What are uterine fibroids?

Uterine fibroids are non-cancerous growths that develop in the muscle of the uterus. They are extremely common; by age 50, the majority of women have had at least one fibroid. Many cause no symptoms and need no treatment. Some cause heavy menstrual bleeding, pelvic pain or pressure, frequent urination, or fertility problems.

Why they cause symptoms. Fibroids respond to oestrogen and progesterone, which is why they tend to grow during reproductive years and shrink after menopause. The symptoms depend on size, number, and location. A small fibroid in one part of the uterus may cause heavy bleeding while a much larger fibroid in a different location causes mainly pressure symptoms.

The medical options. Oral GnRH antagonist plus add-back hormone combinations are the modern medical option for heavy bleeding and pain caused by fibroids. The GnRH antagonist suppresses the ovarian hormones that drive fibroid growth and bleeding, and the small added-back hormone dose keeps the suppression manageable from a side-effect perspective. Other medical options include hormonal contraception (which can reduce bleeding) and tranexamic acid (which reduces heavy menstrual bleeding regardless of cause).

The procedural options. Several uterus-preserving procedures are now well-established. Uterine artery embolisation blocks the blood supply to the fibroids. Radiofrequency ablation uses heat applied through a small probe to shrink fibroids. Focused ultrasound uses sound waves through the abdominal wall. Surgical myomectomy removes the fibroids while leaving the uterus.

The surgical option. Hysterectomy (removal of the uterus) is the only definitive cure for fibroids. For women who have completed childbearing and want a single solution, it remains a common choice. For women who want to preserve fertility, the medical and procedural options take precedence.

What to expect. The right approach depends on what symptoms are bothering you, your fertility plans, and the location of the fibroids. The expanded therapy options in the past several years mean that hysterectomy is no longer the default for most women with fibroids.