A lot of women find out they have fibroids almost by accident — during a routine pelvic exam or an ultrasound done for something else entirely. For others, the symptoms have been building for years: heavy periods that soak through protection, pelvic pressure that never quite goes away, needing to use the bathroom more often than usual, or pain that comes and goes without a clear explanation.
Either way, a fibroid diagnosis tends to come with a lot of questions. What exactly are they? Do they have to be removed? What happens if you want to get pregnant? Why are some women’s fibroids worse than others?
The short answer is that fibroids are extremely common, almost always noncancerous, and entirely treatable — but the right approach depends on your symptoms, your goals, and your individual medical history. This article covers what fibroids are, why they develop, what symptoms they cause, and what your options are when it comes to managing or treating them.
What Are Uterine Fibroids?
Uterine fibroids — also called leiomyomas or myomas — are noncancerous growths that develop in or around the uterus. They’re made of smooth muscle cells and fibrous connective tissue, and they vary significantly in size, from smaller than a pea to as large as a grapefruit. Some women have just one. Others have several.
Fibroids are one of the most common conditions affecting women of reproductive age. Estimates suggest that up to 70–80% of women will develop fibroids at some point during their lifetime, though many never know because their fibroids cause no symptoms at all and are never discovered.
Types of Fibroids
Fibroids are classified by where they grow in relation to the uterus:
- Intramural fibroids — the most common type, growing within the muscular wall of the uterus
- Submucosal fibroids — growing just beneath the inner lining of the uterus; most likely to cause heavy bleeding and fertility complications
- Subserosal fibroids — growing on the outer surface of the uterus, sometimes protruding outward
- Pedunculated fibroids — attached to the uterus by a thin stalk; can be either submucosal or subserosal in origin
The type, size, and number of fibroids all influence whether they cause symptoms and which treatment options are most appropriate.
What Causes Fibroids?
The exact cause of fibroids isn’t fully understood, but research points to a combination of genetic and hormonal factors.
Fibroids are sensitive to estrogen and progesterone — the hormones that regulate the menstrual cycle. This is why they typically develop during reproductive years, tend to grow during pregnancy when hormone levels are elevated, and usually shrink after menopause when estrogen declines. Women who start their periods earlier or have higher estrogen exposure over time may be at greater risk.
Genetics also plays a role. If your mother or sister had fibroids, you’re more likely to develop them too. Other contributing factors include obesity, a diet low in fruits and vegetables, vitamin D deficiency, and possibly chronic stress.
Who Is at Higher Risk?
While any woman of reproductive age can develop fibroids, the risk is not equal across all groups — and that matters.
Black women are disproportionately affected by fibroids. Research consistently shows that Black women develop fibroids at roughly three times the rate of white women, and they tend to develop them earlier — often in their late 20s rather than their 30s. The fibroids are also more likely to be multiple, larger in size, and more symptomatic. By age 50, more than 80% of Black women will have had fibroids at some point.
This disparity has real consequences. Black women are significantly more likely to experience severe symptoms, more likely to require surgical intervention, and historically have been less likely to be offered minimally invasive treatment options. If you’re a Black woman who has been told your heavy periods or pelvic pain are just something you have to manage, it’s worth getting a formal evaluation. You may be living with fibroids that are entirely treatable.
Other risk factors include:
- Family history — a mother or sister with fibroids raises your likelihood
- Age — fibroids are most common in the 30s and 40s and typically shrink after menopause
- Obesity — higher body weight is associated with elevated estrogen levels and increased fibroid risk
- Vitamin D deficiency — more prevalent in Black women and linked to higher fibroid incidence in research studies
- Diet — a diet high in red meat and low in fruits, vegetables, and fiber has been associated with higher fibroid risk
Common Symptoms of Uterine Fibroids
Not every woman with fibroids will have symptoms — many are discovered incidentally during a routine pelvic exam or ultrasound. But when symptoms do occur, they can range from mildly inconvenient to significantly disruptive to everyday life.
