What are Uterine Fibroids?

Uterine fibroids, also called leiomyomas or myomas, are benign growths made from muscle and connective tissue that develop in or around the uterus. They can occur as a single growth or in groups and range from very small fibroids to growths large enough to change the size or shape of the uterus.

Fibroids are very common during the reproductive years, but not everyone who has them experiences symptoms. Some are discovered during a routine pelvic exam or imaging performed for another reason. When uterine fibroid symptoms begin interfering with your periods, comfort, daily activities, or reproductive health, an OB-GYN can help determine whether treatment is appropriate.

What Are the Symptoms of Uterine Fibroids? 

Uterine fibroid symptoms vary depending on the number, size, and location of the growths. Many people have no symptoms at all. When symptoms do occur, they may include:

• Heavy or prolonged menstrual bleeding: Fibroids can cause periods to become heavier, last longer, or occur more frequently. Significant blood loss over time may lead to iron-deficiency anemia.
• Painful periods: Menstrual cramps may become stronger or more disruptive as fibroids affect the uterus.
• Pelvic pain or pressure: Larger fibroids may cause an aching, heavy, or full sensation in the lower abdomen or pelvis.
• Abdominal enlargement or bloating: Fibroids can sometimes cause the lower abdomen to appear or feel enlarged.
• Frequent urination or difficulty emptying the bladder: Fibroids pressing against the bladder can make you feel like you need to urinate more often.
• Constipation or rectal pressure: Pressure on the bowel or rectum may make bowel movements more difficult.
• Lower back pain: Certain fibroids can create pressure that contributes to persistent discomfort in the lower back.
• Pain during sex: Fibroids may cause pain or pressure during intercourse, particularly depending on their size and location.
• Fatigue or weakness: Heavy menstrual bleeding can lead to anemia, which may cause tiredness, weakness, dizziness, or shortness of breath.
• Fertility or pregnancy concerns: Most people with fibroids can become pregnant, but certain fibroids can interfere with conception or contribute to pregnancy complications.

Talk with a healthcare provider if your periods have become significantly heavier or more painful, you have persistent pelvic pressure, or these symptoms are beginning to interfere with everyday activities.

What Causes Uterine Fibroids?

There is no single known cause of uterine fibroids. Researchers believe several factors influence how fibroids develop and grow. These include:

• Hormones: Research suggests that estrogen and progesterone play an important role in fibroid growth. Fibroids commonly develop during the reproductive years and often shrink after menopause as hormone levels decrease.
• Genetics: Fibroids can run in families, suggesting that inherited factors contribute to risk.
• Changes within uterine muscle cells: Fibroids develop from muscle tissue in the uterus, and biological changes within these cells may contribute to their formation and growth.

Having one or more risk factors does not mean you will develop symptomatic fibroids, and people without obvious risk factors can develop them as well.

Who’s at Risk for Uterine Fibroids? 

Uterine fibroids can develop at any point during the reproductive years, but certain factors are associated with a higher likelihood of developing them.
Risk factors for uterine fibroids include:

• Being in your 30s or 40s
• Having a family history of uterine fibroids
• Being African-American; fibroids tend to occur at younger ages and more frequently in Black women
• Obesity

Remember, risk factors alone cannot tell you whether you have fibroids. A healthcare provider can evaluate symptoms and recommend imaging when needed.

What are the Types of Uterine Fibroids? 

The types of uterine fibroids are classified primarily by where they grow in relation to the uterine wall. Location matters because it can influence the symptoms a fibroid causes and which treatment options may be most appropriate.

• Intramural fibroids: These grow within the muscular wall of the uterus and are the most common type. Depending on their size, they may contribute to heavy bleeding, pelvic pressure, or an enlarged uterus.
• Submucosal fibroids: These grow beneath the uterine lining and extend toward or into the uterine cavity. Even smaller submucosal fibroids can sometimes cause significant menstrual bleeding or affect fertility.
• Subserosal fibroids: These form toward the outside of the uterus and may grow outward into the pelvis. Larger subserosal fibroids can press on nearby organs and cause pelvic pressure, urinary symptoms, or constipation.
• Pedunculated fibroids: These fibroids are attached to the uterus by a stalk or stem and can develop either toward the inside or outside of the uterus.
  It is possible to have more than one type of fibroid at the same time. We recommend speaking to your OB-GYN for more information.

How Do Uterine Fibroids Affect Fertility and Pregnancy?

Most people with uterine fibroids can become pregnant and have full-term pregnancies. However, the size and location of certain fibroids may make conception more difficult or affect pregnancy. Fibroids that change the shape of the uterine cavity can be particularly relevant when evaluating fertility concerns.

Depending on your individual situation, fibroids may be associated with infertility, pregnancy loss, preterm delivery, fetal positioning problems, or an increased likelihood of cesarean delivery. Having fibroids does not mean these complications will occur.

If you have fibroids and are planning a pregnancy, struggling to conceive, or currently pregnant, talk with your OB-GYN about whether the size and location of your fibroids require monitoring or treatment.

H2: How are Uterine Fibroids Diagnosed & Treated? 

Uterine fibroids are often first detected during a routine gynecological exam. If your healthcare provider suspects fibroids based on your symptoms or exam, additional testing can help confirm the diagnosis and determine their number, size, and location.

Your evaluation may include:
 

• A review of your symptoms and menstrual history
• A pelvic exam
• Pelvic or transvaginal ultrasound
• Blood tests, particularly when heavy bleeding may have caused anemia
• MRI when more detailed imaging is needed
• Sonohysterography or hysteroscopy when your provider needs a closer look inside the uterine cavity

Not every fibroid requires treatment. If your fibroids are small and are not causing symptoms, your healthcare provider may recommend monitoring them over time.

For symptomatic fibroids, uterine fibroids treatment is personalized based on factors including your symptoms, age, fibroid size and location, and whether you would like to become pregnant in the future. Treatment options may include medication, uterine fibroid embolization, radiofrequency ablation, myomectomy, or hysterectomy.

What Are the Benefits of Diagnosis & Treatment? 

A clear diagnosis can help determine whether fibroids are responsible for symptoms such as heavy bleeding, pelvic pain, or pressure and identify which treatment options best fit your needs.

For people with symptomatic fibroids, treatment may help:

• Reduce heavy or prolonged menstrual bleeding
• Improve iron-deficiency anemia caused by blood loss
• Relieve pelvic pain, pressure, or cramping
• Reduce pressure on the bladder or bowel
• Improve comfort during everyday activities or sex
• Address certain fibroid-related fertility concerns
• Preserve the uterus when a uterus-sparing treatment is appropriate
• Improve overall quality of life

Remember, treatment is not necessary simply because a fibroid is present. The goal is to address symptoms and health concerns while selecting an approach that aligns with your preferences and reproductive plans.