Fibroids, also called myomas or leiomyomas, are non-cancerous growths of the muscle of the uterus. They are extremely common: by the age of 50, up to 70% of women have at least one on ultrasound, and most never know it. Finding a fibroid on a scan is not, by itself, a reason for surgery.
What matters is the symptoms the fibroid is causing, exactly where it sits in the uterus, and whether you would like to have children in future. A small fibroid on the outer wall of a woman with normal periods usually needs nothing more than an occasional scan. A small fibroid bulging into the cavity of a woman trying to conceive may well need removal.
Dr. Devang Patel is a laparoscopic surgeon with more than 3,000 surgeries performed, and offers the full range of fibroid care at Divine Women’s Hospital, Gota, an NABH-accredited hospital: monitoring, medical treatment, hysteroscopic and laparoscopic removal, and hysterectomy when that is the right choice.
Why fibroids develop, and who gets them
Fibroids grow from a single muscle cell of the uterus that begins to multiply. Their growth depends on the hormones oestrogen and progesterone, which is why they tend to appear in the 30s and 40s, may grow in pregnancy, and usually shrink after menopause.
They are more common with increasing age up to menopause, with a family history of fibroids, with early first periods, with obesity and in women who have not had children. Low vitamin D levels, which are very common in India despite plenty of sunshine, have also been linked with fibroids.
Symptoms fibroids can cause
- Heavy or prolonged periods, sometimes with clots and flooding
- Anaemia, with tiredness, breathlessness, hair fall or dizziness
- Pelvic pain or worse period pain
- Pressure on the bladder, causing frequent urination or getting up at night
- Pressure on the bowel, causing constipation, or a dull backache
- A firm swelling in the lower abdomen, or clothes feeling tight at the waist
- Pain during intercourse with some fibroids
- Difficulty conceiving or repeated miscarriage, mainly when the fibroid distorts the cavity
Why location matters: types of fibroid
Fibroids are described by where they lie, using the FIGO classification numbered 0 to 8. In practice, three groups decide most treatment choices.
| Type (FIGO) | Where it sits | Typical symptoms | Usual surgical route if needed |
|---|---|---|---|
| Submucosal (0–2) | Bulges into the cavity of the uterus | Heavy bleeding even when small; affects fertility and miscarriage risk | Hysteroscopic myomectomy through the cervix |
| Intramural (3–4) | Within the muscle wall | Heavy periods, pain, bulk; large ones may affect fertility | Laparoscopic or open myomectomy |
| Subserosal (5–7) | Grows outwards from the surface, sometimes on a stalk | Pressure on bladder or bowel; rarely heavy bleeding | Laparoscopic myomectomy |
| Cervical and other (8) | In the cervix or outside the uterus body | Pressure, difficulty passing urine | Planned individually, laparoscopic or open |
How fibroids are assessed
A pelvic ultrasound, ideally transvaginal for women who are sexually active, maps the number, size and position of each fibroid and checks the ovaries and lining. A 3D scan or saline sonography helps show exactly how far a fibroid pushes into the cavity, and an MRI is used for large or numerous fibroids or when planning complex surgery.
Blood tests include haemoglobin and iron levels, because anaemia is common and needs to be corrected before any operation. Thyroid tests and a check of the lining are added when bleeding patterns suggest other causes, especially after 40.
Fibroids are often confused with adenomyosis, in which the lining of the uterus grows into its muscle wall. Both cause heavy, painful periods and an enlarged uterus, but adenomyosis cannot be shelled out like a fibroid, so telling them apart on the scan changes the treatment plan. Some women have both.
Treatment options
The aim is to relieve symptoms with the least invasive treatment that will work for you, while protecting fertility when it matters.
- Watchful waiting, with a scan every 6–12 months, for fibroids that cause no symptoms
- Non-hormonal tablets taken only during periods: tranexamic acid to reduce bleeding by up to about half, and anti-inflammatory tablets for pain
- Hormonal options: the levonorgestrel intrauterine system (hormonal IUD) or the combined pill, when the cavity is not distorted
- GnRH-analogue injections for three to six months to shrink fibroids and correct anaemia before surgery, or as a bridge to menopause; use is time-limited because of bone thinning
- Iron tablets or an iron infusion to restore haemoglobin, alongside any treatment
- Hysteroscopic myomectomy for submucosal fibroids, usually a day-care procedure
- Laparoscopic myomectomy for intramural and subserosal fibroids, preserving the uterus
- Open myomectomy for very large or numerous fibroids
- Hysterectomy when childbearing is complete and other treatments have not helped
- Referral for uterine artery embolisation by an interventional radiologist, for selected women who wish to avoid surgery
Myomectomy: what to expect
In a laparoscopic myomectomy, each fibroid is shelled out of the uterine wall through small cuts, the wall is stitched in layers to restore its strength, and the fibroid tissue is removed in pieces. The operation usually takes two to three hours and most women stay one to two days.
The main risks are bleeding, sometimes needing a transfusion, infection, adhesions, and a small chance of converting to open surgery. Bleeding is reduced by correcting anaemia beforehand, sometimes by GnRH injections, and by medicines given during surgery that tighten blood vessels. Rarely, an unsuspected cancer called leiomyosarcoma is found in what appeared to be a fibroid, which is why scans are reviewed carefully before surgery and every specimen is sent for examination.
Myomectomy removes the existing fibroids but not the tendency to form new ones. New fibroids show up on scans in a sizeable proportion of women within five years, though only a minority need further treatment.
There is no single size at which a fibroid must be removed; the decision rests on symptoms, location and your plans for pregnancy.
