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By age 50, roughly 70 percent of white women and 80 to 90 percent of Black women in the US will have developed uterine fibroids, making them one of the most common gynecologic conditions. Many cause no symptoms, but others produce heavy bleeding, pelvic pressure, fertility problems, and pregnancy complications that significantly affect quality of life. Treatment options have expanded considerably in recent years, including hormonal medications, uterine-preserving procedures, and minimally invasive surgical approaches. This guide explains what fibroids are, how they are diagnosed, and how they are treated — but it is educational and not a substitute for evaluation by a gynecologist who knows your history.
What Uterine Fibroids Are and How Common They Are
Uterine fibroids — also called leiomyomas or myomas — are benign smooth muscle tumors that grow within or on the wall of the uterus. They range from microscopic to grapefruit-sized and may be solitary or multiple. Despite the word “tumor,” fibroids are non-cancerous; malignant transformation to leiomyosarcoma is thought to occur in well under 1 in 1,000 cases, and current evidence suggests most leiomyosarcomas arise independently rather than from existing fibroids.
According to the NICHD, an estimated 26 million US women between ages 15 and 50 are affected by fibroids, and lifetime prevalence approaches 70 percent in white women and over 80 percent in Black women. Black women also tend to develop fibroids at younger ages, have larger and more numerous fibroids, and experience more severe symptoms — a disparity attributed to a mix of genetic, hormonal, and possibly environmental factors that researchers are still working to disentangle. For broader context, see our medical conditions hub.
Types and Locations
Fibroids are classified by location, and location largely determines which symptoms they cause. Submucosal fibroids grow into the uterine cavity and are most associated with heavy bleeding and fertility problems. Intramural fibroids develop within the muscle wall and are the most common type. Subserosal fibroids project from the outer surface of the uterus and tend to cause pressure symptoms. Pedunculated fibroids hang from a stalk and can occasionally twist, causing acute pain. The FIGO classification system (types 0 through 8) provides finer detail that clinicians use in treatment planning, particularly when deciding whether a fibroid can be removed hysteroscopically.
Causes and Risk Factors
Fibroids are estrogen- and progesterone-sensitive, generally growing during the reproductive years and tending to shrink after menopause. The exact trigger for fibroid formation remains unclear, but genetic factors, hormonal exposure, and chronic inflammation likely contribute. According to research summarized by the American College of Obstetricians and Gynecologists, commonly cited risk factors include Black race, family history, nulliparity (never having given birth), early menarche, obesity, and vitamin D deficiency.
Pregnancy and combined oral contraceptive use are associated with lower risk. Smoking has been associated with somewhat lower risk in some studies, but it is not a recommended preventive measure given its many other harms. Because these are associations drawn from population studies, having a risk factor does not mean you will develop fibroids, and many women with fibroids have no identifiable risk factors at all.
Symptoms
Up to half of women with fibroids have no symptoms. When fibroids do cause symptoms, the most common are heavy menstrual bleeding, prolonged periods, bleeding between periods, and resulting iron deficiency anemia. Pelvic pressure and bulk symptoms — including a noticeable abdominal mass, urinary frequency, constipation, and back pain — tend to appear as fibroids enlarge.
Other symptoms include painful periods, dyspareunia (pain with intercourse), and pregnancy complications such as miscarriage, malpresentation, preterm labor, and postpartum hemorrhage. Submucosal fibroids in particular can impair implantation and contribute to infertility — a topic covered further in our female infertility guide. Because these symptoms overlap heavily with other conditions such as adenomyosis and endometriosis, the only reliable way to sort out the cause is a clinical evaluation.
How Uterine Fibroids Are Diagnosed
A pelvic exam may reveal an enlarged or irregularly shaped uterus, but imaging confirms the diagnosis. Transvaginal ultrasound is the first-line test and reliably detects most fibroids. Saline infusion sonohysterography improves visualization of submucosal fibroids and uterine cavity distortion, which matters for both bleeding and fertility decisions.
MRI provides the most detailed mapping of fibroid number, size, and location, and is used when ultrasound findings are inconclusive or for surgical planning. Hysteroscopy directly visualizes submucosal fibroids and allows simultaneous treatment in some cases. Endometrial biopsy may be performed when bleeding is abnormal — particularly in older or postmenopausal women — to evaluate for hyperplasia or malignancy. The Cleveland Clinic notes that lab work typically includes a complete blood count to assess for anemia, since chronic heavy bleeding can cause significant iron loss.
Treatment Options
Treatment depends on symptoms, the size and location of the fibroids, age, and fertility goals, and there is no single best option for everyone. Recent guidance, including 2025 FIGO best-practice recommendations on medical treatment and the Society of Obstetricians and Gynaecologists of Canada Guideline No. 461 (2025), emphasizes matching therapy to the dominant problem — bleeding, bulk symptoms, or fertility — rather than treating the fibroid for its own sake. Asymptomatic fibroids generally need only periodic monitoring, an approach often called watchful waiting.
Medical management includes NSAIDs and tranexamic acid for bleeding, combined oral contraceptives, oral progestins, and the levonorgestrel-releasing IUD. GnRH antagonist combinations — relugolix–estradiol–norethindrone (Myfembree) and elagolix–estradiol–norethindrone (Oriahnn) — were approved by the FDA between 2020 and 2022 specifically for heavy menstrual bleeding from fibroids, and in pivotal trials reduced bleeding substantially more than placebo. GnRH agonists such as leuprolide reduce fibroid size temporarily and are sometimes used before surgery; when used beyond about six months, add-back hormone therapy is generally recommended to protect bone and limit menopausal side effects. Any of these regimens should be individualized with a clinician rather than self-started, and most control symptoms rather than permanently removing fibroids.
