Uterine fibroids: symptoms, types and treatment options

What are uterine fibroids?

A fibroid (leiomyoma or myoma) is a benign lump that grows from the smooth muscle of the womb wall. You may have a single fibroid or several, ranging from a few millimetres to more than 10 centimetres. Their growth is driven by the hormones oestrogen and progesterone, which is why fibroids appear during the reproductive years and usually shrink after the menopause.

Fibroids are very common: a large proportion of women will have at least one by the age of 50, although only some will ever notice symptoms. Cancerous change is extremely rare. Leiomyosarcoma, a rare cancer of the womb muscle, is a separate disease and is not thought to develop from ordinary fibroids, but a lump that grows quickly after the menopause should always be checked by a specialist.

Types of fibroids

Where a fibroid sits often matters more than how big it is. Gynaecologists use the FIGO classification, but in everyday terms there are three main groups:

A small submucosal fibroid can cause very heavy bleeding, whereas a large subserosal fibroid may go unnoticed for years.

Symptoms of fibroids

Around half of women with fibroids have no symptoms. When symptoms do occur, the most common are:

• heavy or prolonged periods, sometimes with clots, and bleeding between periods;
• tiredness, breathlessness and pale skin caused by iron-deficiency anaemia, which shows up on a full blood count;
• pain or a feeling of heaviness in the lower tummy or lower back;
• needing to pass urine frequently, especially at night, or constipation;
• pain during sex;
• difficulty getting pregnant or repeated miscarriages, mainly with fibroids that distort the womb cavity.

Similar symptoms can be caused by endometriosis, adenomyosis, polyps or, less commonly, womb (endometrial) cancer. Heavy periods should therefore be investigated rather than accepted as normal.

Causes and risk factors

The exact cause is not fully understood. Genetic changes in the muscle cells, hormones and growth factors all play a role. Factors linked to a higher risk include:

• being between 30 and 50 years old;
• a mother or sister with fibroids;
• starting periods at an early age;
• being overweight or living with obesity;
• high blood pressure and, in some studies, low vitamin D;
• being of Black African or Caribbean heritage, where fibroids tend to appear earlier and more often.

Having children seems to be associated with a lower risk. There is no proven way to prevent fibroids, but keeping to a healthy weight and attending regular health check-ups help to pick them up early.

How fibroids are diagnosed

A doctor may feel an enlarged or irregular womb during a pelvic examination. The key test is a transvaginal ultrasound scan, which shows the number, size and position of the fibroids. Other tests may include:

• saline infusion sonography – an ultrasound with fluid placed in the womb cavity, useful for submucosal fibroids;
• hysteroscopy – a thin camera passed through the cervix to look inside the womb, sometimes removing small fibroids or polyps at the same time;
• MRI – for multiple or large fibroids, before surgery or embolisation, or if another condition is suspected (see MRI and CT scans);
• blood tests for anaemia and iron stores.

Women over 45, or those with risk factors and irregular bleeding, may also be offered an endometrial biopsy to rule out precancerous changes.

Treatment options

Treatment is tailored to your symptoms, the size and position of the fibroids, your age and whether you hope to become pregnant. There is rarely a single right answer.

Watchful waiting

Fibroids that cause no problems usually do not need treatment. Regular check-ups and an ultrasound, often once a year, are enough.

Medicines

The aim is to reduce bleeding and pain. Options include non-hormonal treatments (tranexamic acid, anti-inflammatory painkillers), a hormone-releasing intrauterine system or the combined pill, and medicines from the GnRH analogue and GnRH antagonist groups, which temporarily lower hormone levels and shrink fibroids. Some are used before surgery to correct anaemia. The choice of medicine is always made by your doctor.

Minimally invasive procedures

• Uterine artery embolisation – an interventional radiologist uses a thin catheter to block the blood vessels feeding the fibroids, which then shrink. The womb is kept.
• Radiofrequency ablation and MRI-guided focused ultrasound – for selected patients in specialist centres.

Surgery

• Myomectomy – removal of the fibroids only, keeping the womb. It can be done hysteroscopically (for submucosal fibroids), by keyhole surgery, with a robot (see robotic surgery) or through an open incision.
• Hysterectomy – removal of the womb; a permanent solution for women with severe symptoms who do not plan a pregnancy.

New fibroids can develop over the years after myomectomy. Ask your gynaecologist to explain the benefits, risks and expected recovery for each option.

Fibroids, fertility and pregnancy

Many women with fibroids conceive and give birth without difficulty. Submucosal fibroids and those that distort the womb cavity can make it harder for an embryo to implant, and removing them often improves the chances, including before IVF. Fibroids can grow and occasionally cause pain during pregnancy. Most women can carry a pregnancy after myomectomy; your doctor will advise whether a caesarean section is safer, depending on how deeply the womb wall was involved.

When to see a doctor

Book an appointment with your GP or a gynaecologist if:

• your periods last longer than 7 days or you need to change pads or tampons every 1–2 hours;
• you bleed between periods or after sex;
• you feel constantly tired, breathless or notice a racing heart;
• you have pelvic pressure, pass urine very often or your tummy is visibly swelling;
• you have been trying to get pregnant for over a year (or six months if you are over 35).

Seek urgent care for very heavy bleeding with dizziness or fainting, or sudden severe tummy pain. Any bleeding after the menopause should be checked promptly.

Treatment abroad and in Türkiye

Some patients from Europe choose laparoscopic or robotic myomectomy at large accredited hospitals in Istanbul because of short waiting times and teams experienced in minimally invasive gynaecological surgery. Before deciding, check the hospital accreditation, the gynaecologist’s specialist experience, the written treatment plan (type of operation, length of stay, possible complications) and how follow-up will be arranged once you are home. Organisers such as New City Clinic coordinate the hospital, doctor, hotel, transfers and an interpreter. Bring recent ultrasound reports, MRI images and blood results.