Could It Be Fibroids? A Patient’s Guide to Symptoms and Treatment.

If you’ve ever felt like your symptoms were dismissed, you’re not alone.
Just this week, Venus Williams went on The Today Show and shared her years-long struggle to get real answers about her fibroids. Heavy bleeding, pain, nausea —it was all written off. Sound familiar? Everytime I hear a story like this, I wonder. How?! All those years or heavy bleeding and terrible pain and noone checked an ultrasound? They told her it was normal? Straight to doctor jail.

Uterine fibroids are incredibly common, but too often, they’re overlooked, downplayed, or misunderstood—even by medical professionals. If you’ve been wondering whether your symptoms might be something more, or you’ve been told to “just live with it,” this article is for you.

Let’s break down what fibroids actually are, how they show up, and what your options really are—so you can advocate for the care you deserve. 

What are fibroids?

Fibroids are noncancerous tumors of the muscle of the uterus. These tumors are incredibly common – at least half of women will have them in their lifetime, and this number is higher (closer to 80%) among women of African descent. They can be asymptomatic, especially when they are small, but often show up as:

• abnormal bleeding: heavy or unusually long periods

• pelvic pressure and pain: including painful periods, low back pain, chronic pelvic pain, pain with intercourse, difficulty emptying the bladder or increased urinary frequency, constipation

• Infertility or pregnancy loss (miscarriage).

How do I know if I have fibroids?

If you have heavy or long periods, painful periods (or general pelvic pain, presure, difficulty with urination and bowel movements), or difficulty getting pregnant or staying pregnant, have a conversation with your OBGYN provider about your symptoms. Fibroids can be felt on exam, but a pelvic ultrasound is the best way to diagnose them. (Transvaginal ultrasound, where the ultrasound probe is placed in the vagina, gives the best pictures of the uterus and pelvis. Sometimes your provider will follow up the ultrasound with a saline-infused-sonogram (an ultrasound with water pumped into the uterus) to get better pictures of the inside lining or an MRI (usually for surgical planning).

I got an ultrasound. What does this word salad mean?

There are a few common things noted on a pelvic ultrasound:

1) The size of the uterus: Anything under 6-8cm in size is average. Larger than that is considered enlarged.

2) The thickness of the endometrium: If you have not gone into menopause yet, I would not pay too much attention to this number. The lining of the uterus (the endometrium) gets thicker in the weeks leading up to your period and then gets thin as the lining is shed with menses. Its thickness is not meaningful for people who are still having menstrual cycles. If you are past menopause, the lining should be thinner than 5mm.

3) The number, size and location of the fibroids: The size is usually measured in millimeters (mm) or centimeters (cm). Common terms are:

• Submucosal: this means the fibroid is sitting in the inner part of the uterus (the endometrium. Sometimes these are also called intracavitary fibroids

• Intramural: this means the fibroid is sitting in the muscular wall of the uterus

• Subserosal: this means the fibroid is setting under the outer lining of the uterus

• Pedunculated: this means the fibroid is hanging on a stalk, usually attached to the outer part of the uterus

*Technically the grading system for this is more complicated – fibroids can be a combination of intramural/submucosal or intramural/subserosal and so on and fibroids can also be in the abdomen or pelvis separate from the uterus, but for our purposes, these are the 4 main categories you need to know.

So, if your ultrasound says: “2 sub-centimeter intramural fibroids” – that means there are two fibroids in the muscle of the uterus that measure less than 1cm each.  

If it says: 6cm subserosal fibroid – that means, there is a fibroid that measures 6cm across and the fibroid is sitting just under the outside layer of the uterus.

So, what do I do now? Do I need to have surgery?

The answer to this is . . . it depends.

Most women may never have symptoms from their fibroids and will find out about them during an ultrasound for some other reason (for example, pregnancy is a very common time to find them). If your periods are normal (meaning the amount of bleeding and/or discomfort pain you experience does not bother you) and the fibroids are small, the best course of action is to watch them. It is recommended to get a pelvic exam every year and together you and your provider can keep an eye on whether the fibroids are growing, your periods are changing, or you are starting to develop pelvic pain, painful menses or signs of pelvic pressure or bulk symptoms. You may also choose to follow the fibroids with regular ultrasounds.

