Uterine fibroids are non-cancerous growths of muscle and fibrous tissue that form in the uterus. They affect up to 80% of women by age 50, though many experience no symptoms. Because fibroid signs often resemble other reproductive conditions, diagnosis can be tricky.
According to Dr. Sierra J. Seaman, gynecologic surgeon at NewYork-Presbyterian/Columbia University Irving Medical Center, women with heavy periods, urinary urgency, constipation, or a noticeable abdominal mass should ask their doctor about an ultrasound. While fibroids can’t be fully prevented, early detection and treatment make them easier to manage. In this discussion, Dr. Seaman explains fibroid causes, symptoms, and available treatments.
What Causes Fibroids?
The exact cause of fibroids remains unclear, but several factors contribute to their growth. A family history of fibroids, certain genetic changes, and the body’s response to hormones like estrogen, progesterone, and growth hormones all play a role.
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Are There Different Types of Fibroids?
Fibroids are classified by where they grow in the uterus. The most common are intramural fibroids, which develop in the uterine wall. Submucosal fibroids grow inside the uterine cavity, while subserosal fibroids form on the outer surface of the uterus.
Who Is at Risk of Developing Fibroids?
Any woman of reproductive age can develop fibroids, but certain factors increase the risk. Women in their 30s and 40s, those with no pregnancies, a family history of fibroids, obesity, or high blood pressure face a higher likelihood. Black women are also two to three times more likely to develop fibroids compared to white women.
What Do Fibroids Feel Like?
Most fibroids are small, symptom-free, and don’t need treatment. When symptoms do appear, they vary based on the size, location, and number of fibroids. Common signs include:
- Heavy or prolonged periods
- Bleeding between cycles
- Pelvic pain or pressure
- Abdominal bloating
- Frequent urination
- Bowel changes
- Lower back pain
- Pain during sex
- Anemia
- Fertility issues
Fibroids can range from pea-sized to as large as a grapefruit. In severe cases, very large fibroids may make the abdomen appear pregnant.
How Are Fibroids Diagnosed?
Fibroids can grow, shrink, or change in number throughout the reproductive years, which is why early evaluation is important. Because symptoms often mimic conditions like ovarian cysts, endometriosis, or PCOS, diagnosis usually requires imaging. Doctors typically start with a pelvic exam and ultrasound to check for fibroids. In some cases, additional tests such as MRI or saline ultrasound provide a clearer view.
What Does Treatment for Fibroids Look Like?
Not all fibroids need treatment, but care is recommended when symptoms such as heavy bleeding, pelvic pain, or fertility issues interfere with daily life. The best approach depends on age, symptoms, fertility goals, and fibroid type. Treatment options include:
1. Medical Therapy – Helps manage mild symptoms. Options include:
- Over-the-counter pain relievers (e.g., ibuprofen)
- Hormonal therapies, like birth control, to control bleeding
- Non-hormonal medications, such as tranexamic acid, to reduce bleeding
2. Minimally Invasive Procedures – Target fibroids without major surgery.
- Uterine artery embolization (cuts off blood supply to shrink fibroids)
- Radiofrequency ablation or MRI-guided focused ultrasound (destroy fibroid tissue without incisions)
3. Surgical Options – Considered for large, numerous, or treatment-resistant fibroids.
- Myomectomy: Removes fibroids but preserves the uterus for future pregnancy
- Hysterectomy: Removes the uterus, permanently eliminating fibroids and bleeding
Surgical methods vary—laparoscopy (small incisions), hysteroscopy (camera through the cervix), vaginal, or open abdominal surgery—depending on fibroid size and location.
The right treatment plan should be personalized with your doctor to match your health needs and fertility goals.
Can Fibroids Cause Cancer?
Fibroids are almost always noncancerous. Fewer than 1% develop into a rare cancer called leiomyosarcoma. Doctors are most concerned about this possibility in women after menopause who experience new or changing fibroid symptoms.
Can Fibroids Affect Fertility or Pregnancy?
Fibroids can impact fertility and pregnancy, depending on their size, number, and location. Most people with fibroids still have healthy pregnancies, but complications are possible. Fibroids that distort the uterine cavity may interfere with implantation and raise the risk of:
- Placental abruption (placenta separating from the uterine wall)
- Fetal malposition (baby not turning head-down)
- Preterm labor
Submucosal fibroids, as well as large or multiple fibroids, pose the greatest risk to pregnancy outcomes.
Do Fibroids Remain an Issue During Perimenopause and Menopause?
Most fibroids shrink after menopause due to the natural decline in estrogen and progesterone. In some cases, they may even disappear completely.
Are Fibroids Dangerous?
Fibroids are rarely life-threatening, but heavy bleeding can lead to iron deficiency or anemia. See a doctor if you:
- Bleed for more than seven days
- Need to change a pad or tampon every one to two hours
- Experience bleeding twice in the same month
No one should have to live with discomfort. If you notice these symptoms, talk to your provider—effective treatment options are available.
Frequently Asked Questions
What are the first signs of fibroids?
Heavy or prolonged periods, pelvic pressure, frequent urination, bloating, and back pain are common early signs of fibroids.
Can fibroids go unnoticed?
Yes. Many fibroids cause no symptoms and are often discovered during routine exams or imaging.
How do doctors check for fibroids?
Diagnosis usually begins with a pelvic exam and ultrasound. Sometimes MRI or saline ultrasound is used for a clearer view.
Can fibroids cause infertility?
Some fibroids, especially submucosal ones, can interfere with implantation and pregnancy. However, most people with fibroids can conceive and carry a healthy pregnancy.
Do fibroids turn into cancer?
Fibroids are almost always noncancerous. Fewer than 1% become a rare cancer called leiomyosarcoma.
Will fibroids shrink after menopause?
Yes. Most fibroids shrink or disappear after menopause due to lower estrogen and progesterone levels.
When should I see a doctor about fibroids?
Seek care if you experience very heavy periods, prolonged bleeding, pelvic pain, or symptoms that affect daily life.
Conclusion
Fibroids are common, and while many cause no symptoms, others can lead to heavy bleeding, pain, or fertility challenges. Understanding the signs, knowing when to see a doctor, and exploring available treatment options can help you take control of your health. If you notice symptoms that disrupt your daily life, don’t wait—schedule a check-up with your healthcare provider. With the right diagnosis and care, fibroids can be effectively managed.