Gynecologic Conditions
Uterine Fibroids: Symptoms, Causes and When to Get Treatment
Uterine fibroids are noncancerous growths of muscle and connective tissue in or on the uterus. Many people have no symptoms at all, but fibroids can cause heavy or long periods, pelvic pressure, frequent peeing and pain. You only need treatment if they cause symptoms or other problems.
They're very common. According to the National Institutes of Health, most women will have fibroids by age 50, though many never find out. You'll also hear them called leiomyomas or myomas.
The most common way people discover they have fibroids? A period that's been "a little heavy" for years gets mentioned at a checkup, and an ultrasound shows why. If you've been planning your life around your period (dark clothes only, a backup pad in every bag, mapping bathrooms on your commute), that's worth bringing up.
What fibroids are, and why location matters
Fibroids grow from the muscle wall of the uterus. They range from seed-sized to large enough to make the uterus several times bigger, and you can have one or many. Where they sit often matters more than how big they are:
- Submucosal fibroids bulge into the uterine cavity. Even small ones can cause heavy bleeding and may affect fertility.
- Intramural fibroids grow inside the muscle wall. They're the most common type and can cause heavy periods and pressure when large.
- Subserosal fibroids grow on the outside surface. They tend to press on the bladder or bowel rather than cause heavy bleeding.
- Pedunculated fibroids hang from a stalk, either inside the cavity or outside the uterus.
Symptoms
Depending on size, number and location:
- Heavy menstrual bleeding, sometimes with clots
- Periods lasting longer than a week
- Pelvic pressure or fullness
- Frequent urination, or feeling like your bladder never quite empties
- Constipation or rectal pressure
- Lower back or leg pain
- Pain during sex
- A larger lower belly, sometimes enough that people ask if you're pregnant
Heavy bleeding from fibroids can lead to iron deficiency and anemia. If you're unusually tired, weak, or winded on stairs, tell your clinician. A common pattern is someone who's been anemic for years and assumed the exhaustion was just life.
What causes them?
The exact cause isn't known, but hormones and genetics are involved. Estrogen and progesterone seem to fuel growth, which is why fibroids tend to grow during the reproductive years and shrink after menopause.
Things linked to higher risk:
- Age. More common through the 30s and 40s until menopause.
- Race. NIH research shows Black women are more likely to develop fibroids, tend to get them younger and are more likely to have severe symptoms.
- Family history. If your mother or sister had fibroids, mention it.
- Early first period.
- Obesity and certain dietary factors, according to some studies.
Having children appears to be associated with lower risk.
Myth vs. fact
Myth: Fibroids are a type of cancer. Fact: They're almost always benign. A rare cancer can look similar, which is why a fast-growing mass, especially after menopause, gets checked.
Myth: If I have fibroids, I need a hysterectomy. Fact: Fibroids alone aren't a reason to remove the uterus. Many options keep it.
Myth: A big fibroid always needs surgery. Fact: There's no size cutoff. Treatment depends on symptoms, location and pregnancy plans.
Myth: I can't get pregnant with fibroids. Fact: Many people with fibroids have healthy pregnancies. Fibroids that bulge into the cavity are the ones more likely to affect fertility.
How they're diagnosed
Fibroids are often first noticed at a routine pelvic exam when the uterus feels enlarged or irregular. To confirm and map them, your clinician may use:
- Pelvic ultrasound (abdominal or transvaginal), the usual first test. For the abdominal part you may be asked to come with a full bladder, which is the hardest part of the visit.
- Saline infusion sonohysterography, which puts fluid in the uterus to show fibroids inside the cavity
- Hysteroscopy, a thin camera passed through the cervix
- MRI, which gives a detailed map for treatment planning
You may also get a blood count to check for anemia and, depending on your age and symptoms, an endometrial biopsy to rule out other causes of abnormal bleeding.
Do you need treatment?
Not always. If fibroids aren't bothering you, ACOG supports watchful waiting with periodic checkups.
