Uterine fibroids: understanding your options from diagnosis to treatment

What are uterine fibroids?

Uterine fibroids, also called leiomyomas or myomas, are benign growths that arise from the muscular tissue of the uterus. The word tumour understandably alarms women, but fibroids are not cancerous and almost never become so. Transformation to malignancy occurs in fewer than one in a thousand cases.

Their size ranges from a few millimetres to masses as large as an advanced pregnancy. A woman may have a single fibroid or many simultaneously. A comprehensive review published in JAMA in 2024 confirmed that fibroids are among the most common tumours in women, affecting between 20 and 80 percent of women in their reproductive years by age 50.

That large range reflects the fact that many fibroids are small and completely silent, discovered incidentally on an ultrasound done for another reason. A meaningful proportion of women with fibroids, however, have symptoms that significantly affect their quality of life and warrant active treatment.

The hormonal connection is clear: fibroids grow under the stimulation of oestrogen and progesterone, which is why they expand during the reproductive years and shrink naturally after menopause. A 2025 paper in Physiological Reviews provided a detailed molecular map of the mechanisms driving fibroid growth, which is opening paths for more targeted treatments in the coming years.

Symptoms of uterine fibroids

Heavy and prolonged menstrual bleeding is the most common symptom. Women describe using large quantities of sanitary products, changing them very frequently, passing clots, and periods that extend far beyond the usual number of days. This chronic blood loss leads directly to iron-deficiency anaemia.

A paper published in Fertility and Sterility in 2022 confirmed the close connection between chronic heavy uterine bleeding and iron-deficiency anaemia in women of reproductive age. Anaemia does not present only as pallor: severe fatigue, shortness of breath on exertion, palpitations and difficulty concentrating are often its most disabling manifestations. If these symptoms accompany heavy periods, haemoglobin and iron studies are essential.

Other symptoms include a sense of pressure or heaviness in the lower abdomen and pelvis, urinary frequency if fibroids press on the bladder, and constipation if they press on the rectum. Pain during periods or during sex is also common with certain fibroid types and locations.

Large fibroids can cause visible abdominal enlargement that resembles early pregnancy. This is not dangerous in itself but affects appearance and may cause psychological and social distress that is legitimate and worth addressing alongside the physical symptoms.

How are fibroids diagnosed?

Pelvic ultrasound, either abdominal or transvaginal, is the first and most accessible investigation. It gives a clear picture of fibroid number, size and location in most cases. It is a painless test that usually requires no special preparation. A good ultrasound report tells you how many fibroids are present, where they sit relative to the uterine cavity, and their approximate dimensions.

If the doctor needs more detail before planning surgery, MRI provides a three-dimensional map of each fibroid and its relationship to the uterine cavity and surrounding structures. Hysteroscopy, passing a small camera into the uterine cavity, gives a direct view of submucosal fibroids that bulge inward.

Blood tests are always needed to measure haemoglobin and iron, because the degree of anaemia from chronic bleeding determines the urgency of treatment and sometimes the sequence of interventions. Thyroid function tests and clotting studies may also be requested to exclude other causes of heavy bleeding before attributing it entirely to fibroids.

Treatment from medicines to surgery

The treatment decision depends on several factors: the size and number of fibroids, the severity of your symptoms, your age and proximity to menopause, and whether future pregnancy is important to you. A 2024 review in Fertility and Sterility mapped modern approaches to managing fibroid-related abnormal uterine bleeding comprehensively.

Medical treatment is first-line. Hormonal methods including the combined pill, the progestogen-only pill or the hormonal IUD reduce bleeding significantly in many women without directly shrinking the fibroids. Newer medicines called selective progesterone receptor modulators have been shown in trials to shrink fibroids and reduce bleeding as a bridge to surgery or in some cases as an alternative.

GnRH agonists temporarily switch off the ovaries, causing fibroids to shrink and bleeding to stop. They are limited to around six months of use because of their effect on bone density. They are used most often as pre-surgical preparation to reduce fibroid volume and control anaemia before a planned procedure.

Surgical options divide into two: myomectomy, which removes the fibroids while preserving the uterus, and hysterectomy, which removes the uterus entirely. Myomectomy is the appropriate choice for women who want future pregnancy or who wish to keep their uterus. Hysterectomy is the definitive cure but permanently prevents pregnancy and should be considered only after other options have been fully explored.

Fibroids and pregnancy

Most women with fibroids conceive and deliver normally without intervention. The fibroids most likely to cause problems are submucosal ones that protrude into the uterine cavity, because they can disrupt implantation or raise the miscarriage rate. Hysteroscopic removal of these specific fibroids before attempting conception improves outcomes in this group.

