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Overview

What Are Fibroids?

Fibroids are common, noncancerous growths made of uterine muscle and connective tissue. They can vary in number, size, and location, growing within the uterine wall, into the uterine cavity, or on the outer surface of the uterus. Many people have uterine fibroids without symptoms, while others develop bleeding, pain, or pressure. Fibroids most often develop during the reproductive years.

Symptoms

Fibroid Symptoms

  • Heavy or prolonged menstrual bleeding is a common symptom of fibroids.
  • Bleeding between periods may occur when a fibroid affects the uterine cavity.
  • Pelvic pressure can feel like fullness, heaviness, or discomfort in the lower abdomen.
  • Pelvic pain may be constant or may worsen during menstruation.
  • Lower-back pain can occur when a fibroid puts pressure on nearby tissues.
  • Frequent urination may result when a fibroid presses on the bladder.
  • Constipation can occur when a fibroid presses on the bowel or rectum.
  • Pain during sex may occur, depending on the fibroid’s location.
  • Abdominal enlargement may develop as fibroids grow.
  • Difficulty becoming pregnant can occur in some people, particularly when fibroids affect the uterine cavity.

Causes

What Causes Fibroids?

The exact cause of fibroids is not fully known. Genetic changes in uterine muscle cells, exposure to the hormones estrogen and progesterone, and signals from growth factors may all contribute to abnormal cell growth. These influences can lead to a uterine myoma, also called a leiomyoma of the uterus or uterine fibroid.

How Hormones May Affect Fibroid Growth

Fibroids often grow during the reproductive years, when estrogen and progesterone are present, and they commonly shrink after menopause as hormone levels decline. These are suspected biological contributors rather than a single proven cause. Having fibroids is not a sign that a person’s choices or actions caused them.

Risk Factors

Risk Factors for Fibroids

  • A family history of fibroids is associated with a higher likelihood of developing them.
  • Fibroids are most often diagnosed during the reproductive years.
  • Starting menstruation at an earlier age may be associated with increased fibroid risk.
  • Black women are diagnosed with fibroids more often and may develop them at younger ages, although anyone who has a uterus can develop them.
  • Obesity may be associated with a higher risk of fibroids.
  • Low vitamin D levels have been associated with fibroids, but this does not prove that deficiency causes them.
  • Some dietary patterns and metabolic conditions may be associated with fibroid risk, although the evidence is not conclusive.
  • Factors such as age, genetics, and race cannot be changed, while weight and overall health may be modifiable influences for some people.

Complications

Possible Complications of Fibroids

  • Heavy or prolonged bleeding can cause iron-deficiency anemia, leading to tiredness, weakness, or shortness of breath.
  • Persistent pelvic pain or pressure can interfere with comfort, sleep, work, or daily activities.
  • Pressure on the bladder or bowel can cause urinary frequency, constipation, or other changes in normal function.
  • Fibroids may contribute to fertility challenges in some people, especially when they change the shape of the uterine cavity.
  • During pregnancy, fibroids may be associated with pain or other pregnancy complications, depending on their size and location.
  • Rarely, degeneration or twisting of a stalked, or pedunculated, fibroid can cause sudden severe pain.

When size is a concern

What Size Means

There is no single fibroid size that is dangerous for everyone. Location, growth, symptoms, bleeding, and pregnancy plans often matter more than size alone. Seek urgent assessment for severe or sudden pain, heavy bleeding, fainting, or marked weakness.

Diagnosis

How Fibroids Are Diagnosed

Diagnosis typically begins with a review of menstrual and reproductive history, symptoms, and medical history. A clinician may perform a pelvic examination when appropriate to check for changes in the size or shape of the uterus. Imaging and blood tests are then selected according to the symptoms and the information needed for care.

PELVIC ULTRASOUND

Ultrasound uses sound waves to identify fibroids and estimate their number, size, and location. It may be performed through the abdomen or with a vaginal ultrasound.

