Uterine fibroids are one of the most common non-cancerous growths affecting women during their reproductive years. Although many people with fibroids experience no symptoms, others may have heavy menstrual bleeding, pelvic pain, pressure on nearby organs and fertility challenges.
Fibroids are a leading cause of heavy menstrual bleeding and are one of the most common reasons women seek gynaecological care. Fortunately, many fibroids do not require treatment, and a range of effective management options are available for those who develop symptoms.
Understanding fibroids can help individuals recognise when menstrual changes are not normal and when medical assessment is needed.
What are Uterine Fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous (benign) growths that develop from the smooth muscle of the uterus (womb).
A person may have:
• one fibroid;
• several fibroids; or
• many fibroids of different sizes.Fibroids can be as small as a seed or grow large enough to enlarge the uterus significantly.
Importantly, fibroids are not cancer, and the risk of a fibroid becoming cancerous is extremely low.
How Common are Fibroids?
Fibroids are very common.
It is estimated that up to 70–80% of women will develop fibroids by the age of 50, although many never experience symptoms and may not know they have them.
Fibroids are diagnosed more frequently in women of African ancestry, who are also more likely to develop fibroids at a younger age and experience larger or multiple fibroids.
What Causes Fibroids?
The exact cause is not fully understood.
Researchers believe several factors contribute, including:
- Hormones
The hormones oestrogen and progesterone encourage fibroids to grow during the reproductive years.
Fibroids often shrink after menopause when hormone levels naturally decline.
- Genetics
Fibroids frequently occur in families. Having a close relative with fibroids increases the likelihood of developing them.
- Growth Factors
Certain naturally occurring substances that help the body grow and repair tissues may also influence fibroid growth.
Types of Fibroids
Fibroids are classified according to where they develop within the uterus.
- Intramural Fibroids
These grow within the muscular wall of the uterus and are the most common type.
- Submucosal Fibroids
These grow just beneath the lining of the uterus and protrude into the uterine cavity.
Even small submucosal fibroids may cause heavy menstrual bleeding and fertility problems.
- Subserosal Fibroids
These develop on the outer surface of the uterus.
Large subserosal fibroids may press on nearby organs such as the bladder or bowel.
- Pedunculated Fibroids
These fibroids grow on a stalk attached to either the inside or outside of the uterus.
Signs and Symptoms
Many fibroids cause no symptoms.
When symptoms occur, they may include:
• heavy or prolonged menstrual bleeding;
• passing large blood clots during menstruation;
• painful menstrual cramps;
• pelvic pain or pressure;
• abdominal swelling or a feeling of fullness;
• frequent urination due to pressure on the bladder;
• constipation due to pressure on the bowel;
• lower back pain;
• pain during sexual intercourse; and
• difficulty becoming pregnant or recurrent pregnancy loss in some cases.The type, size and location of a fibroid often determine the symptoms experienced.
Possible Complications
Untreated symptomatic fibroids may lead to:
• iron deficiency anaemia due to heavy menstrual bleeding;
• chronic pelvic pain;
• urinary or bowel problems;
• pregnancy complications in some cases; and
• fertility difficulties, particularly when fibroids distort the uterine cavity.Many people with fibroids, however, have healthy pregnancies.
How are Fibroids Diagnosed?
A healthcare professional will ask about:
• menstrual history;
• symptoms;
• medical history; and
• family history.Diagnosis may involve:
• a pelvic examination;
• pelvic ultrasound, which is the most common imaging test;
• MRI scans in selected cases;
• hysteroscopy to examine the inside of the uterus; or
• additional investigations where necessary.Treatment
Treatment depends on:
• the size and location of the fibroids;
• the severity of symptoms;
• the person’s age;
• overall health; and
• whether pregnancy is desired.Some people require no treatment and only regular monitoring.
Treatment options include:
Medicines
Medicines may be prescribed to:
• reduce heavy menstrual bleeding;
• relieve pain;
• temporarily shrink fibroids; or
• improve iron levels if anaemia develops.Minimally Invasive Procedures
Some procedures reduce the blood supply to fibroids or destroy fibroid tissue without removing the uterus.
These options may not be suitable for everyone.
Surgery
Surgical options include:
• Myomectomy, which removes fibroids while preserving the uterus; or
• Hysterectomy, which removes the uterus and permanently cures fibroids.The most appropriate treatment depends on each individual’s circumstances and reproductive plans.
Can Fibroids Be Prevented?
There is currently no guaranteed way to prevent fibroids.
Maintaining a healthy lifestyle supports overall wellbeing but cannot completely prevent fibroid development.
Regular medical check-ups can help identify fibroids before they cause significant complications.
Living with Fibroids
Many people successfully manage fibroids with regular medical care.
Helpful strategies include:
• attending follow-up appointments;
• monitoring menstrual bleeding;
• eating iron-rich foods if experiencing heavy periods;
• taking iron supplements if prescribed;
• staying physically active; and
• discussing any changes in symptoms with a healthcare professional.When Should You See a Healthcare Professional?
Seek medical advice if you:
• have heavy menstrual bleeding that interferes with daily life;
• pass large blood clots regularly during your period;
• develop severe pelvic pain;
• notice persistent swelling of the lower abdomen;
• urinate frequently because of pelvic pressure;
• experience constipation together with pelvic fullness;
• develop symptoms of anaemia, such as fatigue or dizziness; or
• have difficulty becoming pregnant.Early assessment can help determine whether fibroids or another condition is responsible for your symptoms.
Myths and Facts
Myth: Fibroids are cancer.
Fact: Fibroids are benign growths. Cancer developing from a fibroid is extremely rare.
Myth: Every fibroid needs surgery.
Fact: Many fibroids cause no symptoms and only require monitoring.
Myth: Fibroids always prevent pregnancy.
Fact: Many women with fibroids become pregnant naturally and have healthy pregnancies.
Myth: Heavy periods are just something women must live with.
Fact: Heavy menstrual bleeding should always be assessed, as fibroids and other treatable conditions may be responsible.
Frequently Asked Questions
- Can fibroids disappear on their own?
Fibroids usually do not disappear before menopause, although some remain stable or grow very slowly. They often shrink naturally after menopause.
- Can teenagers develop fibroids?
Yes, although fibroids are much more common during the reproductive years.
- Do fibroids always cause pain?
No. Many people have fibroids without experiencing any symptoms.
- Can fibroids come back after treatment?
Yes. Fibroids can recur after treatments such as myomectomy, particularly in younger women.
Key Messages
• Uterine fibroids are common, non-cancerous growths of the uterus.
• Many people have fibroids without symptoms, while others experience heavy menstrual bleeding, pelvic pain or pressure.
• Fibroids are a common cause of heavy periods and iron deficiency anaemia.
• Most fibroids are benign and do not become cancerous.
• Effective treatments are available, ranging from monitoring and medication to minimally invasive procedures and surgery.
• If heavy periods, pelvic pain or pressure affect your daily life, seek assessment from a qualified healthcare professional.Knowledge Hub Series: Period Talk Uganda – Evidence-Based Menstrual Health Resources