Fibroids

A fibroid found on a scan does not automatically need treatment. Fibroids are non-cancerous growths in or around the womb, and some cause no symptoms. When they cause heavy bleeding, pain or pressure, there are medicines and procedures to discuss.

Who gets fibroids

The US Office on Women’s Health estimates that about 20 percent to 80 percent of women develop fibroids by age 50. That broad range is an estimate across a population. It cannot tell you what will happen to you. The same source reports that African-American women are more likely to develop fibroids than white women; NHS guidance also identifies a higher likelihood among people from a Black background.

Fibroids can grow within the muscle wall, towards the cavity inside the womb or on its outer surface. Their size, number and location help guide treatment. Ask your clinician to explain what those details on your scan report mean for your treatment.

Bleeding, pain and pressure symptoms

Symptoms can include heavy or painful periods, lower back or abdominal pain, pressure in the pelvis, and pain during sex. Fibroids can also affect how often you need to pee or make it harder to empty your bowels. Heavy bleeding can cause iron deficiency anaemia. Mention both the bleeding and its effect on your day.

At an appointment, the clinician will usually start with questions and an examination. Ultrasound can show the number, size and location of fibroids. Sometimes they are found during another scan, including a pregnancy scan. If bleeding or pain has changed since that scan, explain what has changed when you speak to the clinician.

Medicines and monitoring

If fibroids are not causing symptoms, monitoring may be enough. When treatment is needed, pain medicines can help with cramps, while tranexamic acid or hormonal options can help reduce bleeding. A hormonal coil is another possible option. Your pharmacist, GP or doctor can advise on suitability; follow the leaflet and your prescription.

Specialist hormone treatments can shrink fibroids or control heavy bleeding. Some are used before surgery. Discuss their side effects and whether they suit you with your clinician. Ask whether the proposed medicine is intended to reduce bleeding, shrink the fibroids, or both, and when the plan will be reviewed.

Procedures and future pregnancy

Myomectomy removes fibroids while keeping the womb. It may be an option if you want a future pregnancy, but new fibroids can develop afterwards. Uterine artery embolisation blocks the blood supply to fibroids so they shrink. Hysterectomy removes the womb. These choices affect the possibility of a future pregnancy in different ways.

Before choosing a procedure, discuss whether you want a future pregnancy, including if you are unsure. Ask which treatments preserve the possibility of pregnancy, what is known about pregnancy afterwards, and whether a fertility specialist’s opinion would help. The NHS warns that some fibroid treatments prevent pregnancy or increase pregnancy risks.

Pregnancy and menopause

Having fibroids does not mean pregnancy complications are inevitable. Some pregnancies are affected by problems such as early birth or needing a caesarean birth. If you become pregnant, tell your pregnancy-care clinician about known fibroids so they can discuss your care.

Fibroids often shrink after menopause, which may influence a treatment decision. Your symptoms and what you want from treatment still matter. Ask how a watch-and-wait plan would work, including which changes would prompt another appointment.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for any vaginal bleeding after menopause, even a small amount or a single episode. Do not assume it is caused by fibroids.

When to ask for help

Call 999 now (UK) or 911 (US), or your local emergency number, if pelvic pain is severe or getting worse, or comes with faintness, difficulty breathing or heavy vaginal bleeding. Also call for heavy vaginal bleeding with faintness, collapse or difficulty breathing, even without pelvic pain.

Get help today from NHS 111 or an urgent GP service (UK), or your doctor or urgent care service (US or elsewhere), for pelvic pain if you are pregnant or could be pregnant, or if pelvic pain comes with a very high temperature or feeling hot, cold or shivery. Use the emergency route above for severe symptoms.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for heavy bleeding, bleeding between periods, or symptoms affecting everyday life. Take any previous scan information and a note of what you want treatment to change.