Uterine Fibroids

 

 

What are uterine fibroids?

Fibroids are solid, rubbery lumps that grow:

• **Inside the uterine wall**
• **On the outside surface of the uterus**
• **Into the uterine cavity** (the space where a pregnancy would develop)

They can be as small as a seed or large enough to noticeably enlarge the uterus. You might have one fibroid or many.

Do fibroids turn into cancer?

Almost always, **no**. Fibroids are benign, and cancerous tumors of the uterine muscle are rare and usually **not** thought to “come from” a typical fibroid. Still, any rapidly changing symptoms, bleeding after menopause, or a fast-growing pelvic mass needs medical evaluation.

Symptoms of fibroids

Many fibroids cause **no symptoms** and are found incidentally on an ultrasound. When symptoms happen, they usually fall into three buckets: bleeding, pressure, and pain.

Bleeding symptoms

• Heavy or prolonged periods
• Bleeding between periods (less common)
• Passing clots
• Fatigue or shortness of breath from iron-deficiency anemia

Pressure symptoms

• Pelvic heaviness or a “full” feeling
• Frequent urination or difficulty emptying the bladder
• Constipation** or rectal pressure
• Low back pain

Pain and sex-related symptoms

• Pelvic pain or cramping
• Pain during sex
• Sudden severe pain can happen with **fibroid degeneration** (when a fibroid outgrows its blood supply) or with twisting of a stalked (pedunculated) fibroid
                                                                                                                                              

 

 

Types of fibroids by location (why location matters)

Doctors often categorize fibroids by where they grow:

Submucosal fibroids (inside the cavity)

These grow under the uterine lining and can bulge into the cavity. They’re the most likely to cause **heavy bleeding** and can interfere with fertility because they distort the space where implantation happens.

Intramural fibroids (within the uterine muscle)

These sit in the muscle layer. If they grow large, they can cause bleeding and pressure symptoms and may affect fertility depending on size and whether they distort the cavity.

Subserosal fibroids (on the outside surface)

These grow outward from the uterus. They’re less likely to cause heavy bleeding but can cause **pressure** on nearby organs.

Pedunculated fibroids (on a stalk)

A fibroid can hang off the uterus on a stalk (inside or outside). Stalked fibroids can sometimes twist and cause sudden pain.
                                                                                                                                                           

 

 

What causes fibroids?

No single cause has been proven, but several factors are strongly linked:

• Hormones: Fibroids tend to grow during reproductive years and often shrink after menopause.
• Genetics: Family history increases risk.
• Age: They’re more common in the 30s and 40s.
• Body weight and metabolic factors: Higher body weight is associated with higher risk.
• Race/ethnicity: In the U.S., fibroids are diagnosed more often and at younger ages in Black women, and symptoms can be more severe.

How fibroids are diagnosed

A clinician may suspect fibroids based on symptoms and a pelvic exam, but imaging confirms it.

Ultrasound (usually first)

A pelvic ultrasound (abdominal and/or transvaginal) is the most common test to identify fibroids and estimate their size and location.

MRI (sometimes)

MRI can help map fibroids in more detail—useful when planning certain procedures or when the picture is complex.

Tests you might also need

If you have heavy bleeding, your clinician may recommend:

• A blood test for **anemia** (CBC and iron studies)
• Evaluation for other causes of abnormal bleeding (such as polyps, thyroid issues, bleeding disorders, or pregnancy)

Fibroids and fertility: can you get pregnant with fibroids?

Most people with fibroids **can still get pregnant**, but certain fibroids can make it harder.

Fibroids are more likely to affect fertility when they:

• Distort the uterine cavity (especially submucosal fibroids)
• Are large intramural fibroids that change uterine shape or interfere with blood flow to the lining
• Block or compress a fallopian tube (less common)

If you’re trying to conceive and have known fibroids, the key question is: Do they distort the cavity or interfere with implantation? That’s where targeted imaging and specialist input matters.

Fibroids in pregnancy: what can happen?

Many pregnancies with fibroids are uncomplicated. When problems occur, they may include:

• Pain from fibroid growth or degeneration (often in the 2nd trimester)
• Increased risk of cesarean delivery depending on fibroid size/location
• Placental issues or malpresentation (baby not head-down) in some cases

If you’re pregnant and have significant pain, fever, bleeding, or contractions, you should contact your obstetric team promptly.

Treatment options for fibroids (how to choose)

The best treatment depends on:

• Your symptoms (bleeding vs pressure vs pain)
• Fibroid type, size, and location
• Your age and whether you want future pregnancy
• Your preference about keeping your uterus
• How quickly you need relief

1) Watchful waiting (no immediate treatment)

If your fibroids aren’t causing symptoms, observation is often the best choice. Many fibroids grow slowly, and symptoms may improve near menopause.

