Is This Pain Normal, or Could It Be Uterine Fibroids?
Your periods have become heavier than they were in the past. Your lower abdomen feels full and uncomfortable. You are visiting the bathroom more frequently. You are exhausted in a way that sleep does not fix. And nobody has given you a clear answer yet. For millions of women, these experiences trace back to a single cause: uterine fibroids.
Fibroids are the most common noncancerous growths of the female reproductive system. By age 50, research suggests that up to 80% of women will develop fibroids at some point, yet the condition remains widely misunderstood, underdiagnosed, and undertreated. Many women spend years managing symptoms without ever knowing the cause.
This guide gives you the full picture: what fibroids are, why they develop, what they feel like, and what your treatment options look like.
What Are Uterine Fibroids?
Uterine fibroids are noncancerous tumours that grow in or around the wall of the uterus. The medical term is uterine leiomyomas or myomas. They are made of smooth muscle cells and fibrous connective tissue and can range enormously in size, from a seedling too small to detect without imaging, to a mass large enough to distort the shape of the uterus and press against surrounding organs.
Fibroids are rarely cancerous. The risk of a fibroid being or becoming malignant is less than 1 in 1,000. That distinction matters because many women hear the word tumour and fear the worst. Fibroids are a separate condition entirely from uterine cancer and do not increase your cancer risk. They grow in four main locations inside and around the uterus.
Intramural fibroids grow within the muscular wall of the uterus. They are the most common type and often cause heavy bleeding and pelvic pressure when they grow large. Subserosal fibroids develop on the outer surface of the uterus and can press into surrounding structures, causing back pain and bladder symptoms.
Submucosal fibroids grow just beneath the inner lining of the uterus and are the most likely to cause heavy periods, prolonged bleeding, and fertility complications. Pedunculated fibroids attach to the uterus via a stalk and can develop either inside or outside the uterine cavity. Many women have more than one fibroid simultaneously. Having multiple fibroids of different types and sizes is common.
What Causes Uterine Fibroids?
Researchers do not yet fully understand what triggers fibroids to develop. But several factors consistently appear in the evidence.
Hormones. Estrogen and progesterone both stimulate fibroid growth. Fibroids contain more hormone receptors than normal uterine muscle cells, which makes them highly responsive to hormonal fluctuations. This explains why fibroids grow during the reproductive years, often accelerate during pregnancy when hormone levels are elevated, and typically shrink after menopause when estrogen declines significantly.
Genetics. Fibroids run in families. If your mother, sister, or aunt had fibroids, your risk of developing them is significantly higher. Certain genetic mutations in uterine muscle cells are associated with fibroid formation.
Race. Black women are disproportionately affected by fibroids. They develop fibroids two to three times more often than white women, experience more severe symptoms, and are more likely to require surgical intervention. The reasons behind this disparity are complex and not fully understood, but hormonal, genetic, environmental, and structural healthcare factors all contribute.
Age. Fibroids are most common in women between their 30s and early 50s. The risk increases through the reproductive years and typically declines after menopause.
Lifestyle factors. Obesity, a diet high in red meat and low in vegetables and fruit, vitamin D deficiency, and alcohol consumption have all been associated with increased fibroid risk. Regular exercise appears to have a modest protective effect.
Symptoms of Uterine Fibroids
Symptoms vary widely depending on the number, size, and location of the fibroids. Some women have large fibroids and experience no symptoms at all. Others have small fibroids that cause significant disruption.
The most common symptoms include the following.
Heavy menstrual bleeding. This is the most frequently reported symptom. Periods may become significantly heavier, lasting longer than seven days, and sometimes including large blood clots. Heavy bleeding often leads to iron deficiency anaemia, which causes fatigue, weakness, shortness of breath, and difficulty concentrating.
Pelvic pressure and pain. As fibroids grow, they create a sensation of fullness, pressure, or bloating in the lower abdomen. Some women describe it as feeling constantly pregnant. Larger fibroids can cause genuine pelvic pain, particularly during periods.
Frequent urination. Fibroids that press against the bladder reduce its capacity and increase the urge to urinate. Some women also experience difficulty fully emptying the bladder.
Constipation and back pain. Subserosal fibroids pressing against the bowel or lower back can cause constipation, bloating, and persistent lower back pain.
Pain during sex. Depending on the fibroid location, intercourse can become uncomfortable or painful.
Fertility and pregnancy complications. Submucosal fibroids in particular can interfere with embryo implantation and increase the risk of miscarriage, preterm labour, and other pregnancy complications.
How Fibroids Are Diagnosed
If your doctor suspects fibroids based on your symptoms, the most common first step is a pelvic ultrasound. This non-invasive imaging test can identify fibroid location, size, and number with reasonable accuracy.
For a more detailed picture, particularly before planning treatment, your doctor may recommend a transvaginal ultrasound, an MRI scan, a sonohysterogram using saline to visualise the uterine cavity, or a hysteroscopy where a thin camera is passed through the cervix to view the inside of the uterus directly.
Blood tests to check for anaemia are also standard, given the rate at which heavy bleeding accompanies fibroids.
Treatment Options for Uterine Fibroids
Treatment depends on the severity of your symptoms, the size and location of your fibroids, your age, and whether you want to preserve your fertility. Not every fibroid requires treatment. Small, asymptomatic fibroids are often monitored rather than actively treated.
When symptoms are significant, several options exist.
Medication. Hormonal medications can shrink fibroids and manage symptoms, though they do not eliminate fibroids permanently. Options include GnRH agonists, which suppress estrogen production and significantly reduce fibroid size before surgery. Tranexamic acid reduces heavy menstrual bleeding without affecting hormones. Combined oral contraceptives and progesterone-releasing IUDs help manage bleeding, though they do not shrink fibroids.
A newer class of oral medication called GnRH antagonists, including elagolix and relugolix, offers a non-surgical option with a more manageable side effect profile and strong clinical evidence for reducing heavy bleeding associated with fibroids.
Uterine Fibroid Embolisation (UFE). This minimally invasive procedure cuts off the blood supply to fibroids by injecting small particles into the uterine arteries. Without blood flow, fibroids shrink and die. UFE preserves the uterus, requires no general anaesthesia in most cases, and has a strong track record for symptom relief. It is not recommended for women who wish to become pregnant.
Endometrial ablation. This procedure destroys the lining of the uterus to reduce or stop menstrual bleeding. It is suitable only for women who do not plan future pregnancies and works best for smaller, intramural fibroids.
Myomectomy. A myomectomy surgically removes fibroids while leaving the uterus intact. It is the preferred surgical option for women who want to preserve their fertility. Fibroids can recur after myomectomy, particularly if multiple fibroids were present.
Hysterectomy. The complete surgical removal of the uterus is the only permanent cure for fibroids. It eliminates all symptoms and all possibility of recurrence. It is a major surgery with a recovery period of several weeks and permanently ends the ability to carry a pregnancy.
Focused Ultrasound Surgery (FUS). This non-invasive technique utilises high-intensity ultrasound waves guided by MRI to destroy fibroid tissue without incisions. It is available at specialist centres and represents an emerging option for carefully selected patients.
When to See a Doctor
Do not wait until your symptoms feel unbearable. Many women normalise heavy periods, pelvic pain, and exhaustion for years before seeking help. These are not things you have to live with. See your doctor if your periods are consistently heavy or lasting more than seven days, if you are experiencing pelvic pain or pressure that affects your daily life, if you are urinating frequently without an obvious cause, if you are trying to conceive and having difficulty, or if you feel constantly fatigued despite adequate sleep.
Early diagnosis means more options. More options mean more control over your own health.