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Uterine Fibroids: Symptoms and Treatment Options
Fibroids affect about one third of reproductive-age women. Watchful waiting, medical and surgical options.
May 3, 20262 min read
Fibroids are benign tumors arising from the smooth muscle of the uterus. They occur in about one third of women in reproductive age. Most are asymptomatic, but some cause bleeding, pain or infertility requiring treatment.
Symptoms
- Heavy or prolonged menstrual bleeding
- Intermenstrual bleeding or spotting
- Pelvic pain or pressure
- Frequent urination, constipation
- Painful intercourse
- Abdominal bloating
- Back and leg pain
- Difficulty conceiving or recurrent miscarriage
Classification by Location
- Submucosal: Close to endometrium — most common cause of bleeding
- Intramural: Within the uterine wall — most common type
- Subserosal: Growing outward — may cause pressure symptoms
- Pedunculated: On a stalk, outside or inside the uterus
Diagnosis
- Pelvic exam
- Transvaginal ultrasound (first-line)
- Saline infusion sonohysterography
- Hysteroscopy (for intracavitary fibroids)
- MRI (for large or numerous fibroids)
Treatment Options
1. Watchful Waiting
For small, asymptomatic fibroids, control every 6-12 months suffices.
2. Medical Treatment
- Combined oral contraceptives: for bleeding control
- LNG-IUD: for non-submucosal fibroids
- GnRH analogs: temporary preoperative shrinkage
- Tranexamic acid: reducing menstrual bleeding
3. Surgical Treatment
- Hysteroscopic myomectomy: incisionless, for submucosal fibroids
- Laparoscopic myomectomy: minimally invasive, ideal for fertility preservation
- Open myomectomy: for very large or numerous fibroids
- Hysterectomy: definitive treatment for those not desiring fertility
4. Other Methods
- Uterine artery embolization (UAE)
- High-intensity focused ultrasound (HIFU/MRgFUS)
Fibroids and Pregnancy
Most women with fibroids have uncomplicated pregnancies. However, large or cavity-distorting fibroids may:
- Increase miscarriage risk
- Be associated with preterm birth
- Cause fetal positioning issues
- Increase cesarean rate
Pregnancy-planning evaluation is therefore important.
A fibroid diagnosis can feel concerning, but effective and personalized options exist. Regular monitoring and accurate information ease the journey.