If you find the fibroids because you have heavy or prolonged periods, work with your OBGYN provider to rule out other causes of heavy bleeding (including cancers of the uterus, PCOS, perimenopausal changes, polyps, medications like blood thinners and the copper IUD, and so on). If it seems fibroids are the most likely cause of your symptoms you have a few options:

1) Medications to control bleeding and reduce pain:

NSAIDs: High doses of over-the-counter medications like ibuprofen and naproxen can help decrease pain. Prescriptions NSAIDs like etodolac are also an option.

Tranexamic acid (brand name: lysteda): This three-times-daily medication can also decrease menstrual bleeding. It works best if you start taking it about a day before your period, so it is a good option for people who have regular periods and can predict when their bleeding might start.

Hormonal birth control: Hormones generally decrease menstrual bleeding and pain, so medications that are also used for birth control including birth control pills, progestin implants and IUDs and depo-provera can help with fibroid Patients are often concerned that the hormones will make their fibroids grow, but so far research has not shown definitively that taking hormones makes fibroids grow. Have a conversation with your provider about how each medication is taking and the potential side effects to decide which may be a good option for you.  

GnRH antagonists: Elagolix (dosed twice daily) and relugolix (dosed once daily) suppress the menstrual cycle and can thus decrease bleeding and pain. These medications can be effective, but because they suppress menses, they can put the body into a sort of medical menopause. Patients may experience hot flashes, night sweats, and some of the decrease in bone density that accompanies menopause. New formulations of these medications that combine the GnRH antagonist with “add-back” hormones (brand names: Oriahnn and Myfembree) can reduce some of the “menopause” effect.

GnRH agonists: (leuprolide or Lupron) can also decrease bleeding and pain and can shrink fibroids but is approved for short-term use (six months or less) to prepare for surgery or as a transition to natural menopause and not as a long-term option. These medications also induce “medical menopause” that reverses after the medication is stopped.

2) Procedures to remove or shrink the fibroids:

Hysteroscopic myomectomy: This is where a surgeon places a camera into the uterus through the cervix and then uses instruments that pass through the camera sheath to remove shave or melt the fibroids down. (Hysteroscopy means entering the uterus with a camera; Myomectomy means removing fibroids) This is a great minimally invasive option – the surgeon does not need to make any cuts on the body and so recovery is easier. However, hysteroscopy can only access fibroids that inside the inner lining of the uterus, so if your ultrasounds are not submucosal or intracavitary, then this would not be a good option.

Uterine fibroid embolization: This is another minimally invasive treatment option. An interventional radiologist passes a catheter into a large artery in your wrist or thigh and follows the blood vessels to the uterus, where they can block blood flow to the fibroids, causing them to shrink. This does not remove the fibroids, but as they shrink in size, the bleeding and/or pain they cause can also be reduced. There is not much data on how well women who have had this procedure are able to get pregnant and it may lead to the ovaries functioning abnormally, so this is not a good choice if you are thinking about having babies in the future.

Focused ultrasound surgery: With this option, a surgeon makes small incisions in the lower abdomen and uses either high intensity focused ultrasound or MRI focused ultrasound to cause the cells of the fibroids to die. The best candidates have no more than three fibroids that are less than 10 centimeters in size and not calcified. Patients who have focused ultrasound surgery may use less pain medication than those who have UFE but are more likely to need another procedure for fibroid symptoms in three years. There are reports of health pregnancies after focused ultrasound surgery, but this procedure is newer, and research is still limited, so this may not be the best option if you are thinking about having babies in future.

Laparoscopic myomectomy: This is where a surgeon places a camera into the abdomen (usually through your belly button) and then makes small keyhole incisions on your lower abdomen to insert instruments to remove the fibroids. This works very well for subserosal fibroids and can also be used for intramural fibroids if they are in a location where your surgeon feels comfortable sewing the gap left by the fibroids closed. Because the surgery is done through smaller incisions, recovery is less intensive (usually two weeks).