Common symptoms include:
- Heavy or prolonged menstrual bleeding — one of the most frequently reported symptoms; periods may be heavier than usual, last longer, or include passing large clots
- Pelvic pressure or fullness — a sensation of heaviness, bloating, or pressure in the lower abdomen
- Pelvic or lower back pain — cramping or aching that may be present throughout the month, not just during periods
- Frequent urination — when fibroids press against the bladder, you may feel the urge to urinate more often or feel unable to fully empty your bladder
- Constipation or rectal pressure — fibroids pressing on the bowel can cause difficulty with bowel movements
- Pain during sex — particularly with deeper penetration
- Abdominal enlargement — larger fibroids can cause the abdomen to look or feel distended, sometimes resembling early pregnancy
Some women also develop anemia — a low red blood cell count — as a result of chronic heavy bleeding, which can lead to fatigue, weakness, and dizziness that gets attributed to other causes for years.
Symptoms can vary depending on where fibroids are located. Submucosal fibroids, closest to the uterine lining, tend to cause the heaviest bleeding and the most fertility concerns. Subserosal fibroids create more pressure-related symptoms. Intramural fibroids — the most common type — can produce a combination of both.
How Fibroids Are Diagnosed
Fibroids are often first suspected during a routine pelvic exam, when a provider notices an irregularly shaped or enlarged uterus. From there, imaging confirms the diagnosis and helps map the location and size of the fibroids.
- Ultrasound — the most common first step; a transvaginal ultrasound provides a detailed view of the uterus and can identify most fibroids accurately
- MRI — used when a more detailed picture is needed, particularly when planning surgery, to map the number, size, and exact location of all fibroids present
If you’ve been experiencing heavy periods, pelvic pain, pressure, or abnormal bleeding that you’ve been attributing to “just how your periods are,” it’s worth bringing it up with your OB-GYN. Many women wait years before seeking evaluation — and in the meantime, symptoms that are very treatable continue affecting their daily lives.
Treatment Options
Treatment for fibroids isn’t one-size-fits-all. The approach depends on your symptoms, the size and location of the fibroids, your age, and whether you want to preserve your ability to get pregnant. Some women don’t need any treatment at all.
Watchful Waiting
If fibroids are small and not causing significant symptoms, the most appropriate approach may be monitoring. Your OB-GYN will check periodically to see whether the fibroids are growing or symptoms are developing. Fibroids often stabilize or shrink after menopause without intervention.
Medications
Several medications can help manage fibroid symptoms, though they don’t eliminate fibroids permanently:
- Hormonal birth control — oral contraceptives, hormonal IUDs, and other hormonal methods can reduce heavy bleeding and cramping associated with fibroids
- GnRH agonists — medications that temporarily lower estrogen levels and can shrink fibroids before surgery; typically used short-term because of side effects including bone density loss and menopausal symptoms
- Tranexamic acid — a non-hormonal medication used specifically to reduce heavy menstrual bleeding
- NSAIDs — nonsteroidal anti-inflammatory drugs like ibuprofen can help manage pain and may slightly reduce bleeding
Minimally Invasive Procedures
For women who want to treat fibroids while preserving the uterus, several minimally invasive options are available:
- Hysteroscopic myomectomy — removes fibroids growing inside the uterine cavity through the cervix, without incisions. This is performed using a hysteroscope and is particularly effective for submucosal fibroids.
- Uterine artery embolization (UAE) — a procedure that cuts off the blood supply to fibroids, causing them to shrink over time; performed by an interventional radiologist rather than a surgeon
- Radiofrequency ablation — a newer, minimally invasive technique that uses targeted heat to destroy fibroid tissue while leaving the uterus intact; increasingly offered as a less invasive alternative to more traditional surgery
Myomectomy
A myomectomy is a surgical procedure that removes fibroids while keeping the uterus intact — making it the preferred surgical option for women who want to maintain fertility or who prefer not to have a hysterectomy. Depending on the number, size, and location of the fibroids, it may be done laparoscopically through small incisions, hysteroscopically through the cervix, or through open abdominal surgery.
