
  • Your age and how close you are to the menopause
  • Whether you wish to fall pregnant and have children in the future

If you have no symptoms then you and your doctor may decide that no treatment is necessary. Your doctor will arrange follow up and investigations to monitor the leiomyomata and check on the size of the leiomyomata.

It is possible to shrink fibroids naturally. 

Click Here to Discover how to Shrink Fibroids Naturally

Treatment with medication

If you have myomata and mild symptoms such as mild fibroid pain, then your doctor may recommend medication such as simple analgesics. Medication bought without a prescription, such as acetaminophen (paracetamol in the UK) or ibuprofen may be sufficient for mild pain.

If you have menorrhagia then your doctor may advise iron supplements to help prevent anaemia or to treat anaemia if you already have a low blood count.

Medication that is commonly taken as oral contraception may be suggested and prescribed for the relief of symptoms from myomata. Taking a low dose oral contraceptive pill does not cause fibroids to enlarge and often helps to reduce heavy bleeding.

The injectable long acting contraceptive containing progesterone (Depo-Provera) has the same beneficial effect.

There is a coil or intrauterine device (IUD) called Mirena that slowly releases a progesterone-like drug into the myometrium and which is used to control menorrhagia. It is also a contraceptive.

Stronger prescription medication sometimes used to treat myomata work as “gonadotropin releasing hormone agonists” (GnRHa). This means that they block the effect of gonadotropin releasing hormone and stimulate the synthesis and secretion of the gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), at the pituitary gland at the base of the brain. These drugs are able to shrink fibroids. They can be administered by injection or nasal spray or implanted. They are sometimes prescribed by gynaecological surgeons prior to surgery to reduce the size of leiomyomata and to make them easier to excise. GnRHa’s do have significant side effects which include hot flushes, depression, insomnia, reduced libido and arthralgia (joint pain). The vast majority of women find that their periods stop with GnRHa therapy. This is an enormous benefit to those women with menorrhagia and allows anaemia to resolve. These drugs mimic the menopause and produce thinning of bones. They are therefore usually only used for six months or less. They are also expensive, which can mean that in the USA some medical insurance companies will only cover some of the cost. GnRHa’s only produce temporary relief from the myomata symptoms. A major drawback is that the myomata often rapidly grow back to their original size.

Surgery

If your myomata are producing moderate or severe problems then your gynaecologist may recommend surgical treatment. There are a number of surgical treatments, which include:

Myomectomy

This is a type of surgical procedure which involves taking out the fibroid without removing healthy uterine tissue. This is a good treatment for those women who want to conceive after they have had treatment for their myomata or who prefer to keep their womb for other reasons. It is possible to fall pregnant after a myomectomy. However you may be advised to or require a caesarean section to deliver the baby. Myomectomy can be carried out in various ways. It can involve an incision in the lower abdomen (this is fairly major surgery), via a laparoscope or through a hysteroscope. Your gynaecological surgeon will discuss the pros and cons of the various options, which often depends on the location and particular size of the myomata. Following surgical removal leiomyomata may recur or new ones may develop and grow. All surgery carries some risk of complications. All the normal surgical risks apply to myomectomy.

removal of fibroid relieves fibroid pain

Hysterectomy

This is an operation which involves removal of the entire uterus. This is the only certain method of curing myomata completely. Myomata are the commonest medical condition leading to hysterectomy. Gynaecologists will usually recommend a hysterectomy if fibroids are substantial, if menorrhagia is an issue or a woman does not to have children. When myomata are large surgeons may need to carry out a hysterectomy by making an incision in the abdomen to take out the womb. When they are smaller the surgeon can carry out a vaginal hysterectomy (accessing the uterus via the vagina). Sometimes it is possible to carry out a laparoscopic hysterectomy. Hysterectomies are either “total” in which case the ovaries and cervix are removed along with the uterus. A subtotal hysterectomy leaves the ovaries and cervix. If the ovaries are preserved then you will not go into the menopause immediately after the hysterectomy. Performing a hysterectomy is a major surgical procedure. It is usually quite safe but there is a risk of surgical complications. The recovery time from a hysterectomy is 6 weeks to 3 months.

Endometrial ablation

In endometrial ablation the endometrium (inner lining of the womb) is destroyed or removed to treat menorrhagia. There are several ways of carrying out the ablation, these are: with wire loops, a laser, electrical current, boiling water, freezing, microwaves and other means. This type of surgery is generally viewed as minor surgery. It may be carried out as a day case, as an outpatient or even in a gynaecologist’s consulting room. There is a small risk of complications, but these are rare. The vast majority of women recover rapidly. The result of endometrial ablation means that about 50% of women experiences no periods after the operation and about 30% have menstrual bleeding that is much lighter. A major disadvantage is that women are unable to fall pregnant after this procedure.

