Uterine Fibroids: When to Worry and What to Do

What Are Uterine Fibroids?

Uterine fibroids are noncancerous growths that develop within the wall of the uterus. They’re made of muscle and fibrous tissue and may grow in different areas:

• Subserosal fibroids – just beneath the outer surface of the uterus
• Intramural fibroids – within the muscular wall
• Submucosal fibroids – just under the lining of the uterus

While benign, fibroids can range in size from as tiny as a seed to as large as a melon. Many people have fibroids without realizing it, but in some cases, symptoms can be disruptive.

Who Gets Fibroids, and What Causes Them?

Fibroids are most common during the reproductive years—especially between ages 30 and 50. While the exact cause isn’t fully known, several factors play a role:

• Hormonal influence: Estrogen and progesterone can promote fibroid growth.
• Genetic predisposition: Fibroids often run in families.
• Ethnicity: Some populations report higher rates or more severe growth patterns.
• Lifestyle and metabolic factors: Obesity, high blood pressure, and insulin resistance may increase risk (though they’re not direct causes).

Fibroids can appear in individuals with none of these risk factors and may remain silent unless they grow or trigger symptoms.

What Symptoms Might Fibroids Cause?

Many people experience few to no symptoms, but when fibroids do become noticeable, common signs include:

• Heavy or prolonged menstrual bleeding
• Periods that become progressively heavier over time
• Pelvic fullness or pressure, sometimes felt as pelvic pain
• Frequent urination or difficulty emptying the bladder
• Constipation or bloating
• Pain during intercourse
• Enlargement of the lower abdomen
• Fatigue due to anemia from heavy bleeding

Severity varies widely. One person may have large fibroids with minimal symptoms, while another may feel significant discomfort from tiny fibroids.

When Should I Worry About Fibroids?

While fibroids are usually benign, certain signs may warrant closer attention:

• Unusually heavy, prolonged bleeding leading to fatigue or weakness
• Severe pelvic or abdominal pain that worsens over time
• Rapid growth or sudden change in symptoms
• Bladder or bowel pressure that interferes with daily activities
• Notable increase in abdominal size unrelated to weight gain
• Symptoms of anemia (dizziness, shortness of breath, persistent tiredness)

If any combination of these symptoms impacts quality of life, discuss next steps with a provider.

How Are Fibroids Diagnosed?

• Physical exam: Pelvic exam to feel for an enlarged uterus or masses.
• Ultrasound: Common tool to visualize fibroids and estimate size and location.
• MRI (less frequent): Detailed mapping before surgical planning.
• Blood tests: For example, iron studies to assess impacts from heavy bleeding.

Diagnosis is personalized. For mild symptoms, a watchful waiting approach may follow initial assessment. If symptoms escalate—or fertility is a concern—further steps can be explored.

What Treatment Options Exist?

Treatment depends on symptoms, fibroid size and location, fertility goals, and personal preference.

Watchful Waiting

• Many fibroids remain small and nonproblematic.
• Regular monitoring with exams or imaging tracks changes—sensible for mild symptoms.

Medications

Medical treatments may temporarily ease symptoms:

• Hormonal therapies (e.g., birth control) may regulate bleeding (do not reliably shrink fibroids long term).
• GnRH agonists may shrink fibroids by suppressing estrogen—extended use has side effects.
• Non-hormonal options can reduce heavy bleeding without changing fibroid size.

Medication isn’t a permanent solution but can help while exploring other options.

Non-Surgical Options

• Uterine fibroid embolization (UFE): An interventional radiologist blocks fibroid blood vessels, causing shrinkage over time.
• Acessa (laparoscopic radiofrequency ablation): Minimally invasive treatment using heat to destroy fibroid tissue via small abdominal incisions; ultrasound guidance targets and treats fibroids.

Both can offer effective symptom relief while retaining the uterus. Effects on future fertility are not fully known. Each has considerations such as scarring, recovery time, and potential regrowth.

Surgical Options

Minimally Invasive Procedures

• Laparoscopic myomectomy: Removal of fibroids via small ports and a camera, preserving the uterus; approaches range from hysteroscopic to laparoscopic/mini-laparotomy depending on fibroid characteristics.
• Laparoscopic hysterectomy: Removal of the uterus via small ports and a camera—an irreversible but definitive solution. Eliminates fibroids and heavy periods; ends fertility and triggers surgical menopause if ovaries are removed.

Open/Abdominal Procedures

• Abdominal myomectomy: Open surgical approach for large or numerous fibroids in people desiring fertility preservation.
• Abdominal hysterectomy: Removal of the uterus via a larger incision—definitive and irreversible; ends fertility and may induce surgical menopause if ovaries are removed.

Given its permanence, hysterectomy is best considered when other treatments haven’t worked or aren’t suitable—and when fertility isn’t a goal.

How Do Fibroids Affect Fertility?

Impact depends on location:

• Submucosal fibroids (encroaching on the uterine cavity) may interfere with implantation or increase miscarriage risk.
• Intramural fibroids (if large) may distort uterine shape or affect blood flow.

Removing problematic fibroids can restore fertility potential, though age and overall uterine health also influence outcomes.

Can Lifestyle Help with Fibroids?

