Fibroids 101: What you need to know

Finding out you have fibroids may initially sound scary, but the reality is they’re more common than you may expect and typically don’t even require treatment.

That initial fear is largely rooted in misinformation. Women’s health is often talked about as a whole, rather than focusing on individual conditions, explains Jess Keesee, MD (they/them), an OB/GYN at MultiCare Capital Women’s Health.

“I want to make sure women feel empowered with the information they have and don’t necessarily panic about it,” Dr. Keesee says.

So, we’re breaking down what you should know about fibroids.

What are fibroids?

Fibroids are benign, noncancerous growths of muscle and connective tissues that can grow on both the inner and outer walls of the uterus, ranging in size from just a few centimeters to that of a large fruit or football, Dr. Keesee says.

Fibroids are the most common type of growth in a woman’s pelvis, according to the American College of Obstetricians and Gynecologists. Seventy percent of women will have fibroids by the time they reach menopause, but only 25 percent of those will require treatment for their symptoms.

How do fibroids form, and who is at risk? 

The exact cause of fibroids remains unclear, but some theories include hormonal changes, genetics, stress and lifestyle choices.

If you’ve had fibroids before, they’re likely to return, but once you go through menopause they typically shrink or stop growing, Dr. Keesee adds.

“I want to make sure women feel empowered with the information they have and don’t necessarily panic about it.”

Systemic racism, which often results in chronic pain, inflammation and stress faced by Black women being ignored or downplayed by health care providers, is also believed to play a role in fibroid growth, Dr. Keesee says. Eighty percent of Black women will have fibroids by the time they hit menopause, compared to 70 percent of white women.

What are the signs of a fibroid?

Most women with fibroids will have no symptoms — or symptoms so minor that treatment isn’t needed, Dr. Keesee explains.

Primary symptoms include:

• Heavy bleeding during period
• Bloating
• “Bulk symptoms” such as frequent urination, constipation or pain/pressure in abdomen
• Anemia
• Fatigue and other mental health challenges, specifically in women with severe, long-term symptoms

Because many of these symptoms are common with other conditions, such as urinary tract infections, pregnancy or endometriosis, an ultrasound is the only way to confirm fibroids, they add.

If you’re experiencing fertility challenges, an ultrasound may also show whether fibroids are a factor. When inside the uterus, fibroids could result in miscarriages; when located on either uterine wall, they could make it harder to recover after delivery, Dr. Keesee says.

When should you see a doctor?

“Fibroids don’t have to be treated just because they’re there,” Dr. Keesee explains. “If you have no symptoms and you’re OK, we can essentially just manage and watch them.”

Fibroids can develop both suddenly and over time, so being aware of what’s normal and what’s not for your body is key to knowing when to see a doctor or other health care provider, they add.

Reasons to see your provider:

• Bleeding has become heavier than what’s typical or lasts more than seven days
• Symptoms of anemia develop or worsen (fatigue, pale skin, dizziness, headaches)
• Bulk symptoms (frequent urination, constipation or pain/pressure in abdomen) are impacting daily life
• Decreased overall quality of life
• Infertility challenges

Know your options and the risks

The good news is you have many options for either living with or treating fibroids.

“No one option is necessarily better than another. It depends on your goals and symptoms,” Dr. Keesee says. “Our goal is to have a shared decision-making process in your treatment.”

Initial treatments will focus on your most severe symptoms. Birth control can lighten bleeding and other medications can help shrink the fibroid, they explain.

Depending on your symptom severity, age and fertility goals, other options to explore include:

• Radiofrequency ablation: A minimally invasive procedure that uses a needle to heat and kill the fibroid from within, causing it to shrink. There is minimal research about the effects on fertility with this option.
• Uterine artery embolization: A minimally invasive procedure that injects particles into the uterine arteries that block blood flow to the fibroids, causing them to shrink. This option has moderate risk to fertility, including increased risk of pregnancy loss, C-section and postpartum hemorrhage.
• Surgical removal: The fibroid is removed to alleviate symptoms. This option carries the least risk to fertility and may be recommended to help with fertility goals. Overall risk depends on the type of fibroid and recurrence.
• Hysterectomy: Surgical removal of the uterus and cervix. This option is best for those with severe symptoms and who do not plan to get pregnant in the future. There are increased risks with this option for women under the age of 35.

When in doubt about your pain or symptoms, it’s always best to see your provider. You don’t have to live with the symptoms.