Uterine Fibroids: Types, Symptoms, Causes, Diagnosis and Treatment
Uterine fibroids are non-cancerous growths that develop in or around the uterus. Also known as leiomyomas or myomas, they are common during the reproductive years and can vary significantly in size, number, and location.
Many women with uterine fibroids do not experience symptoms and may not need treatment. However, some fibroids can cause heavy menstrual bleeding, pelvic discomfort, frequent urination, or difficulties with conception, depending on their size and position.
Understanding the types of uterine fibroids, their potential effects on fertility, and the available treatment options can help women make informed decisions about their reproductive health.
What Are Uterine Fibroids?
Uterine fibroids are growths made primarily of smooth muscle and fibrous tissue that develop in the wall of the uterus or extend from its surface. They are generally benign and are not considered cancerous tumours.
Fibroids can range from tiny nodules to large masses that alter the shape of the uterus. Some grow within the muscular wall, while others project towards the uterine cavity or the outside of the uterus.
The effects of fibroids vary from person to person. Some women remain symptom-free, while others experience heavy bleeding, pelvic pressure, or reproductive difficulties.
Although fibroids are not generally associated with an increased risk of uterine cancer, their symptoms and characteristics should be assessed by a healthcare professional when appropriate.
What Are the Types of Uterine Fibroids?
Uterine fibroids are classified according to where they develop in relation to the uterine wall and cavity.
1. Intramural Fibroids
Intramural fibroids develop within the muscular wall of the uterus. They are a common type of fibroid and may grow larger over time.
Depending on their size and location, they can cause heavy menstrual bleeding, pelvic pressure, or changes in the shape of the uterus.
2. Submucosal Fibroids
Submucosal fibroids develop beneath the inner lining of the uterus and may project into the uterine cavity.
These fibroids can be particularly relevant to reproductive health because they may distort the cavity and are associated with heavy menstrual bleeding and, in some cases, difficulties with implantation or pregnancy.
3. Subserosal Fibroids
Subserosal fibroids grow towards the outer surface of the uterus. They may extend into the pelvic cavity and sometimes become large enough to press against nearby organs.
Depending on their size and position, they may cause abdominal pressure, frequent urination, or discomfort.
4. Pedunculated Fibroids
Pedunculated fibroids are attached to the uterus by a narrow stalk. They can develop on the outer surface of the uterus or project into the uterine cavity.
Their symptoms depend on their location and size. In some cases, twisting of the stalk may cause sudden pain and require urgent medical assessment.
What Causes Uterine Fibroids?
The exact cause of uterine fibroids is not fully understood. However, several factors are associated with their development and growth.
1. Hormonal Factors
Oestrogen and progesterone are involved in regulating the menstrual cycle and appear to influence fibroid growth.
Fibroids often shrink after menopause, when these hormone levels decline. Hormonal changes during pregnancy may also affect fibroid size, although growth patterns vary.
2. Family History
Genetic factors may contribute to the likelihood of developing fibroids. Women whose close relatives, such as their mother or sister, have had fibroids may have a higher risk.
However, a family history does not mean that a woman will necessarily develop them.
3. Pregnancy and Reproductive Factors
Pregnancy changes the hormonal environment and may influence fibroid growth. Some fibroids increase in size during pregnancy, while others remain stable or decrease.
The relationship between pregnancy and fibroid development is complex, and pregnancy itself should not be considered a direct cause in every case.
What Are the Symptoms of Uterine Fibroids?
Many women with uterine fibroids have no noticeable symptoms. When symptoms occur, they often depend on the fibroids’ size, number, and location.
Common symptoms include:
1. Heavy or Prolonged Menstrual Bleeding
Heavy or prolonged periods are among the most common symptoms associated with uterine fibroids, particularly those that affect the uterine cavity.
Excessive bleeding may interfere with daily activities and can lead to iron deficiency or anaemia.
2. Pelvic Pressure or Discomfort
Larger fibroids may cause a feeling of heaviness, fullness, or pressure in the lower abdomen. Some women also experience pelvic pain or discomfort.
3. Frequent Urination
Fibroids that press against the bladder may cause a frequent urge to urinate or difficulty emptying the bladder fully.
4. Constipation or Bowel Pressure
When fibroids press against the bowel, some women may experience constipation or a sensation of pressure in the pelvic region.
5. Lower Back Pain
Depending on their size and location, fibroids may contribute to lower back discomfort or pelvic pain.
6. Anaemia-Related Symptoms
Heavy menstrual bleeding can lead to anaemia, which may cause fatigue, weakness, dizziness, or shortness of breath.