While fibroids aren’t caused by diet or exercise, supportive habits may help:

• Balanced nutrition: Whole foods, fiber, lean protein, and anti-inflammatory ingredients support hormonal balance.
• Healthy weight management: Because excess estrogen is stored in fat tissue, maintaining a healthy weight may reduce stimulation.
• Stress management: Mindfulness, sleep, and gentle activity can help you feel more grounded.

Lifestyle alone can’t remove existing fibroids, but it supports overall well-being and may ease symptom perception.

What Are Recurrence Risks?

• After myomectomy: New fibroids may develop; some remain symptom-free for years.
• After UFE: Treated fibroids typically shrink, but new ones may emerge over time.
• After hysterectomy: Recurrence is eliminated (uterus removed).

Monitoring symptoms—even after successful treatment—supports long-term comfort.

When Is Fibroid Pain Not Just Fibroids?

Symptoms can overlap with other conditions, including:

• Ovarian cysts or torsion
• Pelvic inflammatory disease
• Adenomyosis
• Digestive issues (e.g., IBS, constipation)
• Urinary conditions (e.g., UTIs)

Persistent or worsening symptoms that don’t align with typical fibroid patterns deserve fresh evaluation.

What’s the Long-Term Outlook?

• Many fibroids remain asymptomatic or grow slowly.
• Individualized monitoring tracks shifts over time.
• Treatments can control symptoms, restore fertility, and protect quality of life.
• Fertility often remains intact unless the uterus is removed.
• Lifestyle and holistic care support resilience across the journey.

Do Fibroids Always Require Surgery?

No. Many individuals never need an operation. The decision depends on symptom severity, fibroid size/number, and reproductive goals.

When Is Surgery Not Needed?

• Minimal or no symptoms
• Stable size without rapid growth
• Manageable symptoms with medication or lifestyle changes
• Proximity to menopause (fibroids often shrink afterward)

When Might Surgery Be Best?

• Persistent heavy bleeding causing anemia or life disruption
• Severe pain or bulk symptoms affecting bladder, bowel, or mobility
• Fertility concerns due to uterine distortion or tubal blockage
• Uncertain diagnosis or atypical rapid enlargement

Surgery is one tool among many—often effective for severe symptoms, while others benefit from less invasive approaches or monitoring.

Can Fibroids Come Back After Treatment?

Yes. Fibroids are hormone-sensitive; if the uterus remains, new fibroids can grow.

Recurrence Rates

• After myomectomy: Up to 30–50% within 5–10 years (higher with multiple initial fibroids or younger age).
• After UFE: Treated fibroids shrink/die; new ones can develop elsewhere over time.
• After hormonal therapy: Shrinkage is temporary; regrowth usually occurs once therapy stops unless followed by another intervention or menopause.
• After hysterectomy: No recurrence risk.

What Affects Likelihood of Recurrence?

• Age: Younger than 35 has higher regrowth risk (longer hormone exposure).
• Number of fibroids: More fibroids initially can mean higher recurrence.
• Incomplete removal: Small, undetected fibroids can continue to grow.

Managing Recurrence Risk

• Regular monitoring (e.g., periodic ultrasound)
• Balanced diet, weight management, and physical activity
• Medical management to slow regrowth or mitigate symptoms

Fibroid care is often a long-term conversation—planning ahead helps you feel prepared and empowered.

What Happens to Fibroids After Menopause?

For many, fibroids shrink or become less symptomatic after menopause due to falling estrogen and progesterone.

What to Expect

• Reduced size; some shrink enough to stop causing symptoms
• Heavy bleeding ceases; pelvic pressure often lessens
• Fewer interventions are typically needed

When to Seek Care After Menopause

• Persistent pelvic pressure from large fibroids
• Any postmenopausal bleeding (always abnormal and should be evaluated)
• Continued or rapid fibroid growth (requires closer assessment)

Hormone Replacement Therapy (HRT)

• Some fibroid growth may occur, especially with unopposed estrogen.
• Discuss options to balance symptom relief with fibroid stability.

Are Uterine Fibroids the Same as Polyps or Cysts?

No—these are distinct conditions with different origins and management.

Uterine Fibroids

• Composition: Muscle and fibrous tissue
• Location: In or on the uterus
• Behavior: Noncancerous, hormonally sensitive, may grow over time
• Symptoms: Heavy bleeding, pelvic pressure/pain, frequent urination
• Treatment: Observation, medication, minimally invasive procedures, or surgery

Uterine Polyps

• Composition: Overgrowth of endometrial lining cells
• Location: Project into the uterine cavity
• Behavior: Usually small and benign; may cause irregular bleeding
• Symptoms: Spotting between periods, postmenopausal bleeding, infertility
• Treatment: Often removed via hysteroscopy if symptomatic or concerning

Ovarian Cysts

• Composition: Fluid-filled sacs
• Location: On or inside the ovaries
• Behavior: Many resolve spontaneously; others persist
• Symptoms: Pelvic pain, bloating, delayed periods
• Treatment: Observation, hormonal therapy, or surgery depending on size/persistence

Though symptoms can overlap, origin and management differ. Pelvic imaging—often ultrasound—clarifies diagnosis. In short: fibroids are solid muscular uterine tumors; polyps arise from the endometrial lining; cysts typically develop on the ovaries.