Being told you have a fibroid can sound frightening, but fibroids are extremely common. They are non-cancerous growths of the muscle of the uterus, and by the age of 50 a large proportion of women have at least one. Many women never know they have them. Others develop heavy periods, pain, pressure symptoms or difficulty conceiving. Whether a fibroid needs treatment depends far more on your symptoms and your plans for pregnancy than on its size on a scan.
Types of fibroids
Fibroids are described by where they grow, which largely decides what symptoms they cause:
- Submucosal fibroids bulge into the cavity of the uterus. Even small ones can cause heavy bleeding and affect fertility
- Intramural fibroids grow within the muscle wall. Larger ones can enlarge the uterus and cause heavy periods
- Subserosal fibroids grow on the outer surface. They can press on the bladder or bowel but rarely affect periods
- Pedunculated fibroids hang on a stalk inside or outside the uterus, and can occasionally twist and cause sudden pain
Symptoms
- Heavy or prolonged periods, passing clots, or needing to change pads very frequently
- Tiredness, breathlessness or dizziness from anaemia caused by heavy bleeding
- Pelvic pain, painful periods, or pain during intercourse
- Frequent urination or difficulty emptying the bladder
- Constipation or a feeling of pressure in the lower abdomen
- A visibly enlarged abdomen, sometimes mistaken for weight gain
- Difficulty conceiving or repeated miscarriage, mainly with fibroids that distort the cavity
See a doctor promptly if you have very heavy bleeding that soaks a pad every hour, bleeding between periods or after menopause, sudden severe pelvic pain, or symptoms of anaemia. Bleeding after menopause always needs investigation.
How fibroids are diagnosed
An ultrasound - usually a combination of an abdominal and a transvaginal scan - confirms most fibroids and shows their number, size and position. A saline infusion scan or hysteroscopy can show whether a fibroid is inside the cavity. MRI is sometimes used before surgery to map multiple fibroids. Blood tests check for anaemia and, when relevant, thyroid problems that can also cause heavy periods.
Heavy periods are common, and fibroids are only one of their causes. Others include polyps, adenomyosis (where the lining grows into the muscle of the uterus), hormonal imbalance, thyroid disease, bleeding disorders and, rarely, changes in the lining that need a biopsy. That is why a fibroid seen on a scan is not automatically assumed to be the cause of your symptoms, and a full assessment comes before treatment.
Fibroids are very rarely cancerous. A rapidly growing mass, especially after menopause, is investigated carefully, but the great majority of fibroids are benign.
Treatment options
Treatment is chosen according to your symptoms, the size and position of the fibroids, your age, and whether you want to become pregnant in the future.
- Watchful waiting: fibroids with no symptoms usually need only periodic checks; they often shrink after menopause
- Medicines for heavy bleeding: tranexamic acid during the period, and anti-inflammatory painkillers, which reduce bleeding and pain
- Hormonal options: the levonorgestrel intrauterine system (hormonal IUS) or oral hormones can control bleeding when the cavity is not distorted
- GnRH analogues: injections that shrink fibroids temporarily, used for a few months before surgery or to correct anaemia
- Iron supplements or intravenous iron to correct anaemia before any procedure
- Hysteroscopic myomectomy: removal of a submucosal fibroid through the cervix, with no abdominal cut
- Laparoscopic myomectomy: keyhole removal of fibroids while keeping the uterus, suitable for many women who want future pregnancies
- Open myomectomy: for very large or numerous fibroids
- Uterine artery embolisation: a radiology procedure that blocks the blood supply to fibroids, for selected women not planning pregnancy
- Hysterectomy: removal of the uterus, a definitive option for women who have completed their family and have significant symptoms
Laparoscopic surgery usually means smaller wounds, less pain after the operation, a shorter hospital stay and a quicker return to normal activities compared with open surgery, but it is not suitable for every fibroid. The approach is discussed with you after reviewing the scan.
A few questions help decide between the options: How much are the symptoms affecting your daily life and work? Do you want to keep your uterus or have more children? How close are you to menopause, when fibroids tend to shrink? Are you anaemic? Do you prefer to avoid surgery if possible? There is rarely a single correct answer, and it is reasonable to try medical treatment first when symptoms are moderate. Fibroids can recur after a myomectomy, particularly in younger women with several fibroids, and follow-up scans are part of the plan.
Fibroids, fertility and pregnancy
Fibroids that distort the uterine cavity can reduce the chance of conception and increase the chance of miscarriage, and removing them can help. Fibroids in the wall or on the outside usually do not need removal before trying to conceive unless they are large or causing symptoms.
Many women with fibroids have normal pregnancies. Fibroids can sometimes grow in early pregnancy and cause pain - called red degeneration - which is managed with rest and pain relief. Large fibroids, or one low in the uterus, can affect the baby’s position or the way the baby is delivered, and there is a slightly higher chance of bleeding after birth. After a myomectomy, the timing of pregnancy and the mode of delivery are discussed in advance, as some women will be advised to have a caesarean.
When to see a doctor
Book a consultation if your periods are heavier or longer than before, if you feel tired or breathless, if you have pelvic pressure or pain, or if you are planning a pregnancy and know you have fibroids. At Divine Women’s Hospital, Gota, Dr. Devang Patel evaluates fibroids with ultrasound and offers medical treatment as well as hysteroscopic and laparoscopic surgery when it is needed.
Related care: Uterine fibroid treatment in Ahmedabad
More patient guides
- The NT scan at 11–14 weeks: what it checks and how to prepare
- High blood pressure in pregnancy: the warning signs you should not wait on
- Expecting twins? Why “do they share a placenta?” is the first question
- NIPT or NT scan: which test do you need, and can one replace the other?
- Pregnancy after 35: fertility, risks and how to plan a healthy pregnancy
This guide is general information for patients and does not replace a consultation with your own doctor.