What Are Fibroids?
Uterine fibroids (also called leiomyomas or myomas) are benign (non-cancerous) growths of the smooth muscle of the uterus. They vary enormously in size — from a few millimetres to larger than a grapefruit — and in number, from a single fibroid to dozens. Their location within the uterus determines their symptoms: submucosal fibroids (inside the uterine cavity) tend to cause the heaviest bleeding; subserosal fibroids (on the outer surface of the uterus) cause pressure symptoms; and intramural fibroids (within the muscle wall) can cause both.
Why They Grow: The Oestrogen Connection
Fibroids are oestrogen-dependent: they grow in response to oestrogen and typically stop growing (and may shrink) after menopause when oestrogen falls. This is why they most commonly develop in the reproductive years, particularly in the 30s and 40s, and why hormonal management strategies aim to reduce oestrogen's stimulating effect. Black women are 2–3 times more likely to develop fibroids, to develop them earlier, and to have more severe symptoms — a health disparity that remains incompletely explained by research.
Symptoms That Are Not Normal
Many fibroids are asymptomatic and discovered incidentally on ultrasound. When symptoms do occur, they include: heavy menstrual bleeding (the most common symptom, leading to iron deficiency anaemia in many women); prolonged periods; pelvic pressure or a feeling of fullness; frequent urination (from a fibroid pressing on the bladder); constipation or back pain (from posterior fibroids pressing on the bowel or spine); painful sex; and, depending on location, difficulty conceiving or increased miscarriage risk. None of these should be dismissed as "just part of being a woman."
Diagnosis and Treatment Options
Fibroids are diagnosed by pelvic ultrasound (transvaginal gives the clearest picture) or MRI for complex cases. Treatment depends on symptoms, fibroid characteristics, and future fertility plans. Medical management includes: progesterone-releasing IUD (Mirena) for heavy bleeding; tranexamic acid or mefenamic acid for symptom control; and GnRH agonists to temporarily shrink fibroids pre-surgically. Surgical options range from hysteroscopic resection (for submucosal fibroids, no external incisions) to myomectomy (fibroid removal preserving the uterus, important for women wanting future pregnancy) to uterine fibroid embolisation (UFE, a radiological procedure that cuts off fibroid blood supply) to hysterectomy (definitive, appropriate for women who have completed childbearing and have severe, refractory symptoms).
Medical Disclaimer
This article is written for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making health decisions.
Dr. Rachel Moore
Gynaecologist
All TryHerCare articles are written and reviewed by qualified medical professionals. Our content is clinician-reviewed to ensure accuracy and clinical relevance.
