Fibroids in Women: Symptoms, Types, and Treatment Options
Up to 70 to 80 percent of women will develop uterine fibroids by the time they reach age 50. The majority of women. And yet fibroids remain one of the most misunderstood and most underdiagnosed conditions in women's health.
Many women live with fibroid symptoms for years before receiving a diagnosis told their heavy, painful periods are "just how it is." They manage debilitating pelvic pressure with ibuprofen and quietly wonder why they feel a heaviness in their abdomen that nobody else seems to talk about.
This post gives you the complete picture: what fibroids are, all four types, every symptom worth knowing, how diagnosis works, and the full treatment spectrum including options that preserve the uterus and fertility entirely.
What Uterine Fibroids Actually Are
Uterine fibroids medically called leiomyomas or myomas are non-cancerous growths that develop from the smooth muscle tissue of the uterus. They are benign tumors: they do not become cancer and do not increase the risk of uterine cancer. Despite the word "tumor," fibroids are not malignant and the vast majority cause no long-term health complications beyond their symptoms.
Fibroids range dramatically in size from as small as a pea to as large as a softball or bigger and a single woman may have just one or several simultaneously. An estimated 26 million women between the ages of 15 and 50 in the United States have uterine fibroids, and more than 15 million experience symptoms that affect daily life.
What causes fibroids is not fully understood, but genetics, prolonged estrogen exposure, and hormonal signaling are key contributors. Fibroids grow during the reproductive years and typically shrink after menopause when estrogen falls.
The 4 Types of Uterine Fibroids
Fibroid location within or around the uterus determines which symptoms they cause and which treatments are most appropriate.
Submucosal Fibroids
Submucosal fibroids grow directly beneath the inner uterine lining and project into the uterine cavity. They are the least common type but the most symptomatic. Because they sit inside the cavity, submucosal fibroids directly disrupt the shedding of the uterine lining, making them the primary driver of heavy, prolonged bleeding and large clots. They are also the type most strongly associated with fertility challenges and recurrent miscarriage, as they interfere with implantation and early fetal development.
Intramural Fibroids
Intramural fibroids are the most common type. They grow embedded within the muscular wall of the uterus and range from small and asymptomatic to large enough to distort the uterine cavity. As they enlarge, intramural fibroids cause heavy periods, pelvic pressure, a sensation of fullness, lower back pain, and in some cases bladder or bowel compression. Larger intramural fibroids can also impact fertility by distorting the cavity enough to interfere with implantation.
Subserosal Fibroids
Subserosal fibroids grow on the outer wall of the uterus and project outward into the pelvic cavity. Because they grow away from the uterine cavity, heavy bleeding is less common. Their primary symptoms are mechanical pelvic pressure and heaviness, lower back pain, and compression of nearby organs. When large, subserosal fibroids press on the bladder causing frequent urination, or on the rectum causing constipation and discomfort.
Pedunculated Fibroids
Pedunculated fibroids grow on a thin stalk attached to either the inside or outside of the uterus. They can twist on their stalk a process called torsion cutting off blood supply and causing sudden, severe pelvic pain that may require urgent care. Submucosal pedunculated fibroids can also prolapse through the cervix, causing intense cramping and pressure.
Symptoms of Uterine Fibroids
Roughly half of women with fibroids have no symptoms and never know they have them fibroids are frequently discovered during a routine ultrasound performed for another reason. When fibroids do cause symptoms, they typically include:
Menstrual symptoms:
Heavy menstrual bleeding soaking through pads or tampons quickly, passing large clots
Periods lasting longer than seven days
Bleeding between periods
Severe menstrual cramps not controlled by over-the-counter medication
Pelvic and abdominal symptoms:
Pelvic pressure, heaviness, or feeling of fullness
Lower abdominal bloating or visible enlargement
Lower back pain or pressure
Pain during sex
Bladder and bowel symptoms:
Frequent urination or difficulty fully emptying the bladder
Constipation or rectal pressure
Reproductive symptoms:
Difficulty conceiving
Recurrent miscarriage
Complications during pregnancy
Systemic symptoms:
Fatigue, weakness, and pallor from iron deficiency anemia one of the most frequently missed consequences of fibroid-related chronic blood loss
A small submucosal fibroid inside the cavity can cause more significant bleeding than a much larger subserosal fibroid on the outer wall.
How Fibroids Are Diagnosed
Pelvic exam — an enlarged or irregular uterus may suggest fibroids, but imaging is needed to confirm
Pelvic ultrasound — the standard first-line imaging tool; identifies fibroids, estimates size and number, and assesses location
MRI — provides the most detailed picture of fibroid number, size, and exact location; particularly important when planning surgery or embolization
Sonohysterography — saline infusion ultrasound that gives a clearer view of the uterine cavity; especially useful for identifying submucosal fibroids
Hysteroscopy — direct visualization of the uterine cavity; used both for diagnosis and same-day treatment of submucosal fibroids
Bloodwork — CBC and iron studies to assess for anemia from blood loss
Treatment Options: The Full Spectrum
Treatment decisions are guided by symptom severity, fibroid size and location, age, and reproductive goals. Asymptomatic or minimally symptomatic fibroids often require no treatment at all.
Watchful Waiting
For women with small, asymptomatic or minimally symptomatic fibroids, monitoring with annual ultrasound is entirely appropriate. Fibroids grow slowly and often stabilize or shrink at menopause.