Fibroids can recur after myomectomy, but many women go on to have uncomplicated pregnancies following the procedure.
Hysterectomy
A hysterectomy — surgical removal of the uterus — is the only treatment that permanently eliminates fibroids and prevents their return. For women who are done having children and whose symptoms are severe, it can be an effective and lasting solution.
It’s important to know that hysterectomy is not the default or the only option, even for large or multiple fibroids. Yet research shows that Black women are substantially more likely to be offered or undergo hysterectomy for fibroids compared to other groups, often without a full conversation about alternatives. Knowing your options — and having a provider who will walk through all of them with you — makes a real difference.
Fibroids and Fertility
One of the most common concerns women have after a fibroid diagnosis is what it means for getting pregnant. The answer depends largely on the location and size of the fibroids.
Submucosal fibroids that grow into the uterine cavity are most likely to interfere with implantation or increase the risk of miscarriage. Other types are less likely to directly affect fertility, though larger fibroids or a significant number of them can complicate pregnancy management.
For women who want to conceive, it’s important to discuss the fibroid’s location and treatment options specifically in the context of fertility goals before making any decisions. In many cases, removing the right fibroids through a myomectomy or hysteroscopic procedure can improve the chances of a successful pregnancy.
Frequently Asked Questions
- Are fibroids cancerous?
In almost all cases, no. Fibroids are benign tumors — they are not cancerous and don’t increase the risk of uterine cancer. A very rare form of uterine cancer called leiomyosarcoma can resemble fibroids on imaging, but it is extremely uncommon. Fibroids that grow rapidly or appear after menopause may warrant further evaluation to rule it out.
- Can fibroids go away on their own?
Small fibroids sometimes remain stable for years without growing or causing symptoms. After menopause, when estrogen levels drop significantly, many fibroids shrink on their own. During reproductive years, however, fibroids typically don’t disappear without treatment — though they can stay the same size for long periods.
- Will fibroids affect my pregnancy?
It depends on the size, location, and number of fibroids. Many women with fibroids have completely uncomplicated pregnancies. However, certain types — particularly submucosal fibroids — can increase the risk of miscarriage, preterm birth, or placental complications. If you’re planning to get pregnant and you have known fibroids, discuss it with your OB-GYN before conceiving so a plan can be put in place.
- Do fibroids always need to be treated?
No. Many women with fibroids never develop significant symptoms and don’t require any intervention beyond periodic monitoring. The decision to treat depends on how much the symptoms are affecting your quality of life, the size and location of the fibroids, and your fertility goals.
- What’s the difference between a myomectomy and a hysterectomy?
A myomectomy removes the fibroids while leaving the uterus in place. A hysterectomy removes the entire uterus. Myomectomy is generally the preferred option for women who want to preserve their fertility or keep their uterus. Hysterectomy is permanent and eliminates the possibility of future pregnancy but is the only treatment that guarantees fibroids won’t return.
- How do I know if my symptoms are from fibroids?
Heavy periods, pelvic pressure, frequent urination, lower back pain, and pain during sex can all be symptoms of fibroids — but they can also be caused by other conditions like endometriosis, ovarian cysts, or adenomyosis. A pelvic exam and ultrasound can help distinguish between them. If you’ve been experiencing any of these symptoms regularly, it’s worth bringing up with your OB-GYN rather than assuming it’s just something you have to live with.
Conclusion
Fibroids are one of the most common reasons women seek gynecological care — and one of the most manageable conditions when it’s addressed with the right information and the right provider.
Being common doesn’t mean you have to accept the symptoms. Heavy bleeding that disrupts your daily routine, pelvic pressure that affects your comfort, and pain that shows up month after month are all worth a conversation. So is finding out you have fibroids and never getting a clear explanation of what that means or what your options are.
At KEM Health, we see and treat fibroids regularly — and we make sure every patient understands what’s happening in their body and what choices are available to them. Whether that means monitoring, medication, a minimally invasive procedure, or surgery, we’ll help you figure out what makes sense for your situation.
If you’re experiencing symptoms or have questions about fibroids, schedule an appointment with us today.