Fibroid degeneration is the breakdown of a fibroid through cell death. This is caused by ischemia (a lack of adequate blood supply) in the fibroid.
This ischemia is usually the result of a fibroid growing too large for its blood supply, but it can also be caused by mechanical compression (blockage) of the feeder arteries.
Fibroid degeneration can occur during pregnancy when the growth of the pregnancy compromises the blood supply of the fibroid, or when a pedunculated fibroid (a fibroid attached by a thin stalk to the uterus) becomes twisted (torsion) and cuts off the fibroid’s blood supply.
Degeneration or secondary changes can be found in 65% of uterine fibroids.
Types of Degenerating Fibroids
The type of degeneration appears to depend on the degree and rapidity of onset of the vascular insufficiency (lack of adequate blood supply).
Types of degenerating fibroids include:
Hyaline Degeneration
Accounts for 63% of casesThe fibroid’s normal connective tissue and smooth muscle fibers are replaced by hyaline tissue (the most common type of cartilage, which has a glossy and smooth appearance)Caused by a fibroid outgrowing its blood supply
Myxoid Degeneration
Accounts for 19% of cases Gelatinous appearance (looks like it’s melting) under a microscope Has clear and mucus-like connective tissue No mitotic activity (its cells are not dividing and growing as normal cells do) Can have similar features as some leiomyosarcomas (rare cancer), so it is important that a pathologist takes the time to make the distinctions between the different types of fibroid degenerations
Calcification
Accounts for 8% of casesCalcium deposits form when a fibroid is dyingTransforms some of the tissue into a hard mass
Cystic Degeneration
Accounts for 4% of cases Seen more often after menopause Presents in a liquid, honeycomb pattern under a microscope May mimic an ovarian cyst
Red Degeneration
Accounts for 3% of cases Also called “carneous” Usually occurs during pregnancy, but can happen in people who are not pregnant, particularly those using contraceptive drugs Turns almost completely red due to massive internal hemorrhaging (bleeding) Usually from a ruptured blood vessel inside the fibroid Fibroid degeneration during pregnancy is called necrobiosis Fibroids occur in up to 12. 5% of all pregnancies Can cause abnormal bleeding and severe abdominal pain Can be caused by fibroid tissue outgrowing its blood supply Can be caused by the growing uterus causing distortion and kinking of the blood vessels, interfering with the blood supply to the fibroid Pain may also be caused by the prostaglandins (hormones that influence pain levels and inflammation) produced by damage to the cells in the fibroid
Pedunculated fibroids (fibroids attached to the uterus by a thin stalk) are more prone to degeneration because they can become twisted and cut off the blood supply to the fibroid. They can be more painful and last longer than regular degeneration.
Symptoms
Typical symptoms of fibroids can include:
Menstrual periods lasting longer than seven days More frequent menstrual periods Heavier than normal bleeding during menstrual period Painful menstrual periods Irregular bleeding between periods Pelvic pain Abdominal pain Sudden or severe abdominal pain Abdominal bloating and/or cramping A feeling of fullness or heaviness in the pelvis/lower abdomen Fever Pain during sex Lower back and/or thigh pain Anemia Urinary incontinence Frequent urination Difficulty urinating or other bladder symptoms Constipation Rectal pressure Difficulty with bowel movements, or other bowel symptoms
In addition to the symptoms of fibroids, signs that fibroids may be degenerating include:
Acute pain: Most common symptom. A sharp pain in the abdomen that may be accompanied by swelling. May be acute pelvic pain focused on the site of the fibroid. Can last from a few days to a few weeks. Chronic pain: Less severe, lasting pelvic pain Fever: Often during pregnancy. May be mild. Bleeding: May be severe. Seek immediate care for abnormally heavy bleeding, including during menstrual periods. Temporary elevation in the white blood cell count
Your Symptoms May Go Away
When a fibroid degenerates, it shrinks. Once it has reduced to a size that can once again be supported by its blood supply, it can stop degenerating. This often causes the pain to decrease or subside.
Though symptoms may have gone away, it is still important to see a healthcare professional and address the problem. Fibroids will begin to grow again once they start receiving adequate blood supply, and will eventually reach the point they start degenerating again, causing a painful cycle.
When to See a Doctor
Any symptoms of fibroids or degenerating fibroids warrant a visit to a healthcare provider. While fibroids themselves are not usually life-threatening, they can cause discomfort and complications such as anemia, and put stress on surrounding organs.
In addition to the fibroids themselves, symptoms of degenerating fibroids can mimic more serious conditions, and can also be harder to diagnose with imaging equipment.
Seek immediate medical attention if:
You have severe vaginal bleeding. You have new or worse belly or pelvic pain.
Preventing Degeneration
The best way to prevent fibroids from degenerating is to treat the fibroids before they degenerate and take measures to stop them from recurring.
Fibroid Treatment
Treatment for fibroids and fibroid symptoms include:
Medications such as:
Tranexamic acid (TXA) Combined oral contraceptive pills Progestin-releasing IUD (intrauterine device) Progestin pills Gonadotropin-releasing hormone (GnRH) agonists NSAIDs (nonsteroidal anti-inflammatory drugs)
Surgeries such as:
Hysterectomy (removal of the uterus) Myomectomy (removal of the fibroids)
Medical procedures such as:
Uterine fibroid embolization: A catheter is placed through the groin into the uterine artery, where small coils or pellets are released to block the blood supply to the fibroids. Radiofrequency ablation: High-energy waves are used to generate heat that destroys fibroids. Magnetic resonance imaging (MRI)–guided focused ultrasound: High-intensity ultrasound waves are used while the person is in an MRI scanner to heat and destroy the uterine fibroids. Endometrial ablation: Heat is used to destroy the endometrium (the lining of the uterus).
How long does fibroid degeneration take?
The pain from a degenerating fibroid can last from a few days to a few weeks, but everyone experiences fibroids differently.
It is still important to seek medical care after the symptoms subside, as fibroids are likely to grow and degenerate again.
How do you help fibroid degeneration pain?
In the short term, pain from a degenerating fibroid can be managed by taking an NSAID medication, such as ibuprofen (Advil, Motrin), or naproxen (Aleve).
For long-term, and often permanent, relief, the fibroids need to be treated and/or removed.
What happens to a fibroid after degeneration?
Fibroids shrink during degeneration until they are small enough to reestablish an adequate blood supply.
Once this happens, the fibroids begin to grow again until they get too big and start the process of degeneration again.
For this reason, it is important to seek medical care for degenerating fibroids, even if symptoms subside.
A Word From Verywell
Fibroid degeneration can be painful and may cause unpleasant symptoms, but it can be managed and even go away completely with treatment.
If you notice any signs of fibroids or fibroid degeneration, see your healthcare provider.
