Fibroids (Uterine Fibroids)
Non-cancerous lumps of muscle in or on the womb. Most women get them at some point, most never know, and the ones that cause trouble are very treatable.
Quick answer: Fibroids are common, non-cancerous growths of the womb’s muscle. Many cause no symptoms and need no treatment. When they do, the usual problems are heavy or painful periods, bloating, and pressure on the bladder or bowel. They’re found by ultrasound. Treatment ranges from medicines for bleeding and pain to procedures that shrink or remove them.
How common. Very. In a US ultrasound study, more than 80% of Black women and nearly 70% of white women had developed fibroids by age 50. They shrink after menopause.
Causes. The exact cause is unknown, but fibroids grow in response to oestrogen and progesterone. You’re more likely to get them if you:
- haven’t reached menopause or have never had a full-term pregnancy
- are overweight, or have high blood pressure or diabetes
- are of Black or Asian background
- have a close relative with fibroids
Symptoms. Often none. When they happen:
- heavy or painful periods, sometimes leading to low iron
- tummy or lower back pain, bloating
- needing to wee often or urgently
- constipation, or pain during sex
- sometimes, trouble getting pregnant
How it’s diagnosed. Your GP asks about symptoms and may examine your tummy and pelvis. An ultrasound (often internal, through the vagina) shows how many fibroids there are, where, and how big. Many are found by chance on scans done for other reasons.
Treatment
No symptoms means no treatment. If they bother you, choices depend on your symptoms, the fibroids’ size and position, and whether you want a pregnancy.
- Step 1 · Self-careWatch and waitFibroids that cause no symptoms can be left alone. They usually shrink after menopause.
- Works
- Avoids treatment you don’t need
- Access
- Free
- Watch for
- See your GP if periods get heavier, or you feel tired or breathless (possible low iron).
- Step 2 · PharmacyAnti-inflammatory pain reliefSuch as ibuprofen or naproxen, started at the beginning of a period.
- Works
- Eases period pain; can lighten bleeding a little
- Access
- Over the counter
- Watch for
- Stomach upset; avoid if you’ve had stomach ulcers or kidney problems. See ibuprofen vs paracetamol.
- Step 3 · PrescriptionMedicines for heavy bleedingTranexamic acid on heavy days, or hormone treatments such as the combined pill.
- Works
- Reduce bleeding for many, but don’t shrink fibroids
- Access
- GP prescription
- Watch for
- Tranexamic acid isn’t for people with a history of clots; the pill isn’t suitable for everyone.
- Step 4 · SpecialistRelugolix combination tabletA daily tablet that lowers hormone levels, with added oestradiol and norethisterone to protect bones and limit hot flushes.
- Works
- Substantially reduced bleeding in two large trials (LIBERTY 1 and 2)
- Access
- Specialist; approval and cost vary by country
- Watch for
- Hot flushes; not suitable for everyone; bone health is monitored with long-term use.
- Step 5 · SpecialistUterine artery embolisationA radiologist blocks the fibroids’ blood supply through a fine tube passed into a blood vessel, so they shrink.
- Works
- Shrinks fibroids and eases symptoms without removing the womb
- Access
- Specialist referral
- Watch for
- Pain and cramping afterwards; may affect future pregnancy, so discuss first.
- Step 6 · SpecialistSurgeryMyomectomy removes the fibroids and keeps the womb. Hysterectomy removes the womb and is a permanent fix. Endometrial ablation treats the womb lining for bleeding.
- Works
- Myomectomy relieves symptoms and keeps the womb. Hysterectomy is permanent
- Access
- Gynaecologist
- Watch for
- Usual surgical risks; hysterectomy and ablation end the chance of pregnancy.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Diet and supplement “fibroid cures”No good evidence that any diet, tea or supplement shrinks fibroids.
- Ignoring heavy bleedingHeavy periods can quietly drain your iron. A simple blood test checks.
Living with it
- Track your periods (an app or diary) to show your GP how heavy they are.
- Get iron levels checked if you’re tired, pale or breathless.
- If you’re planning a pregnancy, tell your doctor before choosing a treatment.
See your GP if
- Periods are heavy, painful, or affecting daily life
- You feel bloated or have pressure on your bladder or bowel
- Painkillers aren’t helping
- You’re having trouble getting pregnant
- You have any bleeding after menopause
Get urgent help if you have very heavy bleeding (soaking a pad or tampon every hour for several hours), feel faint or dizzy, or have sudden severe tummy pain: call 000 (Australia) or your local emergency number, or go to an emergency department.
Outlook. Most fibroids cause little trouble, and they shrink after menopause. For those that do, several effective treatments exist, including options that keep the womb.
Common questions
Are fibroids cancer?
No. Fibroids are non-cancerous (benign) growths. Cancer in the muscle of the womb is rare and is a different condition.
Do fibroids go away on their own?
They usually shrink after menopause, when hormone levels fall. Before then they may stay the same, grow or occasionally shrink.
Can fibroids make you put on weight?
Large fibroids can make your tummy look swollen, but they don’t cause general weight gain.
Can you get pregnant with fibroids?
Yes, most people with fibroids can. Fibroids bulging into the womb’s cavity are the type most likely to affect fertility.
What size of fibroid needs surgery?
There’s no single cut-off. Treatment depends on symptoms, position and your plans, not size alone.
Evidence and more information
- NHS: Fibroids
- Baird et al, Am J Obstet Gynecol 2003: High cumulative incidence of uterine leiomyoma in black and white women
- Syed, Drugs 2022: Relugolix/estradiol/norethisterone acetate, a review in symptomatic uterine fibroids
maladywise.com/fibroids/