During pregnancy, fibroids may grow somewhat under the influence of pregnancy hormones and occasionally cause pelvic pain when they outgrow their blood supply, a process called red degeneration. The risk of miscarriage, preterm birth and abnormal foetal lie is modestly elevated with large or numerous fibroids, but the majority of pregnancies proceed normally and result in healthy deliveries.

If you have fibroids and are planning a pregnancy, discuss the specifics with your doctor. The decision about whether to remove fibroids before trying to conceive depends on their size, location, the degree to which they encroach on the uterine cavity, your age and your obstetric history. There is no universal right answer.

After myomectomy, most specialists recommend waiting six months to a year before attempting pregnancy, allowing the uterine wall to heal fully and reducing the small risk of uterine rupture during labour, particularly when large or multiple fibroids have been removed. Your surgeon will give specific advice based on what was done.

Non-surgical intervention options

Uterine artery embolisation (UAE) is performed by an interventional radiologist without open surgery. Tiny particles are injected through a catheter in the groin artery into the uterine arteries that feed the fibroids. The fibroids gradually lose their blood supply, shrink and die. Evidence shows good effectiveness for reducing bleeding and pelvic pressure, and it represents a genuine alternative to surgery for women who want to avoid an operation.

MRI-guided focused ultrasound uses precisely targeted sound waves to heat and destroy fibroid tissue without any incision. It is available in specialised centres and is not yet widely accessible across the Arab world, but it represents an important future option for eligible candidates.

Radiofrequency ablation is a newer technique that destroys fibroid tissue using heat delivered through a small probe inserted via laparoscopy or hysteroscopy. Studies show good short-term fibroid volume reduction with faster recovery than open surgery, and it preserves the uterus.

Managing anaemia alongside fibroid treatment

Anaemia from chronic fibroid-related bleeding is one of the most disabling aspects of the condition. Persistent fatigue, difficulty concentrating, shortness of breath on mild exertion and palpitations are not vague complaints but measurable consequences of low haemoglobin affecting every organ system. A 2022 paper in Fertility and Sterility quantified the impact of iron deficiency anaemia on women's reproductive health and underscored the importance of treating it actively alongside the fibroids themselves.

Oral iron is effective but its absorption depends on how it is taken. It is absorbed best on an empty stomach with a vitamin C source such as a glass of orange juice, and absorption falls considerably when taken alongside tea, coffee or calcium-rich foods. In the Arab world, drinking tea with meals is almost universal, and this habit cuts iron absorption by up to 60 percent. Separating the iron tablet from any tea by at least two hours makes a real practical difference.

In women with very low haemoglobin, intravenous iron infusion replenishes stores far faster than oral supplementation and is increasingly used before planned surgery to reduce the risk of needing blood transfusion. Blood transfusion is reserved for emergencies or when haemoglobin is dangerously low and surgery cannot wait.

Haemoglobin recovery takes around three months of consistent supplementation even after bleeding is controlled, because iron stores replenish more slowly than the haemoglobin level itself. Do not stop iron supplementation as soon as you feel better. If haemoglobin does not rise despite supplementation and controlled bleeding, other causes such as vitamin B12 deficiency or concurrent chronic disease should be investigated.

When to see a doctor

See a gynaecologist if your periods have become noticeably heavier than before, extend beyond seven days, or are accompanied by the kind of chronic fatigue that suggests anaemia. These are symptoms that deserve investigation rather than normalisation.

Also consult a doctor if you notice persistent pressure or heaviness in the lower abdomen, increased urinary frequency without a urinary infection, or if you have been trying to conceive for more than a year without success, or six months if you are over 35. Fibroids are a common finding in fertility investigations and deserve assessment.

For very heavy bleeding with dizziness or near-fainting, seek urgent care rather than waiting for a routine appointment. Sudden severe pelvic pain also needs prompt evaluation because fibroid torsion, when a fibroid twists on its stalk, is a surgical urgency.

Sources

• Marsh EE, Wegienka G, Williams DR et al: Uterine Fibroids, JAMA, 2024
• Giuliani E, As-Sanie S, Marsh EE et al: Epidemiology and management of uterine fibroids, International journal of gynaecology and obstetrics, 2020
• Vannuccini S, Petraglia F, Carmona F et al: The modern management of uterine fibroids-related abnormal uterine bleeding, Fertility and sterility, 2024
• De La Cruz MS, Buchanan EM: Uterine Fibroids: Diagnosis and Treatment, American family physician, 2017
• Petraglia F, Dolmans MM: Iron deficiency anemia: Impact on women's reproductive health, Fertility and sterility, 2022
• Bulun SE, Yin P, Wei J et al: UTERINE FIBROIDS, Physiological reviews, 2025