Management of Fibroids: What to Know

Uterine fibroids (leiomyomas) are common, benign growths of the uterus that can cause heavy menstrual bleeding, pelvic pain, pressure symptoms, and fertility challenges for some people. Others may have fibroids and no symptoms at all. Understanding your options helps you make informed, personalized decisions. This guide summarizes evidence-based approaches to diagnosis and management, drawing on trusted sources such as the National Institutes of Health (NIH), the U.S. Food and Drug Administration (FDA), and leading professional guidelines.

What Are Fibroids and How Common Are They?

Fibroids are noncancerous tumors arising from the muscle tissue of the uterus. They vary in size and location (within the uterine wall, projecting into the cavity, or on the outer surface). By age 50, most women and people assigned female at birth will develop fibroids; they are particularly prevalent and often more severe among Black women. While fibroids do not transform into cancer, a different, rare cancer (leiomyosarcoma) can independently occur in the uterus.

Symptoms to Watch For

• Heavy menstrual bleeding (soaking pads/tampons hourly, passing clots)
• Pelvic pressure or pain; a feeling of abdominal fullness
• Frequent urination, constipation, or back pain due to pressure
• Painful intercourse
• Infertility, miscarriage, or complications in pregnancy (depending on location/size)

Seek urgent care for severe pain, fainting, fever, or bleeding that causes dizziness or signs of anemia (extreme fatigue, shortness of breath, pale skin).

How Fibroids Are Diagnosed

Diagnosis typically starts with a pelvic exam and ultrasound. Transvaginal ultrasound is often sufficient; saline infusion sonography or MRI may be used to better map fibroid size and location, especially before procedures. Blood tests can assess anemia from heavy bleeding. Rarely, imaging cannot distinguish fibroids from other masses; clinicians consider age, growth rate, and symptoms when deciding next steps.

Choosing a Management Plan

Not everyone with fibroids needs treatment. The best approach depends on your symptoms, goals (including fertility), fibroid characteristics, other health conditions, and preferences. Many people use a stepwise approach starting with medications for bleeding and pain, moving to procedures if symptoms persist or worsen.

Non-Surgical Options

Watchful Waiting

If fibroids are small and not bothersome, periodic monitoring with symptom check-ins and occasional imaging may be all that’s needed. Fibroids often shrink after menopause.

Medications for Symptoms

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Reduce menstrual pain; limited effect on bleeding volume.
• Tranexamic acid: Non-hormonal option taken during menses to reduce heavy bleeding.
• Hormonal contraceptives: Pills, patches, rings, or the levonorgestrel intrauterine device (IUD) can lighten periods and cramps. The IUD is particularly effective for heavy bleeding and is reversible.
• GnRH agonists (e.g., leuprolide) and antagonists: Temporarily lower estrogen/progesterone to reduce bleeding and shrink fibroids; often used short-term due to side effects like hot flashes and bone density loss. They can be helpful before surgery to correct anemia or reduce size.

Two oral combination therapies are FDA-approved specifically for heavy menstrual bleeding due to fibroids in premenopausal women: elagolix with add-back therapy (ORIAHNN) and relugolix-estradiol-norethindrone (MYFEMBREE). These can significantly reduce bleeding while minimizing bone loss associated with low estrogen. They are typically used for limited durations and require monitoring.

Iron supplementation and diet adjustments may be necessary if anemia is present. Always review medication risks and benefits with your clinician and consider interactions, bone health, and pregnancy plans.

Minimally Invasive and Surgical Procedures

Myomectomy (Fibroid Removal, Uterus Preserved)

• Hysteroscopic myomectomy: For fibroids that protrude into the uterine cavity; performed through the cervix without incisions. Often best for heavy bleeding and fertility preservation.
• Laparoscopic/robotic myomectomy: Small incisions; removes fibroids on or within the uterine wall.
• Open (abdominal) myomectomy: Larger incision; used for very large or numerous fibroids.

Myomectomy preserves the uterus and fertility potential, but fibroids can recur over time. Recovery varies by approach.

Hysterectomy (Uterus Removal)

Definitive cure for fibroids and bleeding; not appropriate for those desiring future pregnancy. Can be done vaginally, laparoscopically/robotically, or via an abdominal incision. Ovaries may be preserved depending on age and preference.

Uterine Artery Embolization (UAE)

A radiology-guided procedure that blocks blood flow to fibroids, causing shrinkage and symptom relief. Most people go home the same day or next. It preserves the uterus, but its impact on future fertility is less predictable than myomectomy; discuss if pregnancy is a goal.

Radiofrequency Ablation (RFA)

Energy-based destruction of fibroid tissue via laparoscopic (Acessa) or transcervical (Sonata) devices. Typically outpatient with relatively quick recovery, suitable for certain fibroid sizes and locations. Limited long-term data compared with myomectomy, but growing evidence supports symptom relief.

MRI-Guided Focused Ultrasound (MRgFUS)

Noninvasive technique using focused ultrasound to thermally ablate fibroids under MRI guidance. Availability is limited, and not all fibroid types are suitable.

Important Safety Note: Tissue Morcellation

Laparoscopic power morcellators can spread an unsuspected uterine cancer during fibroid surgery. The FDA recommends limiting use to carefully selected patients and using a legally marketed contained tissue extraction system when morcellation is appropriate. Discuss alternatives and safety measures with your surgeon.

Fertility and Pregnancy Considerations

Fibroids can sometimes affect fertility or pregnancy by distorting the uterine cavity or interfering with implantation. Submucosal fibroids (inside the cavity) are most likely to impact bleeding and fertility and are often treated with hysteroscopic removal. Many people conceive and carry healthy pregnancies with fibroids; management should be individualized with a reproductive specialist when pregnancy is a priority.

Lifestyle and Self-Care

• Track cycles and symptoms to gauge treatment effectiveness.
• Address anemia with iron, vitamin C–rich foods, and clinician-guided supplementation.
• Maintain a healthy weight and active lifestyle; while no diet is proven to shrink fibroids, overall metabolic health supports symptom control and surgical recovery.
• Be cautious about unproven supplements or "detox" products marketed for fibroids; efficacy and safety are often untested.

Key Takeaways

• Fibroids are common and often manageable without surgery.
• Treatment should match your symptoms, fibroid type, and goals, especially around fertility.
• Evidence-based options include medications (including FDA-approved oral therapies), uterine-sparing procedures (myomectomy, UAE, RFA), and hysterectomy.
• Discuss risks, recovery, and recurrence with your clinician to choose a plan that fits your life.

This article is informational and not a substitute for medical advice. Consult a qualified clinician for diagnosis and treatment tailored to you.

References and Trusted Resources

• NIH/NICHD: Uterine Fibroids – https://www.nichd.nih.gov/health/topics/uterine
• MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
• Office on Women’s Health (HHS): Uterine Fibroids – https://www.womenshealth.gov/a-z-topics/uterine-fibroids
• ACOG: Uterine Fibroids FAQ – https://www.acog.org/womens-health/faqs/uterine-fibroids
• FDA: ORIAHNN approval for fibroid-related heavy bleeding – https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-drug-combination-treat-heavy-menstrual-bleeding-associated-uterine-fibroids
• FDA: MYFEMBREE approval – https://www.fda.gov/news-events/press-announcements/fda-approves-first-once-daily-therapy-manage-heavy-menstrual-bleeding-uterine-fibroids
• FDA Safety Communication: Contained power morcellation – https://www.fda.gov/medical-devices/safety-communications/update-fda-recommends-only-contained-power-morcellation-during-laparoscopic-myomectomy-or-hysterectomy