Uterine Fibroids: What They Are and When They Need Treatment
Uterine fibroids (leiomyomas) are benign growths of the uterine muscle wall, and they're genuinely common: by age 50, up to 70-80% of people with a uterus have them, though many never know since most cause no symptoms at all. Being told you have fibroids isn't, by itself, something that requires action — what matters is where they are and whether they're causing a problem.
Last updated August 2026
Location matters more than size
Fibroids are classified by where they sit: submucosal (bulging into the uterine cavity), intramural (within the muscle wall), or subserosal (on the outer surface). A small submucosal fibroid can cause significantly more bleeding and fertility impact than a much larger subserosal one, since it directly distorts the uterine lining — which is why "how big is it" is often the wrong first question compared to "where is it."
Symptoms, when there are any
Heavy or prolonged periods are the most common symptom, followed by pelvic pressure or a sense of bulk, and pressure on the bladder or bowel from a larger fibroid. Some fibroids — again, particularly submucosal ones — are linked to fertility difficulty and higher miscarriage risk, which is a separate reason they sometimes need treatment even without bothersome bleeding.
How they're found and monitored
Ultrasound is the standard first-line imaging and is usually enough to characterize location, size, and number. MRI is used selectively when more precise mapping is needed — most often for surgical planning or before a procedure like uterine artery embolization.
Treatment spans a real range
Watchful waiting is entirely reasonable for fibroids causing no symptoms. When treatment is wanted, options include medication (tranexamic acid or a hormonal IUD to reduce bleeding, or GnRH agonists/antagonists to shrink fibroids temporarily, often used short-term or before surgery), minimally invasive procedures (uterine artery embolization, radiofrequency ablation, or MRI-guided focused ultrasound), and surgery (myomectomy, which removes fibroids while preserving the uterus, versus hysterectomy). Which fits depends heavily on symptom severity, fibroid characteristics, and whether future fertility matters to you.
If future fertility matters to you
This changes the conversation meaningfully — myomectomy preserves the uterus, while uterine artery embolization's effect on future fertility is less well-established and generally not the first choice if you're planning pregnancy. Say so explicitly when discussing options, since it isn't always assumed.
Worth discussing with your provider
Educational information only — general patterns that vary by person. This is not medical advice, a diagnosis, or a substitute for care from your own clinician.
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