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Uterine fibroids are among the most common gynecological conditions in the United States. According to data published in Endocrine Reviews, at least 70% of women develop fibroids. They’re more common among women aged 40 and older.

Many people with fibroids don’t experience symptoms and may never know they have them. However, the Journal of Basic and Clinical Physiology and Pharmacology reports that about 25% of people with fibroids develop symptoms.

What Are Fibroids in the Uterus and What Symptoms Do They Cause?

Also known as a leiomyoma, a uterine fibroid is a noncancerous growth within or on the uterus. Some uterine fibroids attach to the uterus via a stalk-like structure called a peduncle.

The three types of fibroids take their names from their location:

• Subserosal fibroids grow on the outside of the uterus.
• Intramural fibroids grow within the muscular wall of the uterus.
• Submucosal fibroids grow inside the uterus, under the inner lining.

Regardless of their type, fibroids can cause symptoms of various types and severities.

Uterine Fibroid Symptoms

Fibroids may make your period longer, heavier, and more frequent. They may also cause bleeding between your regular periods. Many people with fibroids experience painful period cramps.

Fibroids can also cause problems unrelated to your period. These can include:

• Bladder problems such as difficulty emptying the bladder or urges to pee frequently.
• Bowel issues such as constipation.
• Fatigue due to anemia.
• Lower back and/or pelvic pain.
• Pain during penetrative sex.

If you’re experiencing the above symptoms, consult with your health care provider. They can determine if uterine fibroids are causing your symptoms or if another condition is to blame.

How Do Doctors Diagnose Uterine Fibroids?

The current diagnostic gold standard combines a pelvic exam with specialized ultrasound imaging. Your provider uses an ultrasound wand inside the vagina to look for fibroids. Transvaginal ultrasound is very accurate: It rarely misses uterine fibroids when they’re present.

Your provider may also order blood tests. These tests help them rule out pregnancy and other possible causes of your symptoms.

An MRI gives your provider a better picture of your fibroids’ number, size, shape, and blood supply. However, an MRI usually isn’t necessary for routine diagnosis.

During a hysteroscopy, your provider will insert a small camera into your uterus to view your fibroids. They can also insert other tools to remove the fibroids during this procedure if necessary.

What Happens if I Don’t Get Fibroid Treatment?

The symptoms and progression of uterine fibroids vary from person to person. Let’s consider some possible outcomes.

Best case: fibroids in the uterus shrink

Fibroids may naturally shrink over time. A review in the journal Current Obstetrics and Gynecology Reports reported that about 21% of fibroids spontaneously shrink.

Fibroids often get smaller during late pregnancy and after delivery. In the postpartum period, the uterus shrinks, and the arteries that feed it aren’t delivering as much blood. This also reduces blood supply to the fibroids, possibly making them smaller.

Uterine fibroids need ovarian hormones such as estrogen and progesterone to grow. As a person approaches menopause, their estrogen and progesterone levels decline. This may cause fibroids to shrink.

In-between case: uterine fibroid symptoms persist or worsen

For people whose fibroids don’t shrink naturally, their symptoms may persist or worsen. Some common health complications related to uterine fibroids include:

• Anemia due to heavy uterine bleeding.
• Bowel and bladder dysfunctions causing constipation, retention of urine, or urinary incontinence.
• Fertility problems, including trouble becoming or staying pregnant.
• Increasing pelvic, back, and menstrual pain.

Note that fibroids often aren’t the primary cause of someone’s fertility problems. If you have fibroids and are struggling to conceive, your doctor will likely test for other conditions that could contribute.

Worst case: uterine fibroid symptoms become severe or dangerous

For some people, untreated uterine fibroids can pose serious health risks. These conditions are rare, but they require medical attention, sometimes urgently. Consider the following conditions:

• Dangerous blood loss after childbirth (postpartum hemorrhage).
• Decreased fetal growth during pregnancy.
• Extreme anemia requiring blood transfusion.
• Premature labor or delivery.

Rarely, a cancerous tumor called a leiomyosarcoma may masquerade as a benign fibroid. Researchers estimate that surgeons find cancer in 1 of every 340 cases of people who undergo surgery to remove their fibroids. This rate increases to 1 in 98 among patients ages 75 to 79.

What Are the Options for Fibroid Treatment?

Medication

Oral medications aim to reduce pain and bleeding, but they don’t usually shrink fibroids. Your health care provider may recommend one of the following medications:

Hormonal birth control

Hormonal birth control, such as “the pill” or the hormonal IUD, can reduce heavy bleeding. It may also make your periods less painful. It doesn’t shrink fibroids; in some cases, it can cause fibroids to grow.

Gonadotropin-releasing hormone (GnRH) agonists

These medications stimulate your pituitary gland to release more GnRH. This hormone causes your periods to stop and your fibroids to shrink.

GnRH agonists can cause menopause-like side effects, including bone loss and vaginal dryness. For this reason, these medications aren’t ideal for long-term use.

GnRH antagonists and hormones

GnRH antagonists are the opposite of agonists: They reduce the release of GnRH. These medications can decrease heavy bleeding and pain, but they don’t shrink fibroids. Combining them with hormone medication helps reduce their side effects.

Minimally invasive procedures

Minimally invasive procedures may work exceptionally well for people who wish to address their fibroids directly. Patients who undergo these procedures often don’t have to stay in the hospital. However, doctors don’t know how they’ll affect future potential pregnancies.

Here are two standard options:

Uterine artery embolization (UAE)

Your doctor injects tiny particles into the arteries that feed the uterus. These particles reduce blood flow to the uterine fibroids, causing them to shrink. UAE reduces heavy uterine bleeding.

Radiofrequency ablation (RFA)

Your provider will insert an ultrasound probe and a tiny camera through your vagina or tiny abdominal incisions. This helps them see your fibroids. They then insert thin needles into the fibroids and apply heat and energy to destroy them.

Surgery

Surgery is the most invasive option to treat fibroids, but it’s necessary for some people. Removal of the uterus via a hysterectomy is the most “definitive” way to get rid of uterine fibroids.

For people who wish to preserve their uterus, a surgeon may perform a myomectomy to selectively remove fibroids. The success of a myomectomy depends on the location and size of your fibroids, so it won’t work for everyone.

Regardless of how you decide to manage uterine fibroids, share your plans with your health care provider. They can help you find the safest, most effective options for you.

Editor's Note: This article was originally published on January 23, 2025, and was last reviewed on February 27, 2025.