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GynoTalksM.D., F.A.C.O.G.

Patient Education

Uterine Fibroids

Benign growths of the uterus — what they are, when they need treating, and the medical and surgical options available.

Uterine fibroids are benign growths of the muscular wall of the uterus. They are remarkably common, and a great many women have them without ever knowing. Whether a fibroid causes trouble depends far more on where it sits and how large it is than on its simple presence.

When fibroids do cause symptoms — heavy periods, pelvic pressure, pain, or problems with fertility — treatment ranges from medication through minimally invasive procedures to surgery. Hysterectomy is one option among several, not the automatic conclusion.

Symptoms and warning signs

  • Heavy or prolonged menstrual bleeding, sometimes with clots
  • Pelvic pressure or a feeling of fullness in the lower abdomen
  • Frequent urination, or difficulty emptying the bladder, from pressure on it
  • Constipation or rectal pressure
  • Pain during intercourse
  • Lower back pain
  • An enlarged or protruding abdomen
  • Fatigue and shortness of breath from anemia caused by heavy bleeding
  • Difficulty conceiving, or recurrent pregnancy loss, with certain fibroid positions

Causes and risk factors

  • Age — fibroids become more common through the reproductive years and often shrink after menopause
  • Family history of fibroids
  • African ancestry, which is associated with earlier onset and larger fibroids
  • Starting periods at an early age
  • Obesity
  • Never having been pregnant
  • Vitamin D deficiency
  • Estrogen and progesterone exposure, which fibroids depend on to grow

How it is diagnosed

  • Pelvic examination, which often detects an enlarged or irregular uterus
  • Pelvic ultrasound, the usual first-line imaging
  • Saline infusion sonohysterography, to see fibroids that project into the uterine cavity
  • Hysteroscopy, a direct look inside the uterus
  • MRI, for precise mapping before surgery or embolization
  • Blood count, to check for anemia from heavy bleeding

Treatment options

Fibroids that cause no symptoms usually need nothing more than observation. Where treatment is needed, the choice depends on your symptoms, the fibroids' size and position, and whether you want to preserve fertility.

  • Watchful waiting, when fibroids are small and not causing symptoms
  • Hormonal contraception or a progesterone IUD, to control heavy bleeding
  • Tranexamic acid, a non-hormonal medication that reduces menstrual blood loss
  • GnRH agonists and antagonists, which shrink fibroids temporarily, often before surgery
  • Iron supplementation to correct anemia
  • Uterine artery embolization, which cuts off the fibroids' blood supply
  • Myomectomy — surgical removal of the fibroids while preserving the uterus
  • Endometrial ablation, for bleeding when fertility is no longer a consideration
  • Hysterectomy, the only definitive cure, when other options are unsuitable or exhausted

Dr. V on uterine fibroids

Her videos on the medical treatment and the surgical management of fibroids go into each route in detail.

Watch on its own page

When to book an appointment

  • Your periods are heavy enough to disrupt your life, or you are passing large clots.
  • You have pelvic pressure, urinary frequency, or an enlarging abdomen.
  • You have been told you have fibroids and want to understand your options.
  • You are having difficulty conceiving and fibroids have been mentioned.

Frequently Asked Questions

1Are fibroids cancerous?
Fibroids are benign. Cancerous growths of the uterine muscle are rare and are a different entity. Rapid growth, particularly after menopause, is worth investigating, but the overwhelming majority of fibroids are exactly what they appear to be.
2Do all fibroids need treating?
No. Fibroids that cause no symptoms usually need only periodic observation. Treatment is driven by symptoms and by fertility plans, not by the presence of a fibroid on a scan.
3Will I need a hysterectomy?
Not necessarily. Hysterectomy is the only definitive cure, but medication, a progesterone IUD, uterine artery embolization, and myomectomy all treat fibroids while preserving the uterus. Which of them fits depends on your symptoms and your plans.
4Can I still get pregnant with fibroids?
Many women with fibroids conceive without difficulty. Fibroids that distort the uterine cavity are the ones most likely to affect fertility or pregnancy, and those are often worth removing beforehand.
5What happens to fibroids after menopause?
They typically shrink, because they depend on estrogen and progesterone to grow. Symptoms often improve substantially once periods stop.

Explore

Related Conditions

Heavy periods are not something to put up with.

If fibroids are affecting your quality of life, there are more routes forward than most women are told about. Book an appointment to talk through them.

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Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.