Being told during a routine scan that you have fibroids is unsettling, and the immediate assumption is usually that surgery follows. In most cases it does not. Fibroids are found in a large proportion of women by their forties, and the majority never cause symptoms or need treating.
What matters is not whether you have them, but whether they are causing a problem.
What Fibroids Are
Fibroids are benign growths of the muscle wall of the uterus. They are not cancerous, and they do not turn into cancer. Malignant change is exceedingly rare and is a different condition from the outset.
They grow in response to oestrogen and progesterone, which is why they tend to enlarge during reproductive years and shrink after menopause. That natural shrinkage is one reason a conservative approach is often reasonable for a woman close to menopause.
Location Matters More Than Size
This is the point most patients are never told, and it explains why a woman with a huge fibroid may have no symptoms while another with a small one bleeds heavily.
- Submucosal: bulging into the uterine cavity. Even small ones cause heavy bleeding and can affect fertility and implantation
- Intramural: within the muscle wall. Cause symptoms once large enough
- Subserosal: on the outer surface. Can grow very large with little bleeding, but cause pressure symptoms
- Pedunculated: on a stalk, occasionally twisting and causing acute pain
- Cervical: uncommon, and more complex to treat
When you receive a scan report, the location matters as much as the measurement. Ask specifically.
The Symptoms That Justify Treatment
Treatment is driven by symptoms rather than by the existence of a fibroid.
- Heavy or prolonged bleeding, particularly with anaemia
- Pelvic pressure, a sense of fullness, or a visibly enlarged abdomen
- Urinary frequency from pressure on the bladder
- Constipation or difficulty with bowel movements
- Pain during intercourse
- Difficulty conceiving, or recurrent miscarriage, where the fibroid distorts the cavity
- Rapid growth, which requires assessment even without symptoms
Anaemia is the most common serious consequence, and it is often what tips the balance toward treatment.
Watchful Waiting Is a Legitimate Choice
For a woman with small, asymptomatic fibroids, doing nothing while monitoring is entirely appropriate. This usually means an annual ultrasound and a check of haemoglobin.
It is particularly reasonable in the years approaching menopause, since fibroids shrink once oestrogen falls. Being offered a hysterectomy for asymptomatic fibroids at forty eight is a reason to seek a second opinion.
Medical Options Before Surgery
Several treatments control symptoms without removing the fibroid.
- Tranexamic acid: reduces bleeding during periods, non hormonal
- Anti inflammatory tablets: reduce bleeding and pain
- Hormonal intrauterine system: very effective for bleeding, though less suitable when the cavity is distorted
- Combined hormonal contraception
- GnRH analogues: shrink fibroids temporarily, often used for a few months before surgery to reduce size and correct anaemia
- Iron replacement: essential alongside any of these
These control symptoms rather than eliminating fibroids, and effects generally reverse on stopping. That is acceptable for a woman managing symptoms toward menopause.
Surgical and Interventional Options
The right procedure depends heavily on fibroid location, size and whether you want future pregnancies.
- Hysteroscopic resection: for submucosal fibroids, removed through the cervix with no abdominal incision, usually a day case
- Myomectomy: removal of fibroids preserving the uterus, done laparoscopically or open depending on size and number
- Uterine artery embolisation: blocking the blood supply so fibroids shrink, avoiding surgery, though generally not first choice for women planning pregnancy
- Hysterectomy: definitive, appropriate when childbearing is complete and symptoms are severe
Laparoscopic hysterectomy has transformed recovery from this operation, with most women home within two days and back to normal activity in three to four weeks rather than six to eight.
Fibroids and Pregnancy
Most women with fibroids conceive and deliver without difficulty. Problems arise mainly when a fibroid distorts the uterine cavity.
Submucosal fibroids reduce implantation rates and increase miscarriage risk, and removing them improves outcomes. Intramural fibroids over about four centimetres may have some effect. Subserosal fibroids generally do not affect fertility.
During pregnancy, fibroids can undergo red degeneration, causing significant localised pain in the second trimester. It is managed with rest and painkillers and settles, but it needs assessing to exclude other causes. Large fibroids in the lower segment can obstruct delivery, which is why their position is checked in late pregnancy.
If you have fibroids and are planning a pregnancy, discuss it before conceiving rather than after, since myomectomy requires a healing interval.
Questions to Ask Before Agreeing to Surgery
Fibroid surgery is common and sometimes recommended more readily than it should be. These questions clarify the reasoning.
- Where exactly are my fibroids, and which one is causing my symptoms?
- What would happen if I did nothing for a year?
- Have we tried medical treatment and iron correction first?
- Can this be done laparoscopically or hysteroscopically rather than open?
- If I want children, is myomectomy an option rather than hysterectomy?
- What is the chance of fibroids recurring after myomectomy?
A considered answer to each of those is what you are entitled to before consenting.
Having fibroids is common. Needing surgery for them is much less so. The decision should rest on your symptoms, your anaemia, your fertility plans and how close you are to menopause, rather than on a measurement alone.
For a fibroid assessment and a discussion of options, contact our gynaecology department in T. Nagar, Chennai.
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