Treatment is worth considering when fibroids:
- Cause heavy bleeding or anemia
- Cause pain or pressure that affects your daily life
- Press on the bladder or bowel
- Change the shape of the uterine cavity when you're trying to get pregnant
Treatment options
The best fit depends on your symptoms, fibroid location, age and whether you want a future pregnancy.
| Approach | Examples | Keeps the uterus? |
|---|---|---|
| Medicines for bleeding | NSAIDs, tranexamic acid, birth control, hormonal IUD | Yes |
| Hormone-lowering medicines | Oral GnRH antagonist combinations, GnRH agonists | Yes |
| Myomectomy | Hysteroscopic, laparoscopic, robotic or abdominal removal of fibroids | Yes |
| Uterine fibroid embolization (UFE) | Blocks blood flow to fibroids | Yes |
| Ablation-based procedures | Radiofrequency ablation, MRI-guided focused ultrasound | Yes |
| Hysterectomy | Removes the uterus | No |
Medicines can control bleeding and sometimes shrink fibroids, but fibroids may grow back to their previous size after you stop hormone-lowering treatment. Procedures and surgery deal with the fibroids more directly. For a detailed comparison, see fibroid treatment options: myomectomy, UFE and hysterectomy.
Fibroids and pregnancy
During pregnancy, fibroids can sometimes cause pain or be linked to complications such as the baby lying in an unusual position. If you have fibroids and are planning a pregnancy, talk with an OB/GYN before picking a treatment, since some options suit a future pregnancy better than others.
Before your appointment: a two-month period diary
Track a couple of cycles before your visit. Note:
- How many days you bleed
- How often you change pads, tampons or cups on your heaviest day
- Whether you pass clots, and roughly how big (a quarter or larger is worth noting)
- Whether you've bled through clothes or sheets
- Days you missed work, school or plans
This turns "my periods are bad" into something your clinician can act on.
Questions to ask
- How many fibroids do I have, and where are they?
- Are my symptoms likely from the fibroids, or could it be something else?
- Do I need treatment now, or can we monitor?
- How often should I have follow-up ultrasounds?
- Which options would protect my ability to get pregnant?
- Should my blood count and iron be checked?
When to see a doctor
Make an appointment with a gynecologist if you have:
- Periods that are heavy, last more than seven days or include large clots
- Bleeding between periods
- Pelvic pain or pressure that doesn't go away
- Frequent urination or trouble emptying your bladder
- Fatigue, dizziness or shortness of breath that could signal anemia
- Any bleeding after menopause
Go to an emergency department for very heavy bleeding that soaks a pad every hour and makes you feel faint, or for sudden, severe pelvic pain.
Most fibroids are managed by gynecologists. UFE is done by interventional radiologists, and complex surgery may be done by gynecologic surgeons who specialize in minimally invasive procedures. Browse gynecologists in Brooklyn or Queens, or use the provider search anywhere in the five boroughs, Long Island or the Hudson Valley.
Frequently asked questions
Are uterine fibroids cancerous?
Fibroids are almost always benign (noncancerous). A rare cancer called leiomyosarcoma can look similar, which is one reason fast-growing masses, especially after menopause, need evaluation.
What size fibroid needs surgery?
No single size requires surgery. Treatment is usually based on your symptoms, where the fibroids are and your plans for pregnancy, not size alone.
Can fibroids go away on their own?
Fibroids often shrink after menopause when hormone levels drop. Before menopause, they may stay the same, grow or occasionally shrink.
Can fibroids cause weight gain or a bigger belly?
Large fibroids can enlarge the uterus and make the lower belly look or feel fuller, a bit like pregnancy. They don't cause general weight gain across the body.
Sources
- ACOG — Uterine Fibroids (Patient FAQ)
- ACOG — Management of Symptomatic Uterine Leiomyomas (Practice Bulletin 228)
- NIH, National Institute of Environmental Health Sciences — Uterine Fibroids
- NIH, NICHD — Uterine Fibroids
- MedlinePlus — Uterine Fibroids
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.