Open or abdominal myomectomy: This is where a surgeon makes a larger incision on the abdomen (either along the bikini line or down the middle of the abdomen between the breastbone and pubic bone). This is usually the recommended option if the fibroids are large or if there are many of them. With the larger incision, recovery is usually closer to 6 weeks, and you may need to spend a day or two in the hospital.

3) Surgery to remove the uterus (hysterectomy)

This is not the only option for treating fibroids, but it is the only permanent option. It can be done using laparoscopy (keyhold surgery), laparotomy (a large incision on the belly) or through the vagina.* With myomectomy, UFE, or ultrasound-focused surgery, there is a chance of fibroids growing back and causing symptoms again in future. In addition, if there are a lot of fibroids or very large fibroids, there may not be enough normal uterine tissue left to put back together after the fibroids are removed. If your gynecologist recommends a hysterectomy and you are not sure it is the best option for you, it is worth a second opinion, especially with a gynecologist who specializes in minimally invasive surgery.

*Vaginal hysterectomy is not a good option for large, bulky fibroids.

I have heavy periods / painful periods/ chronic pain / pressure symptoms, but my provider says my symptoms are probably not from fibroids? Now what?

Your provider might be right, but you may want to get another opinion. Ask for the report from your pelvic ultrasound. While fibroids can change the hormonal environment of the uterus and increase menstrual bleeding, in general if you have heavy bleeding but small fibroid that is not in the endometrial cavity, it is worthwhile to look for other sources of your symptoms. Same goes for pain and bulk symptoms. If you have pelvic pain or bloating or pressure and you have a single 2-centimeter fibroid, chances are the fibroid is not the main cause. As an OBGYN, I have had patients who were convinced they needed surgery see their symptoms disappear with physical therapy (on exam, they had signs of pelvic floor muscle dysfunction) or increased fiber (they also happened to have terrible constipation)  It is always your right to seek a second opinion and when I tell someone I’m not sure surgery to remove fibroids will help them 1 offer options: 1) they can have a second (or third or fourth) opinion anytime, no questions asked, and I will help set it up if they want 2) they can try the treatment I am recommending for a period of time we decide on together (six weeks of physical therapy, for example) and if they don’t get better we will proceed with surgery or 3) As long as it feels ethically appropriate, I will do their surgery, with good counseling that they may not feel better after (and if the problem is something that pelvic floor dysfunction, surgery can actually make their symptoms worse).

If your provider won’t even investigate your symptoms or order an ultrasound, you definitely need a second opinion. Actually, you just need a new provider.

But if I wait, can my fibroids turn into cancer?

No. Fibroids are not cancer. They are made of the same types of cells as the muscular wall of the uterus. Rarely, patients can have a type of cancer called sarcoma that occurs in up to 7 out of every 100,000 women and can look like fibroids on imaging. But sarcomas don’t behave like fibroids. They grow rapidly, and can have features like central necrosis or irregular borders on imaging. This is where regular surveillance of your fibroids can come in to look for rapid growth. An MRI with contrast can also be helpful in telling a fibroid apart from a sarcoma.

My provider says hystercomy is my only option. Is that true?

Sometimes removing the whole uterus is the best option for patients who have a large number of fibroids because if we have to make too many incisions on different parts of the uterus to remove fibroids it may mean there is not a good way to put the uterus back together afterwards. Again, if you are not comfortable with the plan your providere has given you, ask for a second opinion and try to see a surgeon who specializes in fibroid surgery.

Thanks for reading! Have thoughts, questions, suggestions for future posts or your own story to share? Drop a comment below - I’d love to hear from you. And if you enjoy our content or find it helpful, hit subscribe to stay in the loop!

The information on this site is intended to educate and empower, not to diagnose or treat. It is not medical advice, and it doesn't replace talking with your healthcare provider. Everyone’s body and situation is different—so if you have a concern, please reach out to a trusted clinician who knows you.