Medications
Hormonal contraceptives — combined oral contraceptive pills, progestin-only pills, and the hormonal IUD (Mirena) do not shrink fibroids but effectively reduce heavy bleeding and cramping. The Mirena IUD is one of the most effective non-surgical options for managing fibroid-related bleeding while preserving the uterus.
Tranexamic acid — a non-hormonal prescription taken only during menstruation reduces blood loss by improving clotting at the uterine surface without affecting hormones.
GnRH agonists (such as leuprolide/Lupron) temporarily suppress estrogen, inducing a reversible "medical menopause" that can shrink fibroids 30 to 50 percent. Used short-term before surgery to reduce fibroid size and blood loss, as long-term use causes bone density loss.
GnRH antagonists (such as elagolix/Oriahnn) — a newer option that suppresses estrogen and can be paired with low-dose hormonal add-back therapy to allow longer-term use for symptom management.
Iron supplementation — essential for women with fibroid-related anemia; addresses the blood loss consequences while other treatments target the source.
Minimally Invasive Procedures
Uterine Fibroid Embolization (UFE) — tiny particles are injected into the uterine arteries to block blood supply to fibroids, causing them to shrink and die. No surgical incisions, preserves the uterus, and has a shorter recovery than surgery. Highly effective for most fibroid types but generally not recommended for women who wish to conceive.
Magnetic Resonance-guided Focused Ultrasound (MRgFUS) — a completely non-invasive procedure using high-intensity ultrasound waves directed under MRI guidance to heat and destroy fibroid tissue without any incisions. FDA-approved, preserves the uterus, and minimal recovery time.
Endometrial ablation — destroys the uterine lining to reduce or eliminate heavy bleeding. Only appropriate for small submucosal fibroids and not suitable for women who wish to preserve fertility.
Hysteroscopic myomectomy — removal of submucosal fibroids through the cervix using a hysteroscope, with no external incisions. Outpatient procedure, rapid recovery, preserves the uterus and fertility. The preferred surgical approach specifically for submucosal fibroids.
Surgical Options
Myomectomy — surgical removal of fibroids while preserving the uterus. Can be performed laparoscopically (minimally invasive), robotically, or via open abdominal surgery depending on fibroid size and location. The preferred surgical option for women who wish to preserve fertility. Fibroids can recur after myomectomy, though most women experience significant symptom relief.
Hysterectomy — surgical removal of the uterus and the only permanent cure for fibroids, eliminating recurrence entirely. Recommended for women who have completed childbearing with severe symptoms unresponsive to other treatments.
Fibroids and Fertility
Fibroid impact on fertility depends on type and location. Submucosal fibroids have the clearest negative impact and are generally recommended for removal when fertility is a goal. Intramural fibroids that significantly distort the cavity may also affect implantation. Subserosal fibroids that do not impinge on the uterine cavity typically have minimal effect on fertility. For women trying to conceive with known fibroids, a reproductive endocrinologist can assess the specific location relative to the uterine cavity and guide decisions accordingly.
The Race Disparity in Fibroid Care
Black women are disproportionately affected by uterine fibroids. By age 49, 84 percent of Black women have fibroids documented by imaging or surgical records, compared to 70 percent of white women. Black women tend to develop fibroids at younger ages, experience more severe symptoms, and face greater delays in diagnosis and access to uterine-preserving treatments. This is a documented healthcare disparity not a biological inevitability and every woman deserves access to the full spectrum of diagnostic and treatment options.
When to See a Provider
Make an appointment with your gynecologist if:
Periods have become significantly heavier, longer, or more painful
You are regularly passing large blood clots
You have persistent pelvic pressure, heaviness, or lower back pain
You experience frequent urination without a clear urinary cause
You have unexplained fatigue or symptoms of anemia
You have had difficulty conceiving or recurrent miscarriage
You can feel a firmness or fullness in your lower abdomen
Fibroids are almost always detectable on pelvic ultrasound. If you have symptoms and have never had an ultrasound to investigate them, that is the right place to start.
“This article is based on current medical guidance and research from the following trusted sources:”
Resources & Sources
Mayo Clinic — Uterine Fibroids: Diagnosis and Treatment: mayoclinic.org
American College of Obstetricians and Gynecologists (ACOG) — Uterine Fibroids: acog.org
Johns Hopkins Medicine — Fibroids: What You Need to Know: hopkinsmedicine.org
National Institutes of Health — Management of Uterine Fibroids: ncbi.nlm.nih.gov
NIH / PMC — Current Medical Treatment of Uterine Fibroids: pmc.ncbi.nlm.nih.gov
NIH / PMC — New Non-Surgical Treatment Options: pmc.ncbi.nlm.nih.gov
Yale Medicine — Uterine Fibroids: What Treatments Are Available: yalemedicine.org
American Academy of Family Physicians (AAFP) — Uterine Fibroids: Diagnosis and Treatment: aafp.org
OHSU Center for Women's Health — Fibroid Treatment Options: ohsu.edu
NIH / PMC — Uterine Fibroid Management: From Present to Future: pmc.ncbi.nlm.nih.gov
Did it take years before someone told you your heavy periods might be fibroids? You are not alone and you deserve real answers and real options. Share this with someone who needs it, or drop your story in the comments below.
Author
Becky Freeman is the founder of BVTalks® and Bee Vee Clean. She focuses on women’s intimate health, vaginal microbiome education, and creating practical, easy-to-understand content for everyday care.
Disclaimer: This post is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider for diagnosis and treatment.
