Uterine fibroids are non-cancerous growths that develop in or on the muscular wall of the uterus. Many women with fibroids do not have any symptoms or complications. However, some women may experience pelvic pain, heavy menstrual bleeding, frequent urination, and back pain among other symptoms.
What are fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are benign smooth muscle tumors that grow in the wall of the uterus. Fibroids can grow as a single tumor or in clusters. They typically range in size from a few millimeters to the size of a large melon. There are several types of fibroids:
- Intramural fibroids – grow within the muscular uterine wall
- Subserosal fibroids – grow on the outer wall of the uterus
- Submucosal fibroids – grow just underneath the uterine lining
- Pedunculated fibroids – grow on stalks inside or outside the uterus
Fibroids are very common, affecting about 70% to 80% of women by age 50. However, not all fibroids cause symptoms or problems. Treatment may not be necessary if the fibroids are small and do not cause significant discomfort or disrupt normal activities.
What causes fibroids?
The exact cause of fibroids is unclear. However, fibroids seem to be influenced by the hormones estrogen and progesterone. During the reproductive years, fibroids tend to grow larger when estrogen levels are high. After menopause, when estrogen levels decrease, fibroids usually shrink.
Other factors that can increase a woman’s risk of developing fibroids include:
- Family history – having a mother or sister with fibroids increases risk
- Obesity
- Never having been pregnant
- Early onset of menstruation (before age 12)
- Vitamin D deficiency
- Poor diet
- Genetic changes or mutations
What are the symptoms of fibroids?
Most women with fibroids do not have any symptoms or complications. However, when symptoms do occur, they may include:
- Heavy, prolonged menstrual periods
- Pelvic pain and pressure
- Frequent urination
- Pain during intercourse
- Lower back pain
- Reproductive issues, such as infertility, miscarriages, or early labor
- Bloated abdomen
- Constipation
Symptoms may vary based on the location, size and number of fibroids present. Large fibroids may press on the bladder, rectum or pelvic bones, causing pain and discomfort.
Can fibroids cause back pain?
Yes, in some cases, uterine fibroids can cause back pain. Back pain is not one of the most common symptoms of fibroids, but large fibroids may put pressure on the spine, nerves, muscles or ligaments in the back.
Here are some ways that fibroids could potentially contribute to back pain:
- Compression of spinal nerves – Large fibroids, especially those located at the back of the uterus, can compress or irritate spinal nerves, causing back pain that radiates down the legs.
- Pressure on pelvic bones – Fibroids can grow large enough to press on the sacrum or other pelvic bones, causing aching lower back discomfort.
- Changes in posture – The weight and bulk of enlarged fibroids can pull the pelvis forward, putting strain on the muscles and ligaments that support the back.
- Trigger points – Fibroids may cause trigger points or spasms in the pelvic floor muscles that refer pain to the lower back area.
Women who have existing back problems may find their pain gets worse if they develop large fibroids. Back pain associated with fibroids often improves significantly after uterine fibroid treatment.
How are fibroids diagnosed?
If fibroids are suspected based on symptoms, a doctor will perform a pelvic exam to check for any enlargement of the uterus. Further testing may include:
- Ultrasound – A transvaginal or abdominal ultrasound can allow visualization of the size, shape and location of uterine fibroids.
- MRI – An MRI provides detailed images of the pelvic area and can confirm fibroids.
- Hysteroscopy – A camera on a thin tube is inserted into the uterus allowing direct visualization of fibroids in the uterine cavity.
- Laparoscopy – A minimally invasive surgery where a small incision is made and a camera is used to view the pelvic area, allowing confirmation of subserosal fibroids on the uterus.
These imaging tests can help determine whether back pain and other symptoms are being caused specifically by uterine fibroids rather than another condition.
How are fibroids treated?
Treatment depends on the severity of symptoms and whether a woman still wishes to have children. Options may include:
- Medications – Drugs like ibuprofen, birth control pills, and gonadotropin-releasing hormone agonists can help manage pain and regulate hormones.
- Myomectomy – Fibroids are surgically removed while leaving the uterus in place.
- Hysterectomy – Surgical removal of the uterus. This ends menstruation and the possibility of pregnancy.
- Uterine artery embolization – Blocking blood flow to fibroids to cause them to shrink.
- MRI-guided ultrasound surgery – High-intensity ultrasound waves destroy fibroid tissue.
Treatment is aimed at improving symptoms and may shrink or remove fibroids. Resolving fibroids can potentially relieve associated back pain in many cases.
When to see a doctor
See your doctor promptly if you experience:
- Severe or persistent pelvic pain
- Excessively heavy menstrual bleeding
- Sudden, rapid growth of the abdomen
- Pain or pressure affecting your daily activities
- Back pain that does not respond to over-the-counter painkillers
- New onset sciatica or pain radiating down the legs
- Pain during sex
- Infertility or multiple miscarriages
While fibroids do not always require treatment, large or symptomatic fibroids should be evaluated. Proper management can help resolve pain, bleeding, infertility and other complications.
Conclusion
Uterine fibroids can sometimes contribute to lower back pain, especially when they are large, numerous or located in the posterior uterine wall. Fibroids may compress spinal nerves, put strain on musculoskeletal structures, or cause referred pain from trigger points.
If you develop persistent, worsening back pain along with other fibroid symptoms like heavy periods and pelvic pain or pressure, see your doctor. Imaging tests can determine if fibroids are present and responsible for your symptoms.
Various treatment options are available for shrinking or removing symptomatic fibroids and relieving associated pain. Addressing the underlying fibroids may help resolve back discomfort in many women with uterine fibroid-related back pain.
References
- Uterine Fibroids. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/uterine-fibroids.
- Uterine fibroids. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288.
- Can Fibroids Cause Back Pain? CIGC. https://www.cigc.com/blog/can-fibroids-cause-back-pain/.
- Symptoms of Uterine Fibroids. Fibroid Treatment Collective. https://fibroidtreatment.com/symptoms-of-uterine-fibroids/.
- Uterine fibroids and back pain. IFL Science. https://www.iflscience.com/uterine-fibroids-and-back-pain-all-you-need-to-know-62408.