Uterine-preserving procedures include uterine artery embolization (UAE), which shrinks fibroids by cutting off their blood supply; MRI-guided focused ultrasound; and radiofrequency ablation. Radiofrequency ablation is now available through both a laparoscopic approach (for example, the Acessa system, FDA-cleared) and an incisionless transcervical approach (the Sonata system), both intended to treat fibroids while sparing the uterus. Effects on future fertility with several of these procedures are still not fully established, so women hoping to conceive should discuss the evidence carefully with a specialist.
Surgery. Myomectomy — surgical removal of fibroids while preserving the uterus — is performed hysteroscopically, laparoscopically (including robot-assisted), or by open laparotomy depending on fibroid characteristics, and is often preferred when fertility is a priority. Hysterectomy is the only definitive cure and remains a common choice for women who have completed childbearing and have severe symptoms. The right procedure depends on fibroid size and location, symptom burden, and personal preference, and is best decided together with a gynecologist.
Treatment at a Glance
| Goal | Commonly considered options |
|---|---|
| No or mild symptoms | Watchful waiting with periodic monitoring |
| Reduce heavy bleeding | Tranexamic acid, levonorgestrel IUD, combined pills, GnRH antagonist combinations |
| Shrink fibroids / bulk symptoms | GnRH analogues, UAE, radiofrequency ablation, focused ultrasound |
| Preserve fertility | Individualized medical therapy, myomectomy in selected cases |
| Definitive cure | Hysterectomy (after childbearing is complete) |
This table is a general overview, not a treatment plan; the right choice depends on your symptoms, imaging, and goals, and should be decided with your clinician.
When to See a Doctor
Schedule a visit if you have heavy or prolonged periods, bleeding between periods, pelvic pressure or bloating, urinary frequency or constipation that may be related to a pelvic mass, painful periods worsening over time, dyspareunia, or difficulty conceiving. Fatigue and other symptoms of anemia may signal that fibroid bleeding has caused significant blood loss and deserve evaluation even if the bleeding itself seems manageable.
Postmenopausal women with new or growing fibroids deserve prompt evaluation. While leiomyosarcoma is rare, a rapidly enlarging mass after menopause — or any postmenopausal bleeding — warrants assessment to exclude malignancy.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience heavy vaginal bleeding causing dizziness, weakness, or fainting; sudden severe pelvic pain (possible fibroid degeneration or torsion of a pedunculated fibroid); or signs of severe anemia such as chest pain, shortness of breath, or a rapid heart rate.
Frequently Asked Questions
Do fibroids always need to be treated?
No. Asymptomatic fibroids often need only monitoring. Treatment is driven by symptoms, fertility considerations, or rapid growth. Many women live with fibroids that produce no problems and require no intervention, and watchful waiting is a legitimate, guideline-supported choice.
Can fibroids cause infertility?
Submucosal fibroids and large intramural fibroids distorting the uterine cavity can impair implantation and increase miscarriage risk. Subserosal fibroids generally have less impact on fertility. Removal of cavity-distorting fibroids improves pregnancy rates in selected patients per ASRM guidance, but not every fibroid needs removal for fertility, so this is a decision to make with a specialist.
Will fibroids shrink after menopause?
Most fibroids decrease in size after menopause as estrogen declines, and symptoms often improve. However, women on hormone therapy may continue to have fibroid-related symptoms. New postmenopausal growth or bleeding warrants evaluation.
What is the difference between fibroids and adenomyosis?
Fibroids are discrete benign tumors of smooth muscle. Adenomyosis is endometrial-like tissue infiltrating the uterine muscle wall diffusely or in localized patches. The two conditions can coexist and share symptoms such as heavy bleeding and pain, but their imaging features and treatment approaches differ.
Are the newer fibroid procedures safe for future pregnancy?
Uterine-sparing procedures such as UAE and radiofrequency ablation preserve the uterus, but their effects on future fertility and pregnancy are not fully established, and some are not first choices for women who want to conceive. Myomectomy is often preferred when fertility is a priority. Discuss your specific plans with a gynecologist or fertility specialist before choosing a procedure.
Quick summary: Uterine fibroids are common, usually benign uterine tumors. Many cause no symptoms; when they do, heavy bleeding and pelvic pressure are typical. Diagnosis relies on ultrasound and, when needed, MRI or hysteroscopy. Treatment is individualized and ranges from watchful waiting to medications, uterine-sparing procedures (UAE, radiofrequency ablation, focused ultrasound), myomectomy, and hysterectomy — all clinician-directed decisions. See a gynecologist for heavy bleeding, pelvic pressure, or fertility concerns, and seek emergency care for bleeding causing dizziness or fainting or sudden severe pelvic pain. This article is educational and not a substitute for personalized medical advice.
The Bottom Line
Uterine fibroids are extremely common, often asymptomatic, and treatable through a wide range of medical and procedural options when they cause problems. The right approach depends on your specific symptoms, fibroid characteristics, age, and fertility plans. Newer GnRH antagonist combinations have given many women effective non-surgical bleeding control, and uterine-preserving procedures such as radiofrequency ablation and focused ultrasound have expanded options for those wanting to avoid hysterectomy. A gynecologist familiar with current fibroid management can help map out the best plan for your situation. Use this guide to prepare questions for that visit rather than as a replacement for personalized medical advice.