Why Women With Fibroids Struggle to Get Clear Answers From Doctors

Uterine fibroids are common, benign growths of the uterus that can cause heavy bleeding, pelvic pain, fertility challenges, and a lot of uncertainty. If you’ve felt frustrated by mixed messages, rushed appointments, or conflicting treatment plans, you are not alone. This article explains why getting clear answers can be hard—and how to navigate conversations with your care team more confidently.

Fibroids 101: A common condition with uncommon experiences

Fibroids (also called uterine leiomyomas) are extremely common—most women develop them by age 50. Prevalence and severity are higher among Black women, who often develop fibroids earlier and experience more symptoms. Yet many women have no symptoms at all. This wide spectrum—from silent to life-altering—makes counseling and treatment planning complex.

Trusted resources for background include the National Institutes of Health and MedlinePlus, which provide accessible overviews of causes, symptoms, and treatments (NIH/NICHD; MedlinePlus).

Why clear answers are so hard to get

1) Symptoms vary and don’t always match scan results

Some small fibroids cause severe bleeding; some large ones cause none. The location (inside the cavity, within the wall, or on the surface) can matter as much as size. Because symptoms don’t always correlate neatly with imaging, it can be difficult to predict who will benefit most from which treatment. Clinical guidelines emphasize individualized care rather than one-size-fits-all decisions (ACOG).

2) Evolving evidence and many options

There’s no single “best” treatment for every woman. Options range from watchful waiting and medications to uterine-sparing procedures and hysterectomy. An evidence review from the Agency for Healthcare Research and Quality highlights that while many treatments improve bleeding and quality of life, direct head-to-head comparisons are limited for some choices, which can lead to differing medical opinions (AHRQ).

3) Specialty silos and procedural bias

Gynecologic surgeons, interventional radiologists, and fertility specialists may emphasize treatments they perform most. For example, some gynecologists may focus on myomectomy or hysterectomy; interventional radiologists may highlight uterine artery embolization (UAE/UFE). Ideally, patients should hear a balanced view of all appropriate options, but real-world access to multidisciplinary counseling varies.

4) Safety controversies complicate conversations

FDA safety communications about laparoscopic power morcellation—an approach once used to remove fibroids through small incisions—raised concerns about spreading an unsuspected uterine cancer (a rare but serious risk). This changed surgical practice and sparked debate that still influences counseling and consent. If you’re offered minimally invasive surgery, ask how tissue will be removed and whether containment systems are used (FDA).

5) Racial and gender inequities

Black women are more likely to be diagnosed, experience severe symptoms, and undergo hysterectomy at younger ages. Bias and underrepresentation in research historically contributed to gaps in understanding and delays in care. A clear, respectful, shared decision-making process matters even more in this context, and clinicians are increasingly called to address these disparities.

6) Insurance and access barriers

Coverage rules can limit access to certain imaging (like MRI mapping) or newer therapies and may require trying medications first. Referral pathways to interventional radiology, fertility clinics, or high-volume surgeons vary by system, creating different experiences depending on where you seek care.

7) Short visits, big decisions

Fibroid choices involve fertility goals, symptom burden, recovery time, and long-term outcomes. These conversations take time, and many patients feel rushed. Preparing questions and asking for dedicated counseling visits can help.

What a thorough evaluation usually includes

• Detailed symptom history: bleeding patterns, pain, pressure, fertility goals, anemia symptoms (fatigue, dizziness).
• Pelvic exam and first-line imaging with transvaginal ultrasound; MRI may be used for complex cases or surgical planning (NICE NG88).
• Blood tests if heavy bleeding: complete blood count, iron studies; pregnancy test if indicated.
• Assessment of other causes of heavy bleeding or pain (e.g., polyps, adenomyosis, bleeding disorders).

Treatment options—what to know

Choices should reflect your symptoms, fibroid location/size, overall health, and whether you want to preserve fertility or the uterus. Discuss risks, benefits, and recovery for each option. High-quality overviews are available from ACOG and NIH (ACOG; NIH/NICHD).

Watchful waiting

Appropriate if symptoms are mild or stable. Fibroids often shrink after menopause. Regular follow-up ensures symptoms and anemia are monitored.

Medications

• Nonhormonal options: NSAIDs for pain; tranexamic acid to reduce heavy bleeding during periods (not contraceptive).
• Hormonal options: combined hormonal contraceptives; progestin-only methods including the levonorgestrel IUD, which can significantly lessen bleeding.
• GnRH agonists and antagonists: short-term use can shrink fibroids and reduce bleeding; oral combinations (e.g., relugolix combination therapy; elagolix with add-back therapy) are FDA-approved to manage heavy menstrual bleeding due to fibroids in premenopausal women. These can have menopausal-like side effects; “add-back” estrogen/progestin reduces bone and vasomotor symptoms. Discuss duration limits and monitoring with your clinician.

Uterine-sparing procedures

• Myomectomy: surgical removal of fibroids via hysteroscopy (inside the cavity), laparoscopy, or open surgery. Preserves the uterus; fibroids can recur.
• Uterine artery embolization (UAE/UFE): an interventional radiology procedure that blocks fibroid blood supply to shrink them and reduce bleeding. Recovery is typically shorter than major surgery; not ideal for all fertility plans.
• Radiofrequency ablation (laparoscopic or transcervical): uses heat to destroy fibroid tissue; minimally invasive option for selected cases.
• MRI-guided focused ultrasound (MRgFUS): noninvasive thermal ablation for eligible patients at centers that offer it.

Hysterectomy

Removal of the uterus is definitive for fibroid symptoms and bleeding and eliminates recurrence, but it ends fertility. Approaches include vaginal, laparoscopic, or abdominal surgery. Discuss risks, recovery, and whether ovaries will be removed (often they are not for benign fibroids).

How to get clearer answers

• Ask for a plain-language summary: “What are my top two options and why?”
• Clarify goals: symptom relief, preserving fertility, avoiding major surgery, faster recovery, or minimizing recurrence.
• Request balanced counseling: “Can you also discuss options you don’t perform? Should I meet an interventional radiologist or fertility specialist?”
• Discuss logistics: hospitalization, recovery time, return to work, and likelihood of repeat procedures.
• Review safety specifics: blood loss, infection risk, scar tissue, and (for surgery) how tissue will be removed in light of FDA guidance on morcellation (FDA).
• Consider a second opinion—especially if you feel pushed toward a single option without discussion of alternatives.

When to seek urgent care

• Severe, soaking bleeding or signs of anemia (fainting, chest pain, shortness of breath).
• Severe, escalating pelvic pain, fever, or foul discharge.
• Suspected pregnancy with pain or bleeding.

The bottom line

Fibroids are common, but every woman’s story is different. The range of treatments, evolving evidence, and real-world barriers can make the path to answers feel confusing. Rely on credible sources, ask targeted questions, and consider multidisciplinary opinions. With a clear understanding of your goals and the trade-offs of each option, you can partner with your clinicians to create a plan that fits your life.

Reliable resources: NIH/NICHD; MedlinePlus; ACOG; AHRQ; FDA; NICE NG88.

This article is for educational purposes and does not replace personalized medical advice. Always consult your healthcare professional about your specific situation.