80% Of women develop fibroids by age 50. They're the most common benign gynecological growth.
3× More likely to develop fibroids if you are Black, and more likely to experience severe symptoms
25% Of women with fibroids experience heavy bleeding severe enough to cause iron deficiency anaemia

What are fibroids and why do so many women get them?

Fibroids are non-cancerous growths that develop in or around the uterus, made up of muscle and fibrous tissue. They range from pea-sized to watermelon-sized (in rare cases), and a woman can have just one or several at once.

The exact cause is not fully understood. What the research does confirm is that fibroids are estrogen-dependent: they grow in response to estrogen and progesterone, which is why they tend to develop during reproductive years and typically shrink after menopause.

Genetics, insulin resistance, and chronic inflammation also appear to play a role. Insulin resistance and fibroid risk appear connected in the research.

Research note

A 2024 review in the New England Journal of Medicine (Stewart EA, doi:10.1056/NEJMcp2309623) highlighted the substantial racial disparity in fibroid burden: Black women are diagnosed more frequently, earlier in life, and with larger or more numerous fibroids. The review called for targeted screening and earlier intervention in high-risk populations, not watchful waiting as a default.

The symptoms most women are told to ignore

Here's what often happens: a woman reports heavy periods to her doctor and is told it's normal variation, or is given the pill, or is told to come back if it gets worse. The fibroid causing the bleeding goes undiagnosed for years.

Symptoms worth pushing about include periods that last longer than 7 days, bleeding heavy enough to soak through protection in an hour, pelvic pain or pressure that is persistent, frequent urination caused by the uterus pressing on the bladder, and pain during sex. These are not "just periods."

A transvaginal ultrasound is the standard first-line investigation. It's reasonable to ask for one.

Treatment options: what exists beyond "wait and see"

Watchful waiting is appropriate for small, asymptomatic fibroids. For symptomatic fibroids, there is a spectrum of options most women are never told about.

Medical management

Hormonal treatments including hormonal IUDs and GnRH analogues may help manage symptoms of heavy bleeding associated with fibroids. Research suggests benefit in some women, and your doctor can advise on the options most appropriate for your situation.

These treatments don't remove fibroids but may help manage symptoms while you consider longer-term plans.

Minimally invasive procedures

Uterine fibroid embolisation (UFE) cuts off the blood supply to fibroids, causing them to shrink. MRI-guided focused ultrasound (MRgFUS) uses sound waves to destroy fibroid tissue without surgery. Both preserve the uterus and are performed as outpatient or day procedures.

Surgical options

Myomectomy removes individual fibroids while leaving the uterus intact. This is an important option for women who wish to conceive.

Hysterectomy is the only definitive cure, but it's irreversible. It is not the only option and should not be presented as such without first discussing uterus-preserving alternatives.

Fibroids and fertility: what you need to know

Most fibroids do not affect fertility. The exception is submucosal fibroids (those that grow inside the uterine cavity), which may interfere with implantation.

If you're trying to conceive and have known fibroids, an OB-GYN with fertility expertise can advise whether the type and location of your fibroids are likely to be relevant.

If heavy periods from fibroids have led to iron deficiency, addressing that before conception is important. Low ferritin affects egg quality and early pregnancy outcomes.

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When to push for a referral

Ask to be referred to a OB-GYN if: your periods are consistently heavy and affecting your daily life or requiring you to change plans; you have unexplained pelvic pain; you've been trying to conceive for 12 months without success and have known fibroids; or an ultrasound shows fibroids that are growing quickly. You do not have to accept "manage the symptoms with the pill" as the only answer.

Medical Disclaimer: This article is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

References

  1. Stewart EA. Uterine Fibroids. N Engl J Med. 2023;389(17):1571–1580. doi:10.1056/NEJMcp2309623
  2. Giuliani E, et al. Advancements and Emerging Therapies in the Medical Management of Uterine Fibroids. PMC. 2024. PMC11163935
  3. Bulun SE. Uterine Fibroids. N Engl J Med. 2013;369(14):1344–1355. PubMed 24088094
  4. Stewart EA, et al. Uterine fibroids: mechanisms, clinical management and the quest for a cure. Nat Rev Dis Primers. 2017;3:17043. PubMed 28703221