Uterine Fibroids: Symptoms, Diagnosis, and Every Treatment Option

Uterine fibroids are benign muscular growths of the uterus. They are extremely common — the majority of women develop at least one by age 50 — and most cause no symptoms at all.

When they do cause problems, the problems are worth taking seriously, and there are far more treatment options than most people are offered.

Location matters more than size

This is the single most useful thing to understand, and the thing most often left out.

A 1 cm fibroid sitting inside the uterine cavity can cause heavier bleeding than a 10 cm one growing outward. Fibroids are classified by where they sit:

• Submucosal — bulging into the uterine cavity. Cause the heaviest bleeding and have the greatest effect on fertility and implantation, even when small.
• Intramural — within the muscular wall. The most common type. Cause bleeding and bulk symptoms as they grow.
• Subserosal — growing outward from the outer surface. Often cause pressure symptoms — bladder, bowel, back — with little effect on bleeding.
• Pedunculated — on a stalk, inside or outside. Can twist, which causes sudden severe pain and is a surgical emergency.

So "your fibroid is small" is not, on its own, reassurance. Ask where it is.

Symptoms

• Heavy or prolonged periods — the most common. Soaking through protection hourly, clots larger than a quarter, periods beyond 7 days.
• Anemia from that blood loss — fatigue, breathlessness on stairs, dizziness, ice cravings. Frequently the first thing that actually gets noticed.
• Pelvic pressure or a feeling of fullness; a visibly enlarged abdomen with larger fibroids.
• Urinary frequency or urgency, or difficulty emptying the bladder.
• Constipation or rectal pressure.
• Pain during sex, particularly in certain positions.
• Back or leg pain from a posterior fibroid.
• Difficulty conceiving or recurrent miscarriage, mainly with submucosal fibroids.

Fibroids do not typically cause bleeding between periods. That symptom points elsewhere — polyps, adenomyosis, or endometrial pathology — and needs its own evaluation.

Who gets them

• Age — incidence rises through the 30s and 40s, and fibroids usually shrink after menopause as estrogen falls.
• Family history — a mother or sister with fibroids roughly triples the risk.
• Race — Black women develop fibroids earlier, more often, and with more severe symptoms. This is a well-documented and under-addressed disparity, and it is a reason to take symptoms seriously rather than watch and wait by default.
• Obesity, early menarche, and never having been pregnant are associated.

Diagnosis

• Pelvic examination may find an enlarged or irregular uterus.
• Transvaginal ultrasound — the first-line test, and usually sufficient.
• Saline infusion sonohysterography — outlines the cavity and is far better at finding submucosal fibroids a plain scan misses.
• MRI — for mapping multiple fibroids before surgery or embolisation.
• Hysteroscopy — direct visualisation, and allows removal in the same procedure.
• Blood tests — complete blood count and ferritin, because anemia is so common and so often missed.

One caution: a fibroid that grows rapidly, or grows after menopause, needs prompt assessment. Leiomyosarcoma is rare, but rapid or postmenopausal growth is the presentation that warrants a closer look.

Treatment

Treatment depends on your symptoms, your age, and whether you want to be pregnant in future — not on the fibroid's existence. Asymptomatic fibroids generally need no treatment, only observation.

Medical — for bleeding

• Tranexamic acid on heavy days. Non-hormonal, effective, and consistently underused.
• NSAIDs started at the onset of bleeding, reducing flow and cramping together.
• The levonorgestrel IUD — reduces bleeding substantially. Works well for intramural and subserosal fibroids; less reliable if the cavity is distorted by a submucosal fibroid, which raises expulsion risk.
• Combined hormonal contraception — lighter, more predictable periods.
• GnRH agonists and antagonists — shrink fibroids and stop bleeding, but induce a temporary menopausal state, so they are used with add-back therapy and generally as a bridge to surgery or to correct anemia beforehand.
• Iron replacement — treats the consequence. Take it with vitamin C, away from tea and calcium; IV iron where oral fails.

Note that medication manages symptoms. Apart from the GnRH classes, it does not shrink fibroids.

Procedures that keep the uterus

• Hysteroscopic myomectomy — removes submucosal fibroids through the cervix, no incision, quick recovery. Frequently curative when the bleeding is coming from one.
• Laparoscopic or abdominal myomectomy — removes intramural and subserosal fibroids while preserving the uterus. The option for people who want future pregnancy. Fibroids can recur.
• Uterine artery embolisation (UAE) — an interventional radiology procedure that cuts the fibroids' blood supply. Shorter recovery than surgery. Effects on future fertility are not fully established, so it is generally not first choice for someone actively planning pregnancy.
• Radiofrequency ablation (laparoscopic or transcervical) — a newer uterus-sparing option.
• MRI-guided focused ultrasound — available at limited centres, for selected fibroids.

Hysterectomy

Definitive, and the right answer for some people. It should be a decision made from the full list above, not the first thing offered — and it is offered first far more often than it should be, particularly to Black women.

Fibroids, fertility and pregnancy

Most people with fibroids conceive and carry normally.

• Submucosal fibroids are the ones that clearly reduce fertility and implantation, and removing them improves outcomes.
• Intramural fibroids distorting the cavity may matter; those that do not, generally do not.
• Subserosal fibroids do not affect fertility.
• In pregnancy, fibroids may grow, and can cause pain from red degeneration — painful but managed conservatively. They slightly raise the risk of malpresentation, caesarean, and postpartum haemorrhage.
• Myomectomy before pregnancy may mean a caesarean is recommended later, depending on how deeply the uterine wall was entered. Ask about that at the time of surgery, not afterwards.

When to seek care

• Soaking through a pad or tampon hourly for two or more hours
• Dizziness, breathlessness at rest, or fainting
• Sudden severe pelvic pain — a pedunculated fibroid can twist
• Difficulty passing urine
• Any bleeding after menopause, or a fibroid growing after menopause

Talk to us

If you have been told you have fibroids and simply to live with them, that is worth a second conversation. Fibroids that are not causing problems can be left alone — fibroids that are wrecking your month should not be.

• Heavy periods in your 30s and 40s
• Abnormal uterine bleeding
• Gynecological surgery
• Book an appointment online

Medical disclaimer

This article is general health information, not medical advice for any individual. Treatment depends on your symptoms, your fibroids' size and location, and your plans for pregnancy. Sudden severe pelvic pain, or bleeding after menopause, needs prompt assessment.