Fibroid

Uterine fibroids (leiomyomas) are the most common solid pelvic tumors in women, yet many people who have them never know it because the growths cause no symptoms. They develop from the smooth muscle cells of the uterine wall, forming firm, well-defined masses that can be located within the muscular wall (intramural), beneath the inner lining of the uterus (submucosal), or on the outer surface of the uterus (subserosal). Size varies enormously — from a few millimeters to, in rare cases, the size of a grapefruit.

Estrogen and progesterone both stimulate fibroid growth, which is why fibroids are most common during the reproductive years, tend to grow during pregnancy, and typically shrink after menopause. Women with a family history of fibroids, who are Black (among whom fibroids are significantly more common and often more severe), who began their periods early, or who have never been pregnant are at higher risk of developing them.

When symptoms do occur, the most common are heavy or prolonged menstrual bleeding (which can cause anemia), pelvic pain or pressure, frequent urination (if a fibroid presses on the bladder), and, in some cases, difficulty conceiving or carrying a pregnancy. Diagnosis is most often made with ultrasound. Treatment ranges from watchful waiting and medication to minimize symptoms, to minimally invasive procedures like uterine fibroid embolization (UFE) or focused ultrasound, to surgical options including myomectomy (fibroid removal) or hysterectomy.

The fact that fibroids are so common can be both reassuring and frustrating. On the reassuring side: they are almost never cancerous (uterine sarcoma, a malignant counterpart, is rare), and many women live with them comfortably without ever needing treatment. On the frustrating side: for women with heavy bleeding, chronic pain, or fertility concerns, fibroids can have a real and significant impact on quality of life — and historically, those symptoms were often dismissed or undertreated.

Knowing that fibroids exist and that multiple treatment options are available — including uterus-preserving approaches — is empowering. You do not have to choose between suffering through symptoms and losing your uterus. Conversations with a gynecologist about which option fits your symptoms, your reproductive goals, and your preferences are worth having well before you feel forced into a decision. Advocating for evaluation and treatment if your symptoms are affecting your life is entirely appropriate.