Populations and Risk Factors
- Women of reproductive age (growth stimulated by estrogen)
- African American women (2-3 times higher prevalence, earlier onset, larger tumors)
- Family history of fibroids
- Obesity (increased estrogen conversion in adipose tissue)
- Early menarche
- Nulliparity (pregnancy appears to be protective)
Causes and Pathophysiology
- Estrogen-dependent growth: Fibroids contain more estrogen receptors than surrounding myometrium. Estrogen and progesterone stimulate proliferation
- Genetic factors: Multiple gene mutations identified in fibroid tissue. Strong familial pattern
- Growth patterns: Enlarge during pregnancy (high estrogen) and shrink after menopause (estrogen withdrawal)
- Types by location: Intramural (within myometrial wall — most common). Submucosal (project into uterine cavity — most likely to cause heavy bleeding). Subserosal (project outward from uterine surface). Pedunculated (attached by a stalk — torsion risk)
- Degeneration: Large fibroids may outgrow their blood supply, causing acute pain from necrosis (red degeneration, especially during pregnancy)
Signs and Symptoms
- Heavy or prolonged menstrual bleeding (menorrhagia) — can lead to iron deficiency anemia
- Pelvic pressure or heaviness
- Frequent urination (bladder compression)
- Constipation (rectal compression)
- Enlarged uterus (may be palpable above the pubic bone)
- Lower back pain
- Dyspareunia (pain during intercourse)
- Many fibroids are asymptomatic and discovered incidentally
- Red flags: Post-menopausal fibroid growth or new bleeding requires immediate investigation to rule out uterine malignancy; sudden severe pain may indicate degeneration or torsion of a pedunculated fibroid
CMTO Exam Relevance
- Fibroids are benign — they are NOT cancer, but share some symptoms with uterine cancer
- Heavy menstrual bleeding in a pre-menopausal woman is the most common presentation
- Any post-menopausal growth or bleeding requires investigation to rule out malignancy
- Deep abdominal pressure over known fibroids is contraindicated
- Iron deficiency anemia from chronic menorrhagia may present as fatigue, pallor, and exercise intolerance — modify session intensity
Massage Therapy Considerations
- Avoid deep abdominal pressure over a known large fibroid — risk of discomfort and potential tissue disruption
- Gentle massage for comfort is appropriate and may help with secondary back pain, pelvic tension, and stress
- Position for comfort if the uterus is enlarged (prone may be uncomfortable due to pressure on the abdomen)
- Anemia awareness: Clients with chronic menorrhagia may fatigue easily. Adjust session length and intensity
- Post-surgical considerations: After myomectomy or hysterectomy, follow standard post-surgical protocols (scar mobilization, ROM, lymphatic support)
- Refer immediately if client reports sudden onset of heavy bleeding, severe pain, or rapid growth
Key Takeaways
- Uterine fibroids are extremely common benign myometrial tumors that are estrogen-dependent
- They grow during reproductive years and shrink after menopause. Heavy menstrual bleeding is the hallmark symptom
- Deep abdominal pressure over known fibroids is contraindicated
- Post-menopausal fibroid growth or new bleeding requires immediate medical referral to rule out malignancy
- Chronic menorrhagia can cause iron deficiency anemia — adjust session intensity for fatigued clients