What Are Uterine Fibroids?
Uterine fibroids (leiomyomas or myomas) are non-cancerous (benign) growths of the muscular wall of the uterus. They are the most common benign tumour in women of reproductive age — affecting 20–40% of women over 35. Despite being benign, fibroids can cause significant symptoms that affect quality of life, fertility, and pregnancy outcomes.
At Dhaara Speciality Hospital, Dr. Prathima Srinivas — OBG Consultant and Laparoscopic Gynaecology Surgeon — provides comprehensive fibroid management from medical treatment to minimally invasive laparoscopic surgery.
Types of Fibroids by Location
Intramural
Within the uterine muscle wall — most common type (70%). Causes heavy periods and pelvic pressure.
Submucosal
Grows into the uterine cavity. Even small submucosal fibroids cause heavy bleeding and fertility problems.
Subserosal
Grows outward on the outer uterine surface. Causes pelvic pressure, urinary and bowel symptoms. Can be pedunculated (on a stalk).
Symptoms
Up to 50% of fibroids cause no symptoms and are discovered incidentally on ultrasound. When symptomatic:
- Heavy menstrual bleeding (menorrhagia) — soaking through pads/tampons, passing clots, anaemia
- Prolonged periods — lasting more than 7 days
- Pelvic pain and pressure — heaviness in lower abdomen
- Urinary symptoms — frequent urination, difficulty emptying bladder (large fibroids compressing bladder)
- Bowel pressure — constipation, bloating
- Back and leg pain — from nerve compression
- Infertility or recurrent miscarriages — particularly submucosal fibroids
- Abdominal enlargement — large fibroids can make the abdomen appear pregnant
Diagnosis
- Pelvic ultrasound: Primary investigation — identifies number, size, and location of fibroids
- Sonohysterography (SHG): Saline infused into uterus + ultrasound — best for detecting submucosal fibroids
- MRI pelvis: Most detailed assessment — maps fibroid location, differentiates from adenomyosis, guides surgical planning
- Hysteroscopy: Direct camera visualisation of uterine cavity — diagnoses and treats submucosal fibroids in same session
- Blood tests: CBC for anaemia assessment; thyroid function to exclude other causes of heavy bleeding
Treatment Options
Medical Management (for symptom control, not fibroid removal)
Tranexamic Acid / NSAIDs: First-line for heavy bleeding — reduce blood loss by 40–50% during periods. No effect on fibroid size.
Combined Oral Contraceptive Pill / Progesterone: Regulate periods, reduce bleeding. Does not shrink fibroids.
Levonorgestrel IUS (Mirena): Highly effective for menorrhagia with intramural/small fibroids. Reduces bleeding by 90%.
GnRH Analogues (Luprolide/Triptorelin): Temporarily shrink fibroids by 35–60% by inducing a menopausal state. Used pre-operatively to reduce fibroid size and correct anaemia. Effect reverses when stopped.
Ulipristal Acetate / Mifepristone: Selective progesterone receptor modulators — reduce fibroid size and control bleeding.
Surgical Options
Hysteroscopic Myomectomy: Removal of submucosal fibroids through the cervix using a hysteroscope — no skin incision. Same-day procedure, rapid recovery. Preserves fertility. Treatment of choice for cavity fibroids.
Laparoscopic Myomectomy: Minimally invasive removal of intramural and subserosal fibroids using keyhole incisions. Preserves uterus and fertility. Shorter hospital stay (1–2 days), faster recovery than open surgery, minimal scarring.
Open Myomectomy: For very large or multiple fibroids. Uterus preserved. Larger incision, longer recovery.
Laparoscopic / Robotic Hysterectomy: Removal of the uterus — definitive cure for fibroids. Recommended for women who have completed their family and have severe, recurrent symptoms.
Learn about laparoscopic hysterectomy →
Fibroids and Fertility
Submucosal and intramural fibroids that distort the uterine cavity significantly reduce fertility and increase miscarriage risk. Myomectomy (surgical removal) improves fertility outcomes. However, fibroids during pregnancy can cause complications including pain (red degeneration), preterm labour, abnormal baby position, and obstructed labour. Careful pre-pregnancy planning with your OBG specialist is essential.
Frequently Asked Questions
Can fibroids become cancerous?
Fibroids are almost always benign. Malignant transformation to leiomyosarcoma is extremely rare (0.1–0.3%). Rapidly growing fibroids, especially after menopause, warrant evaluation, but the vast majority of uterine fibroids remain benign throughout a woman's life.
Will fibroids shrink after menopause?
Yes — fibroids are oestrogen-dependent and typically shrink significantly after menopause. Symptoms usually improve or resolve. In women approaching menopause with mild symptoms, watchful waiting is a reasonable option.
Can I get pregnant after myomectomy?
Yes — myomectomy preserves the uterus with the specific goal of maintaining fertility. Pregnancy is typically recommended 3–6 months after laparoscopic myomectomy. Women with intramural fibroids requiring deep myometrial repair may be advised to deliver by C-section to prevent uterine rupture.