Nook Specialist and Fibroids: What to Know

Uterine fibroids (also called leiomyomas or myomas) are common, noncancerous growths of the uterus. Most are harmless, but for some people they cause heavy menstrual bleeding, pelvic pressure, pain, or fertility challenges. If you’re considering care with a Nook specialist—meaning a clinician who offers focused expertise in women’s health through a Nook-branded clinic or virtual service—here’s how they can help you understand your options and choose a treatment aligned with your goals.

What are uterine fibroids?

Fibroids develop from the muscle of the uterus. They can be single or multiple and vary from pea-sized to much larger masses that distort the uterus. Their size and location—submucosal (just beneath the uterine lining), intramural (within the wall), or subserosal (on the outer surface)—drive symptoms and treatment choices.

By age 50, most women will develop fibroids, and they are especially common among Black women. Many people have no symptoms and do not require treatment. When symptoms occur, they often include heavy or prolonged periods, pelvic pressure or fullness, frequent urination, constipation, pain with intercourse, and anemia-related fatigue from blood loss.

Who is at higher risk?

• Age: Most often diagnosed in the 30s and 40s
• Family history of fibroids
• Black race/ethnicity (higher prevalence and earlier onset)
• Obesity and hypertension
• Early onset of menstruation and low parity

How fibroids are diagnosed

A Nook specialist will start with your history and a pelvic exam, then confirm the diagnosis with imaging. First-line imaging is pelvic ultrasound (transvaginal and/or transabdominal). If more detail is needed—especially for surgical planning or when anatomy is complex—MRI can map fibroid size, number, and location. For heavy bleeding, saline infusion sonography or hysteroscopy may be used to look inside the uterine cavity, particularly when submucosal fibroids are suspected. Your clinician may also order blood tests to check for iron-deficiency anemia.

Treatment options: from watchful waiting to procedures

Care is personalized based on your symptoms, fibroid characteristics, age, overall health, and pregnancy goals. Many people do well with active monitoring when symptoms are mild.

Medications (symptom control and sometimes size reduction)

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Help menstrual cramps but have limited effect on bleeding volume.
• Tranexamic acid: A nonhormonal option taken during menses that reduces heavy bleeding.
• Hormonal contraceptives: Combined pills, progestin-only pills, or injections can regulate or lighten periods. The levonorgestrel intrauterine system (LNG-IUD) reduces bleeding for many; effectiveness can be limited if the uterine cavity is significantly distorted by fibroids.
• GnRH agonists (e.g., leuprolide): Temporarily shrink fibroids and reduce bleeding by inducing a reversible low-estrogen state. Often used short-term to correct anemia or shrink fibroids before surgery due to side effects with prolonged use (e.g., bone loss).
• Oral GnRH antagonists with add-back therapy: FDA-approved combinations such as elagolix/estradiol/norethindrone acetate and relugolix/estradiol/norethindrone reduce heavy menstrual bleeding from fibroids while mitigating menopausal side effects with low-dose estrogen-progestin add-back. Typically limited to defined treatment durations per labeling.

Minimally invasive procedures

• Uterine artery embolization (UAE/UFE): An interventional radiology procedure that blocks blood flow to fibroids, shrinking them and easing bleeding and bulk symptoms. Recovery is generally quicker than surgery. It may not be ideal if you plan future pregnancy; discuss risks and benefits with your specialist.
• MRI-guided focused ultrasound (MRgFUS): Uses high-intensity ultrasound waves to thermally ablate targeted fibroids without incisions. Best for select candidates and specific fibroid types and locations.
• Endometrial ablation: May reduce menstrual bleeding but is not a fibroid treatment per se and is not appropriate if future pregnancy is desired.

Surgical options

• Myomectomy: Removes fibroids while preserving the uterus. Approaches include hysteroscopic (for cavity-distorting submucosal fibroids), laparoscopic/robotic, or open abdominal surgery, depending on number, size, and location. Often preferred for those seeking future fertility.
• Hysterectomy: Removes the uterus and definitively resolves fibroid symptoms; ovaries may be preserved depending on age and preference. Appropriate for those who do not desire future pregnancy.

Important safety note: The U.S. Food and Drug Administration (FDA) has issued safety communications about laparoscopic power morcellation for hysterectomy or myomectomy because it can spread unsuspected cancerous tissue in rare cases. If minimally invasive surgery is planned, ask your specialist about alternatives, including contained tissue extraction or en bloc removal, and whether morcellation is appropriate for you.

Fertility and pregnancy considerations

Not all fibroids affect fertility. Submucosal fibroids and large intramural fibroids that distort the uterine cavity are more likely to impair implantation or increase miscarriage risk. A Nook specialist can coordinate imaging to map fibroids and advise on whether removing select fibroids could improve fertility or pregnancy outcomes. After a myomectomy, your clinician may recommend a cesarean birth in future pregnancies depending on the depth of the uterine incisions.

How a Nook specialist supports your care

• Personalized evaluation: A thorough review of your symptoms, anemia risk, and reproductive goals, with appropriate imaging.
• Evidence-based counseling: Clear explanation of all options—medical, interventional, and surgical—tailored to your priorities, including recovery time, impact on bleeding and pain, and effects on fertility.
• Coordinated care: Referrals to interventional radiology, reproductive endocrinology, or pelvic floor therapy when needed.
• Shared decision-making: Decision aids and risk–benefit discussions, including FDA safety considerations for surgical techniques.
• Follow-up and monitoring: Tracking symptom relief, anemia correction, and any fibroid regrowth.

Questions to ask your specialist

• Which fibroids are causing my symptoms, and how do their size and location influence treatment?
• What are the likely outcomes, side effects, and recovery times for my top two or three options?
• How will this choice affect my ability to get pregnant or carry a pregnancy?
• If surgery is recommended, will you use any form of morcellation, and how will you manage the FDA safety guidance?
• What is the plan if my symptoms recur?

When to seek care now

• Soaking through pads or tampons hourly for several hours
• Symptoms of anemia: dizziness, shortness of breath, palpitations, profound fatigue
• Severe pelvic pain, fever, or rapidly worsening symptoms
• Bleeding after menopause

Bottom line

Fibroids are common and treatable. A Nook specialist can help you confirm the diagnosis, stabilize symptoms like heavy bleeding and pain, and navigate choices ranging from medication to minimally invasive procedures to surgery. With evidence-based guidance and shared decision-making, most people find an effective plan that fits their health and life goals.

This article is for informational purposes and does not replace personalized medical advice. Always consult a qualified clinician about your symptoms and treatment options.

Trusted sources

• ACOG: Uterine Fibroids – Patient FAQ. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/uterine-fibroids
• NIH MedlinePlus: Uterine Fibroids. National Library of Medicine. https://medlineplus.gov/uterinefibroids.html
• U.S. FDA: Safety communications on laparoscopic power morcellation for removal of uterine tissue (leiomyomas). https://www.fda.gov/medical-devices
• Office on Women’s Health (HHS): Uterine Fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids