Uterine Fibroids: Symptoms, Types, Causes, Diagnosis, Risk Factors and Best Treatments

Introduction:

Curious if your painful periods or heavy bleeding could mean something more?
You’re not alone—millions of women live with uterine fibroids, often without even knowing it. Let’s explore how to recognize the signs, understand your treatment options, and know when to talk to your gynecologist.

What are uterine fibroids

Uterine fibroids, medically termed as leiomyomas, fibromyomas, or uterine myomas, are non-cancerous growths (benign tumours) that arise from smooth muscle cells of the uterus. These fibroids are surrounded by a thin layer of compressed muscle fibres and collagen tissue.

Fibroids are very common growths that usually appear during childbearing age, between 30 and 40 years old, and vary significantly in shape, size, and location. Females who have not matured yet typically don’t have these fibroids, and they are less common in women with menopause.

Although they are not a serious concern, they cause painful symptoms, including pain or pelvic discomfort, heavy bleeding, and urinary problems affecting the woman’s quality of life. Rarely do they turn into cancer.

Symptoms and types

Symptoms

The symptoms of uterine fibroids can vary significantly, based on the size, number, and location. The following are the common symptoms of fibroids:

• Painful sex
• Excessive bleeding during menstruation
• Long-term vaginal discharge
• Lower back pain
• Painful bleeding during periods
• Bloating (feeling of fullness in the lower belly)
• Frequent urination

Types

Depending on the location they grow or form and how they attach, uterine fibroids are divided into several types, including:

• Intramural fibroids: These fibroids are the most common type that grow or are embedded within the muscle wall of the uterus
• Subserous or subserosal fibroids: This type of fibroid develops under the lining of the outer surface of the uterus. They are quite capable of becoming large and growing into the pelvis.
• Submucosal fibroids: They develop just under the surface of the lining or endometrium.
• Pedunculated fibroids: These are the least common type of fibroids, which attach to the womb with a stem or a stalk-like structure called a peduncle. They are always described as having a mushroom-like appearance due to the stalk and a wider top.
• Cervical: These fibroids are located in the cervix rather than the uterine body.

Causes and Risk factors:

The exact cause is still unknown; however, the following are believed to cause this condition:

• Hormonal factors: Many studies concluded that fibroids develop from an abnormal muscle cell in the uterus and multiply rapidly when the hormone levels in women are higher (like during pregnancy), promoting the tumour’s growth, and shrinkage when hormone levels are low (like during the transition to menopause). Especially hormones, including estrogen and progesterone, play a major role in the development of fibroids.
• Genetic factors: As per certain studies, specific gene mutations are associated with uterine fibroids; the common one is the MED 12 gene.
• Other growth factors: Insulin-like growth factors may play a part in fibroid growth.

The following are some of the common risk factors that increase the risk of developing uterine fibroids:

• African-Caribbean origin
• Early menarche (younger than 10 years)
• Late age for menopause
• Early onset of fibroids
• A family history of fibroids
• A high body weight (BMI) or obesity
• 30 years old or older
• Nulliparity

Complications

Most fibroids don’t lead to serious complications, but in some cases, they can cause issues such as:

• Anaemia
• Swelling of the pelvic region or abdomen
• Infertility (rare)
• Unbearable pain
• Excessive bleeding

Diagnostic tools (MRI, pelvic exams)

Uterine fibroids are most often found incidentally during a routine pelvic examination or other tests. Heavy bleeding and other related symptoms may alert your gynecologist to consider fibroids as part of the diagnosis.

The following are several tests that can be performed either alone or in combination to confirm the diagnosis of fibroids and determine their location and size. These tests are:

