Many women with uterine fibroids have no symptoms and need no treatment, but some develop heavy menstrual bleeding, pelvic pain or fertility problems.
Uterine fibroids are non-cancerous growths that develop in the muscular wall of the uterus. They are common among women of reproductive age, but many cause no symptoms and do not require treatment, according to medical guidance from the Mayo Clinic and the American College of Obstetricians and Gynecologists.
The growths, also known as leiomyomas or myomas, vary in size and location. Some remain small, while others can enlarge the uterus and press against nearby organs. Their presence does not automatically mean a woman will experience pain, fertility problems or complications during pregnancy.
Where fibroids develop
Doctors classify uterine fibroids according to their position in or around the uterus.
- Intramural fibroids grow within the muscular wall of the uterus.
- Subserosal fibroids develop on the outer surface of the uterus and may extend into the pelvis.
- Submucosal fibroids grow beneath the uterine lining and project into the cavity, where they can contribute to heavy menstrual bleeding and reproductive difficulties.
- Pedunculated fibroids attach to the uterus by a narrow stalk. They can develop on the inner or outer surface.
The location, size and number of fibroids help determine whether they cause symptoms and which treatments may be appropriate.
Symptoms can vary
Many women do not know they have fibroids until a routine pelvic examination or an ultrasound identifies them. Others develop symptoms that affect their daily activities.
Common symptoms include heavy or prolonged menstrual periods, painful menstruation, pelvic pressure, lower abdominal or back pain, frequent urination, difficulty emptying the bladder, constipation and pain during sexual intercourse.
Larger fibroids can enlarge the abdomen, sometimes making it appear similar to a pregnancy. Heavy menstrual bleeding can also cause anaemia, a condition in which the body has too few healthy red blood cells to carry sufficient oxygen, potentially leading to tiredness and weakness.
Persistent pelvic pain, bleeding between periods or menstrual bleeding that disrupts normal activities should be assessed by a healthcare professional. Severe vaginal bleeding or sudden, intense pelvic pain requires urgent medical attention.
What causes fibroids?
The exact cause remains unclear, although research points to a combination of genetic changes, hormones and other biological growth factors.
Oestrogen and progesterone, the hormones involved in regulating the menstrual cycle, appear to support fibroid growth. Fibroids commonly develop during the reproductive years and often shrink after menopause as hormone levels decline. Their growth patterns differ, however, and not all fibroids enlarge at the same rate.
Family history is an established risk factor. Women whose mothers or sisters have had fibroids are more likely to develop them.
Research also shows that Black women are more likely to develop fibroids than women from some other racial groups. They are also more likely to develop them at younger ages and experience larger growths or more severe symptoms. The reasons for these differences are not fully understood.
Other factors associated with an increased risk include obesity, starting menstruation before age 10 and low vitamin D levels. Some dietary patterns have also been associated with fibroid risk, but these associations do not establish that a particular food causes the condition.
Diagnosis and treatment
An ultrasound is commonly used to confirm the presence of fibroids and establish their size, number and location. A healthcare professional may also recommend blood tests when heavy menstrual bleeding raises concerns about anaemia or other conditions. Further imaging or examination may be needed in some cases.
Treatment depends on the severity of symptoms, the characteristics of the fibroids, the woman’s general health and whether she hopes to become pregnant.
Women who have no symptoms, or whose symptoms are mild, may be advised to monitor the condition rather than undergo immediate treatment.
Medication can help control heavy bleeding and pain. Hormonal contraceptives may reduce menstrual bleeding, while certain medicines that act on reproductive hormones can temporarily shrink fibroids. These treatments differ in their effects, and some control symptoms without eliminating the growths.
Procedures offer other options. Uterine artery embolisation reduces the blood supply to fibroids, causing them to shrink, while radiofrequency ablation uses heat to destroy fibroid tissue.
Surgery may be considered when symptoms are severe or other treatments are unsuitable. A myomectomy removes fibroids while preserving the uterus, although new fibroids can develop later. A hysterectomy, which removes the uterus, permanently eliminates uterine fibroids but also ends the ability to carry a pregnancy.
For women who want children, the choice of treatment requires particular care. Some procedures may affect future pregnancy outcomes, so a gynaecologist should explain the benefits, risks and alternatives before a decision is made.
Can women with fibroids become pregnant?
Yes. Many women with uterine fibroids conceive and have healthy pregnancies. The condition does not automatically cause infertility.
However, the effects depend partly on the size, number and location of the growths. Fibroids that distort the uterine cavity, particularly some submucosal fibroids, can interfere with conception or increase the risk of pregnancy loss. Fibroids may also be associated with certain pregnancy complications.
Women who have difficulty conceiving should not assume fibroids are the cause without a medical assessment, since infertility can have several explanations. Where fibroids are suspected of affecting fertility, a specialist can assess whether treatment is appropriate before pregnancy is attempted.
There is no single treatment that is best for every woman with fibroids. Medical assessment remains important in deciding whether monitoring, medication or a procedure offers the most appropriate option.