CAVITY EVALUATION

Saline infusion sonography or hysteroscopy gives clinicians a closer view of the uterine cavity. These tests can help identify fibroids that bulge into the cavity.

MRI

MRI provides detailed images that can map fibroids and their relationship to the uterus. It may be useful when planning treatment or when ultrasound does not provide enough detail.

BLOOD TESTS

Blood tests can check for anemia caused by heavy bleeding. They may also help assess other possible explanations for symptoms.

Treatment & Management

Fibroids Treatment and Management

Treatment may not be needed for fibroids that cause no symptoms. When symptoms occur, management is based on bleeding, pain, pressure, anemia, fibroid location, age, general health, and plans for pregnancy. You and your gynecologist can weigh the benefits, risks, recovery time, and long-term effects of each option.

ApproachWhat it may help withKey considerations
Watchful waitingMonitoring stable fibroids and mild or absent symptomsFollow-up may include symptom reviews or imaging; no procedure-related fertility effects.
Medicines for bleeding or painReducing heavy bleeding, cramps, or pelvic discomfortMedicines may control symptoms but do not permanently remove fibroids; pregnancy considerations vary by medicine.
Hormonal or hormone-suppressing medicinesTemporarily reducing bleeding or fibroid-related symptomsEffects are often temporary, and side effects and plans for pregnancy should be discussed.
Uterine artery embolization or radiofrequency ablationShrinking fibroids and reducing bleeding or pressure with minimally invasive treatmentRecovery and fertility considerations vary; ask about future pregnancy and the possibility of new fibroids.
MyomectomyRemoving fibroids while preserving the uterusMay support future pregnancy for some people, but fibroids can recur and recovery depends on the approach.
HysterectomyProviding definitive treatment by removing the uterusPregnancy is not possible afterward, and recovery depends on the surgical approach.

Choosing treatment

Treatment Depends on Your Goals

Medicine may control symptoms without permanently removing fibroids. A gynecologist can explain how each procedure may affect future pregnancy, recurrence risk, and recovery.

Outlook and Prognosis

Outlook and Prognosis for Fibroids

Fibroids are usually benign and manageable, but their course varies from person to person. They may grow, remain stable, or shrink, and they often become less active after menopause. Symptoms may improve with treatment, but they should not be expected to resolve without care when they are persistent or severe.

  • The symptom burden, including bleeding, pain, and pressure, strongly influences quality of life and treatment decisions.
  • Anemia from ongoing heavy bleeding can affect energy and health until the bleeding is addressed.
  • Fibroid location can affect symptoms, fertility, pregnancy, and which treatments are suitable.
  • Pregnancy plans may influence whether monitoring, medication, a uterus-preserving procedure, or another approach is considered.
  • The treatment chosen affects recovery, symptom control, and whether the uterus is preserved.
  • New or recurrent fibroids can develop after uterus-preserving treatment, even when the original fibroids are successfully treated.

When Should You See a Doctor

When Should You See a Doctor for Fibroids?

  • Arrange medical care for heavy or prolonged menstrual bleeding.
  • Bleeding after menopause should always be evaluated by a clinician.
  • Make an appointment for ongoing pelvic pain or pressure.
  • Seek evaluation for new urinary or bowel changes.
  • Symptoms of anemia, such as unusual tiredness, weakness, dizziness, or shortness of breath, need medical review.
  • Discuss difficulty becoming pregnant or concerns about fibroids during pregnancy with a clinician.
  • Seek care when fibroid symptoms interfere with daily life, sleep, work, or activities.

Seek urgent care

Some Symptoms Should Not Wait

Seek urgent care if you are soaking through pads rapidly, fainting, severely weak, or experiencing heavy bleeding with dizziness. Sudden severe pelvic or abdominal pain also needs prompt assessment, especially if pregnancy is possible or severe pain occurs with bleeding.

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