Uterine Fibroids: Symptoms, Diagnosis & Treatment

What Are Uterine Fibroids?

Uterine fibroids, also called leiomyomas, are growths made of muscle and connective tissue that develop in or on the uterine wall. They can grow as a single nodule or in clusters and range in size from as small as a seed to as large as a watermelon, with clusters sometimes exceeding 20 centimetres in diameter.

There are four main types based on their location. Intramural fibroids grow within the muscular wall of the uterus and are the most common type. Submucosal fibroids develop under the inner lining of the uterus. Subserosal fibroids grow under the outer surface of the uterus and can become quite large. Pedunculated fibroids are the least common and attach to the uterus via a thin stalk, giving them a mushroom-like appearance.

Fibroids occur most often in people between 30 and 50 years old and are less common before a first period begins or after menopause.

What Causes Uterine Fibroids? 

The exact cause of uterine fibroids is not fully understood. However, healthcare providers believe the hormones oestrogen and progesterone play a significant role. Most fibroids develop during the reproductive years, tend to grow when hormone levels are higher, such as during pregnancy, and tend to shrink when hormone levels drop, such as during the transition to menopause.

Risk factors that increase your likelihood of developing fibroids include:

• Obesity and a higher body mass index
• A family history of fibroids
• Not having had children
• Early onset of menstruation
• Late age for menopause

Common Symptoms of Uterine Fibroids

Many small fibroids produce no symptoms and require no treatment beyond routine monitoring. When symptoms do occur, they typically include:

• Excessive or painful bleeding during periods
• Bleeding between periods
• A feeling of fullness or bloating in the lower abdomen
• Frequent urination caused by a fibroid pressing on the bladder
• Pain during sex
• Low back pain
• Constipation or pressure on the rectum
• Chronic vaginal discharge
• An enlarged abdomen that may resemble pregnancy

Symptoms often stabilise or resolve after menopause as hormone levels decline. If you experience any of the above, speak to a healthcare provider to rule out other gynaecological conditions with similar presentations.

How Are Uterine Fibroids Diagnosed?

Fibroids are often discovered incidentally during a routine pelvic examination. Heavy bleeding or related symptoms may also prompt a provider to investigate. Several tests can confirm the presence, size, and location of fibroids:

• Ultrasonography uses sound waves to create images of the internal organs
• MRI provides detailed images using magnets and radio waves
• CT scan uses X-ray imaging from multiple angles
• Hysteroscopy uses a thin, flexible scope inserted through the vagina and cervix to view fibroids inside the uterus
• Hysterosalpingography involves injecting contrast material and taking X-rays of the uterus
• Sonohysterography uses saline injected into the uterus to produce a clearer ultrasound image
• Laparoscopy involves small abdominal incisions and a camera to examine the organs directly

How Are Uterine Fibroids Treated? 

Treatment depends on the number, size, and location of fibroids, the symptoms they are causing, and whether you wish to preserve your fertility. Small fibroids without symptoms often require no treatment at all. When treatment is needed, options include:

Medications include over-the-counter pain relievers such as paracetamol and ibuprofen for pain management. Iron supplements address anemia caused by heavy bleeding. Hormonal contraception, including pills, rings, injections, and IUDs, helps manage heavy bleeding and cramping. Gonadotropin-releasing hormone (GnRH) agonists temporarily shrink fibroids and are sometimes used before surgery to make removal easier. Oral therapies such as elagolix manage heavy uterine bleeding and can be taken for up to 24 months. Tranexamic acid reduces heavy menstrual bleeding directly.

Surgical options include myomectomy, which removes fibroids while preserving the uterus. This can be performed via hysteroscopy, laparoscopy or laparotomy depending on the size and location of the fibroids. Hysterectomy, the complete removal of the uterus, is the only definitive cure for fibroids and is typically recommended for severe cases where future pregnancy is not desired. Minimally invasive hysterectomy options include vaginal, laparoscopic and robotic methods. Uterine fibroid embolisation blocks blood flow to the fibroids by injecting small particles into the uterine artery, causing them to shrink. Radiofrequency ablation uses microwave energy to treat smaller fibroids and is recommended for those who have not yet reached menopause.

Which Fibroid Treatment Is Right for You?

The best treatment option depends on several individual factors, including the number and size of your fibroids, your symptoms, your age, and your plans for future pregnancy. Some surgical options preserve the uterus and allow future pregnancies, while others remove the uterus entirely. Medication may be sufficient for mild symptoms, while larger or more problematic fibroids may require surgery.

Talk openly with your healthcare provider about your fertility goals, your tolerance for risk, and how significantly fibroids are affecting your daily life. Together, you can determine the most appropriate plan for your specific situation.

Can Uterine Fibroids Affect Fertility and Pregnancy? 

You can become pregnant with uterine fibroids, though large fibroids can increase certain risks during pregnancy. Your healthcare provider will develop a monitoring plan if you have known fibroids when you conceive. Elevated hormone levels during pregnancy can cause fibroids to grow, which may lead to an increased risk of caesarean delivery if the baby cannot move into a head-down position, labour that does not progress, placental abruption, or preterm delivery.

Infertility from fibroids is rare but possible. If you are planning a pregnancy and have significant fibroids, discuss treatment options with your provider before conceiving, where possible.

Recovery After Fibroid Treatment 

Recovery time varies depending on the type of treatment. Medications require no recovery time but may take weeks to produce noticeable symptom relief. Minimally invasive procedures such as laparoscopy or fibroid embolisation typically involve a shorter recovery of one to two weeks. Open surgery, such as laparotomy or hysterectomy, requires a longer recovery of four to six weeks.

People who have undergone myomectomy may need to deliver future pregnancies by caesarean section. It is important to attend all follow-up appointments after treatment so your provider can monitor your recovery and check that symptoms have resolved.

Can Uterine Fibroids Be Prevented? 

There is no reliable way to prevent uterine fibroids. However, maintaining a healthy body weight and attending regular pelvic examinations can help reduce your risk and ensure that any fibroids are detected early. If you have small fibroids already, work with your healthcare provider to develop a monitoring plan so that any changes in size or symptoms can be addressed promptly.

References:

• Bulun, S. E. (2013). Uterine fibroids. New England Journal of Medicine, 369(14), 1344–1355. 
• Donnez, J., Dolmans, M. M., Fellah, L., & Donnez, O. (2020). Ulipristal acetate for the management of large uterine fibroids prior to surgery. Best Practice and Research: Clinical Obstetrics and Gynaecology, 66, 22–37. 
• Laughlin-Tommaso, S. K. (2018). Alternatives to hysterectomy: Management of uterine fibroids. Obstetrics and Gynecology Clinics of North America, 45(3), 397–413. 
• Stewart, E. A., Cookson, C. L., Gandolfo, R. A., & Schulze-Rath, R. (2017). Epidemiology of uterine fibroids: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology, 124(10), 1501–1512. 
• Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.