Most uterine fibroids are small and do not produce any symptoms. Many women may not even be aware that they have them until their physician, usually a gynecologist, discovers them during a routine pelvic examination.

When symptoms occur, they are related to the number, size and location of the fibroids. They include:

• Abnormal uterine bleeding. Prolonged and heavy menstrual periods (menorrhagia) are often associated with large intramural and submucosal  fibroids, which can distort or enlarge the uterine cavity and create a larger surface area for bleeding. However, women with all types of fibroids can experience heavy menstrual bleeding. The cause of abnormal bleeding is not completely understood. Menorrhagia can put women at risk of developing anemia (reduced blood iron levels). Women with fibroids also may experience more severe menstrual cramps. Sometimes, fibroids may cause bleeding or spotting between periods (metrorrhagia).
  
  
• Pelvic pain or pressure. Depending on the location, large fibroids can press and/or cause pain in the pelvic organs including the uterus, ovaries, fallopian tubes, cervix, vagina, bladder or rectum. The pain also may extend to the lower back and legs. Large and bulky fibroids also may make sexual intercourse uncomfortable or painful. Pain is most frequently associated with the premenstrual period and menstruation, but in some rare cases pain may occur throughout the menstrual cycle.
  
  
• Bladder and/or bowel problems. Large fibroids that press on the bladder or ureters can cause frequent urination or difficulty urinating. Prolonged pressure on the ureters also can result in recurrent urinary tract infections, urinary incontinence and bladder or kidney infections if the fibroids are not removed. Large fibroids that are located in the lower portion of the uterus can put pressure on the large bowel and rectum, which can result in bloating and gas, painful bowel movements (dyschezia), constipation and/or hemorrhoids (swollen veins in the anus and lower rectum that may bleed).

Patients experiencing any of these symptoms should consult their physician, preferably a gynecologist, to determine the cause.

In rare cases, a fibroid can cause sudden and severe pain when it outgrows its blood supply. Deprived of blood, the tumor begins to break down (degenerate) and eventually dies. Substances from a degenerating fibroid can seep into surrounding tissue in the uterus causing severe pelvic pain accompanied by mild fever and nausea. A pedunculated fibroid, which hangs by a stalk, also may cause acute pain by turning on the stalk. This condition also is uncommon. In such instances, uterine fibroids can require emergency treatment.