Understanding Uterine Fibroids: What Every Woman Should Know Part 1
Part 1: Fibroid Basics
July is Fibroid Awareness Month, a time dedicated to shedding light on one of the most common—but often overlooked—gynecologic conditions affecting women: uterine fibroids. As a women’s health nurse practitioner, I see firsthand how fibroids impact women’s quality of life, from heavy menstrual bleeding and pelvic pain to fertility challenges and emotional distress.
What Are Uterine Fibroids?
Uterine fibroids, also called leiomyomas or myomas, are benign (non-cancerous) growths of muscle and connective tissue that develop within or around the uterus. They are extremely common, affecting up to 70–80% of women by age 50, although not all women experience symptoms.
Fibroids are estrogen- and progesterone-sensitive, meaning they tend to grow during the reproductive years and often shrink after menopause.
Who Gets Fibroids?
Fibroids can affect any woman, but certain factors increase risk:
Age: Most common between ages 30–50
Race: Black women are up to three times more likely to develop fibroids, and tend to have larger, more symptomatic fibroids at younger ages
Family History: A close relative with fibroids increases your risk
Lifestyle Factors: Obesity, a diet high in red meat, and low intake of fruits and vegetables may contribute
Types of Fibroids:
Fibroids are classified by where they grow in or around the uterus. Location often determines the type and severity of symptoms.
Intramural Fibroids
Grow within the muscular wall of the uterus
Most common type
Can cause heavy bleeding, pelvic pain, or pressure
Submucosal Fibroids
Grow into the uterine cavity
Least common, but most likely to cause heavy menstrual bleeding and fertility issues
Subserosal Fibroids
Grow on the outer wall of the uterus
Can cause pelvic or back pain and pressure symptoms (like frequent urination or constipation)
Pedunculated Fibroids
Attached to the uterus by a thin stalk
Can be subserosal or submucosal
May twist, causing sharp pain
Symptoms of Fibroids
Some women have no symptoms, while others experience life-disrupting effects.
Common symptoms include:
Heavy or prolonged periods
Pelvic pain or pressure
Frequent urination or difficulty emptying the bladder
Constipation
Pain during sex
Lower back or leg pain
Fatigue or anemia (due to heavy bleeding)
Enlarged abdomen or bloating
Health Consequences and Related Conditions
Fibroids are non-cancerous, but they can cause significant medical issues:
Anemia from heavy blood loss
Infertility or miscarriage, especially with submucosal fibroids
Recurrent pregnancy loss
Obstructed labor or complications during pregnancy
Urinary tract issues from pressure on the bladder
Mental health impacts due to chronic pain, fatigue, or quality-of-life disruption
How Are Fibroids Diagnosed?
Fibroids are often diagnosed through:
Pelvic exam
Ultrasound (transvaginal or abdominal)
Saline infusion sonohysterography (SIS)
MRI, especially when surgery is being considered
Hysteroscopy, for a detailed look inside the uterine cavity
Fibroid Treatment Options:
Treatment depends on symptoms, fibroid size/location, age, reproductive goals, and personal preferences. Here’s a comprehensive look at current options:
Watchful Waiting
Appropriate if fibroids are small, not growing, and not causing symptoms
Regular follow-up to monitor for changes
Medical Management
Hormonal Birth Control
Pills, patch, ring, injections, IUDs (like Mirena)
Helps reduce bleeding and pain, but won’t shrink fibroids
GnRH Agonists and Antagonists (e.g. leuprolide, elagolix)
Induce temporary menopause-like state
Used short-term to shrink fibroids before surgery or as bridge therapy
May cause hot flashes, bone loss if used long-term
Tranexamic Acid
A non-hormonal pill taken during heavy bleeding days
Reduces blood loss during periods
Iron Supplements
Treats anemia caused by heavy menstrual bleeding
Minimally Invasive Procedures
Uterine Artery Embolization (UAE)
Interventional radiology procedure that blocks blood flow to fibroids, causing them to shrink
Not recommended if you plan to become pregnant
MRI-guided Focused Ultrasound (MRgFUS)
Uses high-frequency ultrasound waves to destroy fibroid tissue
Outpatient, noninvasive, fertility-sparing
Surgical Options
Myomectomy
Surgical removal of fibroids, preserving the uterus
Can be done hysteroscopically, laparoscopically, or via open surgery
Preferred if fertility is desired
Endometrial Ablation
Destroys the uterine lining to reduce bleeding
Not effective if fibroids are large or located in the uterine wall
Not for women wanting future pregnancies
Hysterectomy
Surgical removal of the uterus
Definitive treatment—no more fibroids, no more periods
Recommended if other options fail or if fibroids severely impact quality of life
Final Thoughts
Fibroids are common, complex, and often misunderstood. They’re not one-size-fits-all, and neither is the treatment.