Myolysis

During myolysis a fine needle is placed within the fibroid and freezing or electric current is used to destroy the myomata. The needle is usually guided with the help of a laparoscope.

Uterine Artery Embolisation (UAE) or Uterine Fibroid Embolisation (UFE).

In this procedure a fine tube is passed into the artery that supplies the myoma. The radiologist will then inject gel or tiny plastic particles into the artery. These block the artery and cut off the blood flow to the myoma. The myoma subsequently shrinks. UAE is performed as an inpatient or outpatient procedure. It is rare to get complications, but very rarely the procedure may precipitate an early menopause. Medical research has found that the re-growth rate is low, but more long term studies are required. A disadvantage is that not all myomata are suitable for treatment with this method. Women that are suited to this procedure are those who:

  • Women who do not want a hysterectomy
  • Women who have leiomyomata pressing on the rectum or bladder.
  • Women who have fibroids causing menorrhagia
  • Women who do not want to fall pregnant in the future.

Other therapies that are being researched for treating uterine leiomyomata Doctors are researching other methods for treating fibroids. These are not yet mainstream procedures and may not be available locally or covered by medical insurance in the USA. Anti-hormonal medications such as Mifepristone and others are being researched. These may provide symptomatic relief without the side-effects such as osteoporosis. These look like being promising therapies but are not yet FDA approved in the US. There is on-going medical research into other drug treatments for fibroids.

Laser treatment is provided by some gynaecologists to cut off the blood supply to the fibroid to make it shrink or to excise a fibroid.

MRI-guided ultrasound surgery uses a high intensity ultrasound beam to shrink myomata. The MRI scanner enables the radiologist to identify the myoma. The ultrasound uses extremely powerful sound waves to heat and destroy the myoma. One medical device that uses this technique is the ExAblate 2000 System. 

Fibroid Problems in Pregnancy

Fibroids can cause several problems during pregnancy and also reproductive problems with infertility. It is known that with a fibroid there is a greater rate of unavoidable miscarriage, infertility, placental abruption, premature onset of labour and childbirth, abnormal presentations of the baby (such as a breech presentation), difficult childbirth, a greater rate of lower segment caesarean section and bleeding after the baby is born (postpartum haemorrhage).

Red or carneous degeneration is a particular problem with fibroids during pregnancy, and a cause of severe agony and sometimes a fever.

Fibroids can grow during pregnancy, especially in the first trimester (mostly in the initial ten weeks) and produce pelvic discomfort or ache. It is reassuring to state that the majority of women with fibroids are able to conceive without difficulty and go on to have uncomplicated pregnancies and childbirth.

Before blaming a fibroid on infertility it is vital to fully investigate a woman and her partner to exclude other more common causes of infertility. A submucosal fibroid is the type most commonly associated with infertility and early miscarriages.

Fibroid pain in pregnancy - uterine fibroid and pregnancy seen with ultrasound scan

Above: uterine fibroid and pregnancy seen with ultrasound scan 

Read more: Fibroids and pregnancy

Read more about fibroids:

Pain following Uterine Artery Embolization (UAE) 

Nearly all women who undergo uterine artery occlusion by embolization have severe pelvic pain generally lasting 4 to 6 hours, but others, lasting up to a day. A few women do not experience pain. Women without pain may have a major collateral, such as a large communicating artery from the ovary, feeding the uterus. Or, women without pain may not have had complete bilateral occlusion of their uterine arteries. Close examination of published angiograms obtained at the completion of UAE with PVA particles reveals that the degree of “occlusion” of the uterine artery with bilateral embolization is different from one interventional radiologist to another. Some interventional radiologists carry out embolization until there is no antegrade flow in either uterine artery. Other interventional radiologists do not completely stop antegrade flow in the uterine arteries, bilaterally. If at the end of UAE there is no antegrade flow in both uterine arteries and the uterine arteries are clotted, the uterus will be ischemic. If, on the other hand, antegrade flow is still present at the completion of UAE, less of the uterus will be ischemic.

Three general types of pain occur following UAE. Pain immediately following UAE is most likely caused by transient ischemia of normal myometrium. Within 2 or 3 days following uterine artery occlusion, approximately 30%–40% of women also experience a second, longer episode of lesser pelvic pain associated with fever and leukocytosis. This type of pain is probably caused by the inflammation of fibroid degeneration. Finally, Min et al. have described a third type of nonmenstrual pain in 14 (16.1%) of 87 women that started, on average, 2 menstrual cycles following UAE.

It is possible to treat fibroids and fibroid pain