Are Intramural Fibroids Dangerous and Fibroids: What to Know

September 13, 2025

Are Intramural Fibroids Dangerous? What to Know

Intramural fibroids are one of the most common benign growths found in women of reproductive age. They can be confusing and concerning—especially when symptoms affect daily life or fertility. This guide explains what intramural fibroids are, when they can be dangerous, and how they’re diagnosed and treated, drawing on trusted information from organizations like the NIH, ACOG, and the FDA.

What Are Intramural Fibroids?

Uterine fibroids (also called leiomyomas or myomas) are noncancerous tumors that grow in or on the uterus. Intramural fibroids specifically develop within the muscular wall of the uterus. They vary in size—from barely detectable to large masses that distort the uterus—and may be single or multiple. Most fibroids are benign and do not turn into cancer. According to the NIH, fibroids are very common and many people have no symptoms at all.^{NIH (NICHD)} ^MedlinePlus

Are Intramural Fibroids Dangerous?

In most cases, no. Intramural fibroids are benign and not life-threatening. However, they can cause significant symptoms or complications that warrant medical attention:

Heavy menstrual bleeding and anemia: Intramural fibroids can increase menstrual flow and duration. Chronic heavy bleeding may lead to iron-deficiency anemia, causing fatigue, shortness of breath, and dizziness.^ACOG
Pelvic pressure and pain: Larger intramural fibroids can create a sense of fullness, pelvic pressure, back pain, or pain during intercourse.^{Office on Women's Health (HHS)}
Urinary and bowel symptoms: Pressure on the bladder may cause frequent urination; pressure on the rectum may cause constipation.^ACOG
Fertility and pregnancy effects (sometimes): Some intramural fibroids—particularly those that distort or press on the uterine cavity—may affect implantation, increase miscarriage risk, or contribute to preterm birth or malpresentation. Many people with fibroids still conceive and have healthy pregnancies.^{NIH (NICHD)} ^ACOG
Very rare cancer risk: Uterine sarcoma (including leiomyosarcoma) is rare and is usually not caused by a benign fibroid. Unfortunately, imaging cannot reliably rule it out before surgery. The FDA notes that unexpected uterine sarcoma during surgery for presumed fibroids is rare, but possible.^FDA ^ACOG

Common Symptoms

Symptoms vary by number, size, and location. Intramural fibroids may cause:

Heavy or prolonged periods (sometimes with clots)
Pelvic pressure or fullness
Pain with periods or intercourse
Frequent urination or difficulty emptying the bladder
Constipation
Fatigue related to anemia

When to Seek Urgent Care

Go to urgent care or the emergency department if you have severe pelvic pain, soaking through a pad or tampon every hour for several hours, fainting, fever with pelvic pain, or positive pregnancy test with severe pain or bleeding.

How Are Intramural Fibroids Diagnosed?

Diagnosis begins with a medical history and pelvic exam. Imaging confirms size and location:

Ultrasound: The first-line test to visualize fibroids.
MRI: Helps map number, size, and exact position—useful for planning treatment such as surgery or embolization.^ACOG

Do Intramural Fibroids Affect Fertility and Pregnancy?

Impact varies. Small intramural fibroids that do not distort the uterine cavity often have minimal effect on fertility. Larger intramural fibroids or those impinging on the cavity may be associated with reduced fertility or increased risk of miscarriage and pregnancy complications. Your clinician may recommend imaging to assess whether fibroids alter the uterine cavity and discuss whether removal could improve outcomes in your specific case.^{NIH (NICHD)} ^ACOG

Treatment Options

Management is individualized and depends on symptom severity, fibroid characteristics, age, and reproductive goals. Many people with mild symptoms choose watchful waiting, since fibroids often shrink after menopause.^MedlinePlus When treatment is needed, options include:

Medications

NSAIDs (e.g., ibuprofen): Help period pain but do not reduce bleeding significantly.
Tranexamic acid: An antifibrinolytic that reduces menstrual blood loss during cycles.^MedlinePlus
Hormonal contraception: Combined pills, patch, ring, or progestin-only methods can lighten bleeding and cramps.
Levonorgestrel intrauterine system (LNG-IUD): Reduces heavy bleeding for many patients; best when the uterine cavity is not significantly distorted.^ACOG
GnRH agonists/antagonists: Temporarily shrink fibroids and reduce bleeding by lowering estrogen/progesterone levels. FDA-approved oral combinations include elagolix + estradiol + norethindrone acetate and relugolix + estradiol + norethindrone acetate for heavy menstrual bleeding associated with fibroids; these are typically limited in duration due to bone and other side effects.^{FDA (elagolix combo)} ^{FDA (relugolix combo)}

Uterus-Preserving Procedures

Myomectomy: Surgical removal of fibroids while preserving the uterus. For intramural fibroids, this is typically done laparoscopically/robotically or via an open abdominal incision, depending on size and number. It can improve symptoms and may benefit some patients seeking fertility.^ACOG
Uterine artery embolization (UAE): A minimally invasive radiologic procedure that shrinks fibroids by blocking their blood supply. It can effectively reduce bleeding and bulk symptoms; future fertility after UAE is uncertain and should be discussed individually.^ACOG
Radiofrequency ablation (RFA): Uses energy to destroy fibroid tissue (e.g., laparoscopic or transcervical systems). May reduce recovery time; data on fertility is still evolving.^ACOG
MRI-guided focused ultrasound: Noninvasive ultrasound energy targets fibroids under MRI guidance. Not suitable for everyone; availability varies.^MedlinePlus

Definitive Treatment

Hysterectomy: Surgical removal of the uterus. This is a definitive cure for fibroid symptoms in people who do not plan future pregnancy. Route depends on fibroid size, anatomy, and surgeon expertise.^ACOG

Safety Consideration: Tissue Morcellation

For some minimally invasive surgeries, surgeons may use a technique called morcellation to remove large tissue through small incisions. Because it is not possible to completely rule out a hidden uterine cancer before surgery, the FDA recommends that if power morcellation is considered appropriate, it should be performed only with a containment system and in carefully selected patients after detailed counseling.^FDA

Choosing the Right Approach

The “right” treatment depends on your symptoms, fibroid characteristics, overall health, and reproductive plans. A gynecologist can help you weigh benefits, risks, likely effectiveness, recovery time, and impact on fertility. Shared decision-making—often using imaging to map fibroids—ensures care aligns with your goals.^ACOG

Key Takeaways

Intramural fibroids are common and usually not dangerous, but they can cause heavy bleeding, anemia, pain, and pressure.
Fertility and pregnancy can be affected in some cases, particularly when the uterine cavity is distorted.
Treatment ranges from watchful waiting and medicines to minimally invasive procedures and surgery; choices depend on symptoms and goals.
Discuss surgical risks and FDA guidance on morcellation with your surgeon if a minimally invasive approach is planned.

This article is for educational purposes and does not replace medical advice. If you have symptoms or concerns about fibroids, consult a qualified healthcare professional.