Fibroids: When to Worry and When to Wait

Uterine fibroids are benign growths of muscle tissue in or on the uterus. By the age of 50, up to 70% of women will have at least one. Most are discovered incidentally on ultrasound and cause no symptoms at all — these do not need treatment, only periodic monitoring.

Fibroids become a problem when they cause heavy or prolonged periods, pelvic pressure or pain, frequent urination from bladder compression, or fertility difficulties. The location of the fibroid matters more than the size: a small fibroid inside the uterine cavity can cause heavier bleeding than a large one on the outer surface.

Medical management is the first step for symptomatic fibroids. Hormonal treatments (combined pills, progestogens, or the Mirena coil) reduce bleeding significantly. Tranexamic acid, a non-hormonal tablet taken during periods, cuts blood loss by about 50% and is safe for long-term use.

Surgical options depend on whether you want to preserve fertility. Myomectomy removes the fibroids while keeping the uterus intact and is the preferred option for women planning future pregnancies. Hysterectomy — removal of the uterus — is definitive but is only considered when family is complete and other treatments have failed.

Fibroids in pregnancy are common and usually do not cause problems, but they can occasionally grow rapidly, cause pain (red degeneration), or affect the baby's position. If you have known fibroids and are planning a pregnancy, a preconception ultrasound helps us plan monitoring during pregnancy.

The bottom line: if your fibroids are not causing symptoms, they almost certainly do not need surgery. If they are causing problems, there are multiple effective options before surgery becomes the conversation.