Patient education
Fibroids (leiomyomas)
Fibroids are common, non-cancerous growths of the muscle of the uterus. Many women have them and never need treatment. When they do cause problems, it’s usually because of bleeding, pressure/bulk, pain, or fertility/pregnancy effects. We focus on identifying what’s driving your symptoms and choosing the least invasive option that reliably solves them.
A quick reassurance
Most fibroids are managed without major surgery. Even when a procedure is the right option, modern treatment is usually minimally invasive, with faster recovery and a plan tailored to your goals.
Tip: If your main issue is heavy bleeding, the “type” of fibroid (especially whether it distorts the cavity) often determines the best first step.
What are fibroids?
Fibroids (also called leiomyomas or myomas) are non-cancerous growths that arise from the muscle wall of the uterus. They can be a single fibroid or multiple, and they vary in size from tiny to large. Many women have fibroids and feel completely well.
Key idea: symptoms are usually driven by location (whether a fibroid affects the uterine cavity), size, and how many there are.
Common symptoms
Fibroids most often become relevant because of one (or more) of these symptom patterns: heavy/prolonged bleeding, pressure/bulk symptoms, pain, or fertility concerns.
Bleeding pattern
- Heavy bleeding (flooding, clots, changing protection often)
- Periods that last longer than your usual pattern
- Iron deficiency symptoms (fatigue, shortness of breath, dizziness)
- Bleeding that interferes with work, travel, exercise, intimacy, or sleep
Pressure / pain
- Pelvic pressure, bloating, “pregnant” abdomen feeling
- Urinary frequency, difficulty emptying, or constipation
- Period pain that is worsening over time
- Non-period pelvic pain or back pain
Note: heavy bleeding is often most strongly linked to fibroids that affect the uterine cavity (submucosal, or intramural that distort the cavity).
When it’s urgent
Seek same-day care if you feel faint, short of breath, have chest pain, or you are soaking through pads hourly for several hours. If you are bleeding after menopause, that should be assessed promptly.
How we diagnose fibroids
Step 1
Your symptom pattern
We clarify bleeding (duration, volume, clots), pressure symptoms (bladder/bowel), pain (cyclic vs non-cyclic), and how it affects your daily life.
Step 2
Examination
A pelvic exam helps assess uterine size, contour, and tenderness, and checks for cervical/vaginal causes of bleeding.
Step 3
Ultrasound
Ultrasound is usually the first imaging step to map fibroids and assess the lining of the uterus.
Step 4
Targeted tests (only when needed)
Blood tests for anaemia and iron stores are common. Lining sampling is reserved for specific bleeding patterns and risk factors.
Why this matters: the “best” treatment depends on what we’re treating: bleeding vs bulk/pressure vs fertility goals.
Types (location matters)
Fibroids are described by where they sit in (or on) the uterus. This often predicts which symptoms they cause and which procedures are possible.
Submucosal
Projects into the uterine cavity. Often linked to heavy bleeding and spotting. These are frequently suitable for hysteroscopic treatment (through the cervix, no abdominal cuts).
Intramural
Within the muscle wall. Can contribute to bleeding and pain, and may distort the cavity if large or positioned near it.
Subserosal
On the outer surface of the uterus. More likely to cause pressure/bulk symptoms (bladder/bowel) than heavy bleeding.
Treatment options
We choose treatment based on your symptoms, ultrasound mapping, medical history, and whether fertility is a goal. Many patients do well with simple options first. Others need a targeted procedure.
If the main problem is heavy bleeding
Mirena (LNG-IUD)
A highly effective option for bleeding control in many women, with the convenience of long-acting treatment. It’s less suitable if a fibroid significantly distorts the cavity.
Tranexamic acid
Non-hormonal tablets taken during heavy days to reduce menstrual blood loss (ideal if you want treatment only when symptoms are present).
Hysteroscopic myomectomy
If a fibroid is in the cavity (submucosal), it can often be removed via a camera through the cervix. It’s typically a day-theater case with a fast recovery.
If pressure/bulk symptoms are the main issue (with or without bleeding)
Myomectomy
Removes fibroids while keeping the uterus. Approach depends on fibroid map: hysteroscopic (inside), laparoscopic (keyhole), or open in selected cases.
Uterine artery embolisation (UAE)
A minimally invasive radiology procedure that can improve both bleeding and bulk symptoms. It’s generally not chosen when future fertility is a priority.
Hysterectomy
Definitive treatment for fibroid symptoms when childbearing is complete. Often minimally invasive, depending on anatomy and surgical history.
How I approach this: we start with your goals, then match the least invasive option that reliably addresses the symptom driver (bleeding vs pressure vs fertility). Where a procedure is needed, I prioritise techniques that reduce pain and recovery time while aiming for a durable result.
Fibroids, fertility & pregnancy
Not all fibroids affect fertility. The fibroids most likely to matter are those that distort the uterine cavity. If pregnancy is a goal, we focus on mapping the cavity, clarifying priorities, and choosing options that support safe conception and pregnancy.
When we consider removal
Often when a fibroid is in the cavity (submucosal) or significantly distorting it, especially with infertility, recurrent miscarriage, or persistent heavy bleeding.
When we monitor
Many intramural or subserosal fibroids can be watched if symptoms are mild and the cavity is not affected.
During pregnancy
Most pregnancies with fibroids progress well. We individualise monitoring depending on fibroid size, location, and symptoms.
What to expect in consultation
We’ll map your fibroids, confirm what’s driving symptoms, check for anaemia when relevant, and then talk through options in a stepwise way. Many patients arrive fearing they have only one option. Usually, there are several.
Bring along: your ultrasound report/images if you have them, your latest blood results (if done), and a quick note of how many days you bleed and which days are heaviest. This makes the plan faster and more precise.
FAQs
Do fibroids turn into cancer?
Fibroids are benign. If something about the history or imaging is atypical, we investigate appropriately and choose the safest path forward.
Will they shrink after menopause?
Fibroids often stabilise or shrink in low-oestrogen states like menopause. If symptoms are controlled and risk is low, observation may be appropriate.
Do I need surgery?
Not always. Many women do well with medical options for bleeding control. Procedures are chosen when symptoms persist, quality of life is affected, or fertility goals require it.