Women experiencing persistent tiredness alongside heavy periods should consider medical evaluation.
How Can Uterine Fibroids Affect Fertility?
Not all uterine fibroids affect fertility. Their impact depends largely on their location, size, and whether they distort the uterine cavity.
Fibroids may affect reproductive health in several ways:
- Changes to the uterine cavity: Fibroids that project into the cavity may interfere with the environment needed for implantation.
- Heavy menstrual bleeding: Persistent bleeding can contribute to anaemia and affect overall wellbeing.
- Changes in pelvic anatomy: Larger fibroids may occasionally affect the position or function of nearby reproductive structures.
- Pregnancy-related concerns: Some fibroids may be associated with pregnancy complications, depending on their characteristics.
Submucosal fibroids and certain intramural fibroids that distort the uterine cavity are generally more relevant to fertility than fibroids that grow entirely on the outside of the uterus.
A fibroid diagnosis does not automatically mean infertility. A fertility specialist can assess whether a fibroid is likely to affect conception or pregnancy and whether treatment may be beneficial.
How Are Uterine Fibroids Diagnosed?
Diagnosis helps determine the number, size, and location of fibroids. These details are important when assessing symptoms, planning treatment, and considering pregnancy.
1. Ultrasound
Ultrasound is commonly used as the initial imaging test for uterine fibroids.
Transvaginal ultrasound: A probe is inserted into the vagina to provide detailed images of the uterus and nearby reproductive organs. It is often useful for evaluating fibroid size and location.
Abdominal ultrasound: This approach may help assess larger fibroids or provide a broader view of the pelvic region.
Ultrasound findings help clinicians determine whether fibroids may explain the symptoms and whether further investigation is necessary.
2. Magnetic Resonance Imaging (MRI)
MRI may be recommended when more detailed imaging is needed, particularly in cases involving multiple or large fibroids or when surgery is being planned.
It can provide information about fibroid location, size, tissue characteristics, and their relationship to nearby structures.
MRI is not necessary for every woman with fibroids.
3. Hysteroscopy
Hysteroscopy involves passing a thin instrument with a camera through the cervix to examine the inside of the uterus.
It may be recommended when a submucosal fibroid or another abnormality affecting the uterine cavity is suspected. In selected cases, fibroids that project into the cavity can be removed during the procedure.
4. Sonohysterography
Sonohysterography, also called saline infusion sonography, involves introducing sterile saline into the uterine cavity during an ultrasound examination.
The saline helps outline the cavity and may make it easier to identify submucosal fibroids or other abnormalities that distort its shape.
This test may be particularly useful when evaluating the uterine cavity as part of a fertility assessment.
Why Early Assessment Matters
Evaluating fibroids can help clinicians:
- Identify the cause of heavy or prolonged bleeding
- Assess the risk of anaemia
- Determine whether the uterine cavity is affected
- Plan treatment according to symptoms and reproductive goals
- Consider whether fibroids may be contributing to fertility difficulties
Not every fibroid requires treatment. The purpose of assessment is to understand its clinical significance and choose an appropriate management approach.
How Are Uterine Fibroids Treated?
Treatment depends on symptoms, fibroid size and location, age, overall health, and whether pregnancy is desired now or in the future.
Women with small, symptom-free fibroids may need only observation. Others may benefit from medication or a procedure.
1. Observation and Monitoring
If fibroids are not causing significant symptoms or complications, a clinician may recommend monitoring rather than immediate treatment.
Follow-up depends on the individual’s symptoms, medical history, and initial findings. Treatment may become appropriate if symptoms develop or the fibroids change in a clinically significant way.
2. Medical Management
Medication may help control symptoms such as heavy menstrual bleeding and pelvic pain.
Hormonal contraceptives: Combined hormonal contraceptives may help manage menstrual bleeding in suitable patients, although they do not usually eliminate fibroids.
Progestogen-based treatments: Certain treatments may help control bleeding. A progestogen-releasing intrauterine device may be appropriate for selected women, depending on whether the fibroids distort the uterine cavity.
GnRH-based medicines: Certain gonadotropin-releasing hormone (GnRH) agonists or antagonists may reduce bleeding and, in some cases, shrink fibroids temporarily. These medicines have specific indications, potential side effects, and treatment limitations. They may be used before surgery or in other selected situations.
Pain relief: Medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve menstrual pain in suitable patients, but they do not remove fibroids.
Medication choices should be guided by a clinician, particularly for women who are trying to conceive.
3. Myomectomy
Myomectomy is a surgical procedure that removes fibroids while preserving the uterus. It may be considered for women with significant symptoms or selected fibroids that may affect fertility.
