What Doctor To See For Fibroids and Fibroids: What to Know

What Doctor To See For Fibroids and Fibroids: What to Know

Uterine fibroids are common, benign (noncancerous) growths of the muscle tissue of the uterus. They can be as small as a seed or as large as a grapefruit and may cause symptoms such as heavy menstrual bleeding, pelvic pressure, frequent urination, pain with sex, or fertility challenges. If you think you have fibroids—or you’ve been told you do—knowing which doctor to see and what to expect can help you take the next confident step.

Which doctor should you see for fibroids?

  • Obstetrician–Gynecologist (OB-GYN): Your primary specialist for evaluation and most treatments. OB-GYNs diagnose fibroids, manage symptoms, and offer medical therapies and surgeries, including myomectomy and hysterectomy.
  • Minimally Invasive Gynecologic Surgeon (MIGS): An OB-GYN with additional training in advanced laparoscopic and hysteroscopic procedures. If you want uterine-sparing surgery with the smallest possible incisions and faster recovery, a MIGS specialist may be ideal.
  • Interventional Radiologist (IR): A physician who performs uterine artery embolization (UAE/UFE), a non-surgical, image-guided procedure that shrinks fibroids by blocking their blood supply. Referral from an OB-GYN or primary care provider is common.
  • Reproductive Endocrinologist/Infertility Specialist (REI): If you’re trying to conceive or undergoing fertility treatment, an REI will coordinate care with your OB-GYN to choose fibroid management strategies that preserve fertility.
  • Primary Care Clinician: A good starting point for preliminary evaluation, anemia screening, and referrals to appropriate specialists.

When to seek care—sooner rather than later

  • Heavy bleeding that interferes with daily life (e.g., soaking through a pad or tampon every hour for several hours)
  • Symptoms of anemia (fatigue, shortness of breath, dizziness, pale skin)
  • Pelvic pressure or pain, urinary frequency or urgency, constipation, or pain with sex
  • Difficulty getting pregnant or recurrent pregnancy loss

Urgent care: Seek immediate medical attention for severe bleeding with lightheadedness/fainting, severe pelvic pain plus fever, or symptoms of severe anemia.

How fibroids are diagnosed

After a symptom review and pelvic exam, most clinicians confirm fibroids with imaging:

  • Transvaginal pelvic ultrasound: First-line imaging to identify fibroid number, size, and location.
  • Saline infusion sonography (sonohysterography): Adds detail about fibroids inside the uterine cavity that may cause heavy bleeding or fertility issues.
  • MRI: Used when ultrasound is inconclusive or for pre-procedural planning (e.g., myomectomy, UFE, or MRI-guided focused ultrasound).

Treatment options: from watchful waiting to definitive surgery

The right plan depends on your symptoms, fibroid size and location, age, overall health, and goals for fertility and preserving the uterus. Many people combine approaches over time.

Symptom management and medications

  • Watchful waiting: If fibroids are small and asymptomatic, periodic monitoring may be appropriate.
  • NSAIDs (e.g., ibuprofen): Can reduce menstrual cramps and pelvic pain; limited impact on bleeding.
  • Tranexamic acid: A non-hormonal option taken only on heavy bleeding days to reduce menstrual blood loss.
  • Hormonal contraceptives: Pills, patches, rings, depot injections, or the levonorgestrel intrauterine system can decrease bleeding and cramps. They may not shrink fibroids but often improve symptoms.
  • GnRH agonists (e.g., leuprolide) and oral GnRH antagonists: Temporarily lower estrogen to shrink fibroids and control bleeding. FDA-approved combinations—elagolix with estradiol/norethindrone (Oriahnn) and relugolix with estradiol/norethindrone (Myfembree)—are indicated for heavy menstrual bleeding associated with fibroids. Use is typically limited due to potential bone mineral density loss; many patients also take “add-back” hormones to mitigate side effects.

Medication is often the first step for heavy bleeding or pain and may be used to improve blood counts before a procedure.

Uterus-preserving procedures

  • Myomectomy: Surgical removal of fibroids with reconstruction of the uterus. Approaches include hysteroscopic (through the cervix for cavity-distorting fibroids), laparoscopic/robotic (small incisions), or open abdominal surgery (for very large or numerous fibroids). Myomectomy is typically preferred for those seeking future pregnancy, though fibroids can recur.
  • Uterine artery embolization (UAE/UFE): Performed by an interventional radiologist through a small puncture in the wrist or groin to block blood flow to fibroids, causing them to shrink. UFE can substantially reduce bleeding and bulk symptoms with a relatively quick recovery. It preserves the uterus, but the impact on future fertility is less certain and should be discussed if pregnancy is a goal.
  • Radiofrequency ablation (RFA): Laparoscopic (Acessa) or transcervical (Sonata) energy-based treatment that shrinks fibroids while sparing healthy uterus. Recovery is typically faster than traditional surgery; fertility data are evolving.
  • MRI-guided focused ultrasound (MRgFUS): Noninvasive thermal ablation for select fibroids. Availability is limited, and candidacy depends on fibroid size, number, and location.

Definitive treatment

  • Hysterectomy: Removal of the uterus. This cures fibroids and bleeding but ends fertility. Minimally invasive approaches (vaginal or laparoscopic) are preferred when feasible.

How to choose the right specialist

Start with an OB-GYN for evaluation. If you’re considering UFE, ask for a referral to an interventional radiologist; if you want a minimally invasive myomectomy or RFA, seek a surgeon with high case volumes in those techniques. When fertility is a priority, involve a reproductive endocrinologist early.

Smart questions to ask at your visit:

  • Which fibroids are causing my symptoms, and how do their size/location affect options?
  • What treatments do you offer, and how many of these procedures do you perform each year?
  • How will this option affect bleeding, pain, and bulk symptoms—and for how long?
  • What are the risks, recovery time, and the chance I’ll need another procedure?
  • How will this choice affect my fertility or pregnancy?

Insurance and referrals

Check your plan’s network for OB-GYNs, interventional radiologists, and specialized surgeons. Some plans require a referral from a primary care clinician. If travel is feasible, consider centers with multidisciplinary fibroid programs.

Bottom line

If fibroids are affecting your life, you have options. OB-GYNs, minimally invasive gynecologic surgeons, interventional radiologists, and fertility specialists often collaborate to tailor care. The best choice balances symptom relief, safety, recovery time, and your goals for your body and future family.

This article is for general education and not a substitute for personal medical advice. Always consult a qualified clinician for diagnosis and treatment.

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