Uterine Fibroids
Understand fibroid types, symptoms, and the full range of treatment options
Overview
Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus and are extremely common -- up to 80% of women will develop them by age 50. Black women experience higher prevalence, earlier onset, larger and more numerous fibroids, and more severe symptoms, making equitable access to screening and treatment particularly important.
Fibroids are classified by location: submucosal (protruding into the uterine cavity, most symptomatic for bleeding), intramural (within the muscle wall), subserosal (on the outer surface), and pedunculated (attached by a stalk). Location matters more than size for determining symptoms and treatment approach.
Many fibroids are asymptomatic and require no treatment. When they do cause symptoms, the full range of options spans hormonal management, minimally invasive procedures (uterine artery embolization, radiofrequency ablation), myomectomy (which preserves the uterus), and hysterectomy. Too often, individuals are told to simply "wait for menopause" rather than being offered active management.
Symptoms
Heavy menstrual bleeding
Prolonged or excessively heavy periods, often with large clots, that can lead to iron-deficiency anemia.
Pelvic pressure and bulk symptoms
A sensation of fullness, heaviness, or pressure in the lower abdomen as fibroids enlarge the uterus.
Urinary frequency
Needing to urinate more often due to fibroids pressing on the bladder.
Constipation
Difficulty with bowel movements when fibroids press against the rectum.
Back or leg pain
Pain radiating to the lower back or legs from large fibroids compressing pelvic nerves.
Pain during intercourse
Discomfort during sex, particularly with certain positions, depending on fibroid location.
Abdominal distension
Visible abdominal enlargement in cases of large or multiple fibroids.
Treatment Options
LNG-IUD
Levonorgestrel-releasing IUD reduces heavy menstrual bleeding effectively for many fibroid patients.
GnRH antagonists
Elagolix and relugolix with hormonal add-back shrink fibroids and reduce bleeding with a manageable side effect profile.
Myomectomy
Surgical removal of fibroids while preserving the uterus. Approach (laparoscopic, hysteroscopic, or open) depends on fibroid size and location.
Uterine artery embolization (UAE)
Interventional radiology procedure that blocks blood supply to fibroids, causing them to shrink. No incisions required.
Radiofrequency ablation
Minimally invasive treatment that uses heat to destroy fibroid tissue while preserving the uterus.
Hysterectomy
Definitive treatment when fertility is no longer desired and other approaches have been insufficient.
Frequently Asked Questions
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Important Notice
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for medical decisions specific to your situation.