2) Medications (to control symptoms)

Medicines can reduce bleeding and pain, and some can temporarily shrink fibroids. Common options include:

• NSAIDs for period pain (they don’t shrink fibroids)
• Hormonal birth control or a **hormonal IUD** to reduce heavy bleeding in some people
• Tranexamic acid (taken during periods) to reduce bleeding
• GnRH-based therapies (used for a limited time; sometimes with “add-back” hormones to reduce side effects) to shrink fibroids or bridge to surgery

Medication choice depends on your health history and goals, and it’s not one-size-fits-all.

3) Minimally invasive procedures (uterus-sparing for many people)

Uterine artery embolization (UAE/UFE)

A radiologist blocks blood flow to fibroids so they shrink. It can improve bleeding and bulk symptoms, but it may not be the best fit if you’re planning pregnancy soon—talk with a gynecologist and fertility specialist if that’s your goal.

Ablation techniques (including radiofrequency ablation)

Some procedures destroy fibroid tissue using heat/energy. Availability and candidacy depend on fibroid location and size.

MRI-guided focused ultrasound (in select cases)

A noninvasive approach that targets fibroids with focused ultrasound energy under MRI guidance. It’s not suitable for all fibroid patterns.

4) Surgery

Myomectomy (removes fibroids, keeps the uterus)

Myomectomy is often considered when:

• You want to preserve fertility or keep the uterus, and
• Fibroids are clearly linked to symptoms or fertility issues

Myomectomy can be done hysteroscopically (through the cervix) for some submucosal fibroids, laparoscopically/robotically for others, or via open surgery depending on size/number.

Fibroids can recur after myomectomy, so long-term planning matters.

Hysterectomy (removes the uterus)

This is the only treatment that guarantees fibroids won’t come back. It’s usually reserved for:

• Severe symptoms not controlled by other options
• People who do not want future pregnancy
• Certain complex cases

A hysterectomy ends the ability to carry a pregnancy.
                                                                                                                                                         

 

Lifestyle, diet, and supplements: what actually helps?

Lifestyle changes may help overall health and anemia, but they usually **don’t eliminate fibroids**.

Practical steps that can help symptoms:

• If bleeding is heavy, ask about iron testing and treatment.
• Maintain a healthy weight if possible (for broader hormonal and metabolic health).
• Use heat, sleep, and exercise to help with pain coping.

Be cautious with supplement claims like “detox” or “guaranteed shrinkage.” Some products can interact with medications or affect bleeding risk.

When to seek urgent care

Get urgent medical help if you have:

• Bleeding that soaks through pads/tampons every hour for 2+ hours
• Dizziness, fainting, chest pain, or shortness of breath (possible severe anemia)
• Severe sudden pelvic pain, especially with fever or vomiting
• Pregnancy with heavy bleeding, severe pain, or contractions

Frequently asked questions

1) How do I know if my heavy periods are from fibroids?

Fibroids are a common cause, but not the only one. If you have heavy bleeding, clots, or anemia symptoms, an exam and ultrasound can help identify the cause.

2) Can fibroids shrink on their own?

They often shrink after menopause. During reproductive years, some stay stable, some grow slowly, and some change with pregnancy or hormones.

3) Which fibroids cause the most bleeding?

Submucosal fibroids and fibroids that distort the uterine cavity are most linked with heavy bleeding.

4) Do fibroids cause infertility?

Most people with fibroids are not infertile. Fertility impact is more likely when fibroids distort the uterine cavity or are large and intramural.

5) Should fibroids be removed before trying to conceive?

Sometimes yes, especially for cavity-distorting submucosal fibroids. The decision should be individualized with your clinician based on imaging and your fertility history.

6) Is uterine artery embolization safe if I want children later?

Some people conceive after UAE, but it may carry different pregnancy considerations compared with myomectomy. If pregnancy is a priority, discuss options with both a gynecologist and a fertility specialist.

7) Will fibroids come back after treatment?

They can recur after myomectomy or some procedures, especially if you’re younger. Hysterectomy prevents recurrence because the uterus is removed.

8) What questions should I ask at my appointment?

Ask about: fibroid location/type, whether the uterine cavity is distorted, treatment choices that preserve fertility, expected recovery time, and how success is measured.

9) Can fibroids cause a big belly?

Large or multiple fibroids can enlarge the uterus and create visible abdominal fullness, but many people have fibroids without any size change.

10) What’s the best treatment for fibroids?

There isn’t one “best” option. The best treatment is the one that matches your symptoms, fibroid type, and pregnancy goals—with the lowest risk for you.