Fibroids, fertility and pregnancy
Many women with fibroids conceive and deliver without problems. Submucosal fibroids that distort the cavity are the ones most clearly linked with difficulty conceiving and miscarriage, and removing them hysteroscopically improves the chances. Large intramural fibroids may also play a role, and the decision to remove them is individual.
After a laparoscopic myomectomy, a gap of about three to six months is usually advised before trying to conceive. The risk of the scar on the uterus giving way in a later pregnancy is low, generally well under 1 in 100, but because it is serious, a planned caesarean may be advised if the fibroid was deep or the cavity was opened.
Fibroids sometimes grow in early pregnancy and can cause pain from red degeneration, when a fibroid outgrows its blood supply. This is managed with rest and pain relief and usually settles within days. Large or low-lying fibroids may affect the baby’s position or the route of delivery, and are monitored on growth scans.
Fibroid care at Divine Women’s Hospital
Dr. Devang Patel reviews your symptoms and scans and explains, in Gujarati, Hindi or English, whether the fibroid needs treatment at all. If it does, the options are set out side by side with their benefits, risks and recovery times, and the decision is yours.
Hysteroscopic and laparoscopic myomectomy and hysterectomy are performed at Divine Women’s Hospital, Gota. Because the hospital also provides 24 × 7 labour and emergency care, women who conceive after a myomectomy can have their pregnancy and delivery managed by the same team that knows their surgical history.
Your care, step by step
- ConsultationYour symptoms, period pattern, fertility plans and haemoglobin are reviewed.
- Fibroid mappingUltrasound, with 3D imaging or MRI where needed, shows the number, size and position of each fibroid.
- Choosing a treatmentOptions from monitoring and medicines to surgery are compared, with the benefits and risks of each explained.
- Preparation and treatmentAnaemia is corrected first, and surgery, if chosen, is planned with a clear estimate of stay and recovery.
- Follow-upA review of the tissue report and recovery, with advice on future scans and on timing a pregnancy.
When to book a visit
- Periods are heavy enough to soak through pads every one to two hours, or last more than seven days
- You feel tired or breathless and your haemoglobin is low
- You feel pressure in the pelvis, a lump in the abdomen, or need to pass urine more often
- A fibroid has been found on a scan and you are planning a pregnancy
- You have had difficulty conceiving or more than one miscarriage and have a known fibroid
- You have been advised a hysterectomy and want to explore uterus-preserving options
Warning signs - get same-day care
- Bleeding so heavy that you soak a pad every hour for two hours or more, or feel faint
- Sudden severe pelvic pain with fever, which can occur when a fibroid degenerates or a stalked fibroid twists
- Inability to pass urine
- Severe abdominal pain in pregnancy with a known fibroid
- Rapid growth of a known fibroid, or any new bleeding after menopause
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Every fibroid needs an operation.
Most fibroids cause no symptoms and need only occasional monitoring. Treatment is for symptoms, fertility concerns or significant growth.
Myth: Fibroids turn into cancer.
Fibroids are benign and do not turn into cancer. A rare cancer, leiomyosarcoma, can resemble a fibroid, and unusual features or growth after menopause are investigated.
Myth: Having fibroids means removing the uterus.
Medicines, hysteroscopic removal and myomectomy all preserve the uterus. Hysterectomy is one option among several, usually when family is complete.
Myth: Fibroids are caused by eating certain foods.
No food causes fibroids. Genetics and hormones are the main drivers, though a healthy weight and adequate vitamin D may help.
Frequently asked questions
Can fibroids be treated without surgery?
Yes, in many cases. Fibroids that cause no symptoms often need only monitoring, and heavy bleeding can frequently be controlled with tablets or a hormonal IUD. Surgery is considered when symptoms persist despite medicines, when a fibroid affects fertility, or when it is large and growing.
What size of fibroid needs surgery?
There is no single cut-off. A 2 cm fibroid inside the cavity can cause heavy bleeding and affect fertility, while a 6 cm fibroid on the outer surface may cause no symptoms at all. The decision rests on symptoms, location and your plans for pregnancy.
Can fibroids turn into cancer?
Fibroids are benign. A cancer called leiomyosarcoma is very rare and is thought to arise separately rather than from a fibroid. Rapid growth after menopause or unusual scan features are investigated further.
Can medicines dissolve fibroids?
No tablet dissolves fibroids permanently. GnRH injections can shrink them by roughly a third to a half over three months, but they regrow when treatment stops, so these injections are mainly used before surgery or near menopause.
Can I get pregnant with fibroids?
Many women do. Fibroids inside the cavity are the ones most likely to affect conception and miscarriage, and removing them can help. If you are trying to conceive and have a fibroid, its position should be assessed before you start fertility treatment.
Is normal delivery possible after myomectomy?
Sometimes. If the fibroids were small and superficial, a vaginal birth may be possible. If the fibroid was deep or the cavity was opened, a planned caesarean is usually advised to avoid strain on the scar.
Do fibroids come back after removal?
Myomectomy removes the existing fibroids but not the tendency to form new ones, so some women develop new fibroids over the years. Many never need further treatment. Hysterectomy is the only treatment that removes the possibility entirely.
Do fibroids shrink after menopause?
Yes. Fibroids depend on oestrogen and usually shrink after menopause, and symptoms often ease. Women close to menopause with manageable symptoms may choose to wait for this.
How long is recovery after laparoscopic myomectomy?
Most women go home within one or two days, return to desk work in about two to three weeks and resume full activity in four to six weeks, depending on the size and number of fibroids removed.