Depending on the fibroids’ size and location, the procedure may be performed hysteroscopically, laparoscopically, or through open surgery.
Myomectomy may improve symptoms and may benefit fertility in selected patients. However, it involves surgical risks, and fibroids can recur. The potential benefits and risks should be discussed before proceeding.
4. Hysterectomy
Hysterectomy involves removing the uterus and is a definitive treatment for uterine fibroids.
It may be considered for women with severe symptoms who do not wish to become pregnant in the future and for whom other options are unsuitable or have not been effective.
Because hysterectomy permanently removes the ability to carry a pregnancy, it is not an appropriate option for women who wish to preserve their ability to carry a pregnancy.
5. Uterine Artery Embolisation (UAE)
Uterine artery embolisation is a procedure that reduces the blood supply to fibroids, causing them to shrink over time.
It may be an option for selected women who want relief from fibroid-related symptoms without undergoing a hysterectomy.
However, its suitability for women planning a future pregnancy requires careful consideration. The potential effects on fertility and pregnancy outcomes should be discussed with an appropriately qualified specialist.
How Is Fibroid Treatment Personalised?
Every woman has different symptoms and reproductive goals. Treatment planning may consider:
- Severity of menstrual bleeding or pelvic discomfort
- Number, size, and location of fibroids
- Whether the uterine cavity is distorted
- Age and overall health
- History of infertility or pregnancy complications
- Desire to conceive now or in the future
- Previous treatments and their outcomes
A fertility-focused evaluation can help determine whether monitoring, medication, or a procedure is appropriate. Treatment should aim to address symptoms and reproductive needs without exposing patients to unnecessary intervention.
When Should You See a Doctor for Uterine Fibroids?
Consider consulting a gynaecologist if you experience:
- Heavy or prolonged menstrual bleeding
- Persistent pelvic pain or pressure
- Frequent urination or ongoing bowel pressure
- Fatigue, weakness, or dizziness associated with heavy periods
- A noticeable increase in abdominal size
- Difficulty conceiving
- Known fibroids and plans for pregnancy
Seek urgent medical attention if you experience severe or sudden pelvic pain, fainting, or very heavy bleeding accompanied by weakness or dizziness.
Early evaluation can help identify complications and clarify whether treatment is necessary.
Uterine Fibroids and Fertility Care at Jyoti IVF
Uterine fibroids vary considerably, and not every fibroid needs to be removed before attempting pregnancy or undergoing fertility treatment.
At Jyoti IVF, you can discuss your symptoms, ultrasound findings, and pregnancy goals with a qualified fertility specialist. An individual assessment can help determine whether fibroids are likely to affect fertility and whether monitoring, further investigation, or treatment should be considered.
If you have been diagnosed with uterine fibroids or are experiencing heavy menstrual bleeding or difficulty conceiving, consider booking a consultation with Jyoti IVF to discuss your options.
Frequently Asked Questions About Uterine Fibroids
1. Are uterine fibroids cancerous?
Most uterine fibroids are benign, non-cancerous growths. They are not generally associated with an increased risk of uterine cancer. Any unusual or concerning symptoms should still be evaluated by a healthcare professional.
2. Can uterine fibroids affect fertility?
Some fibroids can affect fertility, particularly those that distort the uterine cavity. Many women with fibroids can conceive naturally, and the need for treatment depends on the fibroids’ characteristics and the individual’s reproductive history.
3. Do all uterine fibroids need to be removed?
No. Fibroids that cause no symptoms or significant complications may only require observation. Treatment is considered according to symptoms, location, size, and reproductive goals.
4. Can medication shrink uterine fibroids?
Certain medicines can reduce fibroid size temporarily or help control associated bleeding. The effects vary, and some treatments are intended for short-term use or specific clinical situations.
5. Can I get pregnant after a myomectomy?
Pregnancy may be possible after myomectomy, depending on the underlying condition, surgical approach, and other fertility factors. The recommended timing for attempting pregnancy after surgery should be discussed with the treating clinician.
6. Is IVF necessary if I have uterine fibroids?
No. IVF is not automatically necessary for women with fibroids. The appropriate fertility approach depends on whether the fibroids affect the uterine cavity, whether other fertility factors are present, and the individual’s circumstances.
7. Can uterine fibroids disappear after menopause?
Fibroids often shrink after menopause because reproductive hormone levels decline. However, the extent of shrinkage varies, and symptoms or new findings should still be assessed by a healthcare professional.
Medical Disclaimer: This article is intended for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. The appropriate evaluation and management of uterine fibroids vary between individuals. Consult a qualified healthcare professional for personalised guidance.