• Lab tests: For the patients of reproductive age presenting with symptoms like irregular menstrual bleeding or heavy menstrual bleeding, a gynecologist recommends certain lab tests such as complete blood count, TSH, and prolactin levels to look for possible causes of it.
• Magnetic resonance imaging (MRI): This is a form of advanced imaging test to detect the size and location of fibroids, creating highly detailed pictures of internal organs by using radio waves and magnets, determining the exact location, surrounding tissues, and characteristics of fibroids.
• Ultrasound: This is the test that uses a tiny instrument, called a transducer, which is either inserted into the vagina (transvaginal ultrasound – best tool for initial examination) or pressed over the abdomen (pelvis ultrasound) to produce images of the uterus to diagnose the fibroids.
• Hysterosalpingography: It is also called a saline infusion sonogram, a type of X-ray that examines the fallopian tube and uterus, using a special dye to visualize these organs easily and to find if fibroids block the fallopian tubes.
• Hysteroscopy: This is a visual exam of the interior of the uterus and cervix canal using a hysteroscope (viewing instrument), using a long and thin tube inserted through the vagina to detect any fibroids.
• Endometrial biopsy: It is used to remove a tiny piece of the uterus tissue lining to look for any unusual bleeding and to confirm the cancer.

Treatment considerations for uterine fibroids

If the woman is not experiencing any uterine fibroid symptoms, then they may not need treatment. Some women may present with small fibroids but never experience any symptoms or have any issues associated with fibroids. In these cases, your gynecologist may suggest monitoring the fibroids with pelvic exams or ultrasounds.

Treatment is required when a woman experiences symptoms such as heavy bleeding, moderate to severe pain, bowel problems, and urinary tract infections.

A gynecologist plans treatment by considering a few factors, including:

• Age
• General health
• Size of fibroids
• Number of fibroids
• Location of fibroids
• Symptoms
• The desire to keep the uterus
• Access to therapy
• Physician’s experience

Treatment: medication, myomectomy, UFE

Available treatment options include:

• Medical
• Surgical
• Non-surgical

Treatment options for uterine fibroids include:

Medical management

• Over-the-counter (OTC) pain medications: These medications help manage discomfort and pain caused by fibroids.
• Iron supplements: These supplements are prescribed to treat or prevent anaemia that occurs due to heavy bleeding.
• Birth control: These are pills, a patch, or a vaginal ring, which are recommended to help control heavy periods.
• Gonadotropin-releasing hormone (GnRH) agonists: Doctors recommend these agonists to decrease the estrogen level and trigger a temporary “medical menopause,” helping to shrink the fibroids, also used to stop the period in preparation for surgery or to improve the blood count.
• Oral therapies: It is   a new therapy used to manage heavy uterine bleeding in people who haven’t experienced menopause with symptomatic uterine fibroids.

Surgical management

Some surgical options for fibroid removal can preserve the uterus, allowing you to become pregnant in the future, while others can either remove the whole uterus or damage it:

Myomectomy: It is a common procedure that is performed to remove the myoma. There are several types of myomectomies, and their application depends on the location of fibroids, size, and number. The types of myomectomy procedures to remove fibroids can include:

• Hysteroscopy: This minimally invasive surgery inserts a scope (a thin, flexible, tube-like tool) through the vagina and cervix and into your uterus to cut away and remove the fibroids.
• Hysterectomy: It involves the surgical removal of the uterus, including the fibroids.
• Laparoscopy: This technique also uses a small scope to remove the fibroids. Unlike hysteroscopy, this method involves placing a few tiny incisions in the abdomen.
• Laparotomy: This is the open (traditional) surgery that makes a larger incision in the abdomen to remove the fibroids through one cut.

Non-surgical management (treatment to reduce the growth of fibroids)

Uterine artery embolization (UAE): UAE involves passing a fine catheter tube to inject a fine substance into an artery (usually in the groin) that is attached to and feeds the uterus, stopping the fibroid from growing.

Fertility and recovery outlook

Fertility can often return quickly with the right treatment and healthy lifestyle changes, but recovery depends on the underlying cause and age-related factors. If conception doesn’t happen within a reasonable time, it’s best to consult a gynecologist for proper evaluation and guidance.

Conclusion:

Uterine fibroids are common non-cancerous growths that can vary in size, type, and symptoms, often affecting women during their reproductive years. While some fibroids may not need treatment, others can lead to pain, heavy bleeding, or fertility issues and require proper diagnosis through imaging and exams. Treatment options range from medications to surgery and non-surgical procedures like UAE—guided by a woman’s symptoms, health, and fertility goals. Always consult a gynecologist for personalized care and treatment planning.