7 Things You Need to Know About Uterine Fibroids

Cramps? Painful sex? It could be fibroids.

Medically reviewed in January 2021

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You may have heard of uterine fibroids, but you may not know exactly what they are or how they’re treated. In fact, they are quite common. One study found that by age 50, a whopping 70 percent of Caucasian women and 80 percent of African-American women had developed fibroids.

In a nutshell, uterine fibroids, otherwise known as leiomyomas or myomas, are growths that develop in the wall of the uterus. Though fewer than 1 in 1,000 fibroids are cancerous, many patients worry they have the disease.

“When you tell patients that they have fibroids or you explain it as a smooth muscle growth on their uterus, they can oftentimes become nervous that this might mean it is cancer,” says Samantha Bunting, DO, an OBGYN affiliated with Plantation General Hospital and Westside Regional Hospital in Plantation, Florida. “I always assure my patients that it’s very, very rare for fibroids to be cancerous.”

Here’s what you need to know about the signs, symptoms and treatment options for uterine fibroids.

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There are different types

Fibroids can differ in location, shape and size. They can be as tiny as an apple seed or as large as a walnut or grapefruit. They are usually characterized by their location.

  • Intramural: on the inner, muscular layer of the uterine wall
  • Submucosal: bulging into the uterine cavity 
  • Subserosal: within the outside layer of the uterine wall
  • Pedunculated: hanging from a stalk or stem inside or outside the uterus 
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Symptoms vary

“Fibroids can often be asymptomatic,” says Dr. Bunting. “Many women may not even know they have them at all.” Other women, however, will develop mild to severe symptoms.

“Patients most likely experience heavy or prolonged periods,” Bunting says. “They may have bleeding in between their cycles. They could have some bad cramping. It may also be associated with pelvic pain or pressure or low back pain.” Pain with sex, frequent or problematic urination, constipation and an enlarged uterus are other common symptoms.

The bleeding is not completely understood. “It may involve abnormalities in the blood vessels that are in and surrounding the fibroids,” Bunting notes. “More specifically, the vessels can be abnormally dilated [made wider] and then during menstruation, the normal process that shuts down the bleeding does not function properly.”

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They’re more common in African-American women

Any woman can have fibroids, but they’re most common in women who are 30 to 40 years old. More African-American women have fibroids than Caucasian women. Fibroids also tend to appear at a younger age, grow more quickly and cause more severe symptoms for African-American women.

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Experts aren’t sure what causes them

Researchers aren’t exactly sure what causes fibroids, but they do think they could be hereditary and that they may be connected to a woman’s estrogen and progesterone levels.

“There’s definitely a genetic component to them,” Bunting says. “They tend to run in families. We often see that if someone’s mother had fibroids or heavy bleeding, they pass it down to their children.”

Why fibroids grow or shrink is somewhat of a mystery, too, but hormones may control this to some extent. Fibroids typically shrink when hormone levels are low, during menopause or when a woman takes anti-hormone medication.

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There are a lot of treatment options

When determining a path for treatment, Bunting says she focuses on the type and severity of a patient’s symptoms, how their life is affected by fibroids, and their goals for the future—including whether they plan to have children. Some common treatment options include:

  • Over-the-counter medications: Acetaminophen or ibuprofen may be recommended for mild pain.
  • Birth control: Birth control pills, hormone injections or intrauterine devices can encourage the fibroids to shrink and help control heavy bleeding.
  • Gonadotropin releasing hormone agonists: These injections, nasal sprays or implants help to shrink the fibroids and can reduce heavy bleeding. These medications may also be recommended before surgery, since they make the fibroids easier to remove.
  • Uterine fibroid embolization (UFE): A non-surgical procedure performed by an interventional radiologist, UFE involves using a catheter to deliver special particles that cut off blood supply to fibroids. The success rate of UFE is very high—about 90 percent, according to Johns Hopkins Medicine. Recovery time is usually a few days, complications are typically uncommon and your uterus is preserved.

There are a few different surgical options, as well. For example, your doctor may remove your uterus—and the fibroids—if you don’t plan to have children, or leave your uterus intact while removing the fibroids if you plan to become pregnant. 

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They may cause issues for pregnant women

“Many women with fibroids do not have additional complications during their pregnancy,” says Bunting. Most carry pregnancies to term with no problems.

But in general, pregnant women who have fibroids do have an increased risk of preterm labor, since fibroids occupy space in the uterus. There is also an increased risk for a cesarean section, breech baby, labor problems and placental abruption, where the placenta fails to release from the uterus prior to delivery.

Talk to your OBGYN before you become pregnant so you can discuss any necessary precautions. If you are pregnant and learn you have fibroids, your OBGYN can monitor you closely.

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See your OBGYN if you have symptoms

Since not all women have symptoms, you may not know you have fibroids until you have a routine pelvic exam, during which your OBGYN checks your uterus, ovaries and vagina. If they feel a lump on your uterus, they may suspect you have fibroids. Many other asymptomatic fibroids are found incidentally, explains Bunting, during imaging for a completely separate health issue.

 Additional tests and procedures can confirm fibroids, including:

  • Pelvic ultrasounds
  • Hysterosalpingograms (HSG) or sonohysterograms
  • Magnetic resonance imaging (MRIs)
  • CT scans
  • Laparoscopy
  • Hysteroscopy

From there, you and your OBGYN can determine any necessary treatment plans.

Slideshow sources open slideshow sources

National Institutes of Health. “Fact Sheet: Uterine Fibroids.” “Uterine Fibroids.”
American College of Obstetricians and Gynecologists. “Uterine Fibroids.”
Hartmann KE. “Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk.” Am J Epidemiol. 2017 Jun 7:1-9.
Cleveland Clinic. “Uterine Fibroids.”
Stewart EA, et al. “The burden of uterine fibroids for African-American women: results of a national survey.” Journal of Women's Health (2002) vol. 22,10 (2013): 807-16.
Mayo Clinic. “Uterine Fibroids.” “Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history.”
Johns Hopkins Medicine. “Is Uterine Fibroid Embolization (UFE) the Right Treatment for You?” 2021. Accessed January 18, 2021.
SJ Smith. “Uterine Fibroid Embolization.” American Family Physician. June 15, 2000. 61(12):3601-3607.
E Marsh, A Al-Hendy, et al. “Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women.” Journal of Women's Health. November 1, 2018. 27(11), 1359–1367. “Uterine fibroids (leiomyomas): Differentiating fibroids from uterine sarcomas.” December 2020. Accessed January 20, 2021.
Charlie C. Kilpatrick. “Cervical Myomas.” Merck Manual Consumer Version. July 2019. Accessed January 20, 2021.
MedlinePlus. “Uterine Fibroids.” January 27, 2020. Accessed January 20, 2021.
JN Hellwege, JM Feff, DR Velez Edwards. “A multi-stage genome-wide association study of uterine fibroids in African Americans.” Human Genetics. August 23, 2017. 136, pages 1363–1373.
Shyneice Porter. “Examining Racism as a Risk Factor for Uterine Fibroids Among African American Women.” University of Maryland. 2021. Accessed January 20, 2021.
MSD De La Cruz & EM Buchanan. “Uterine Fibroids: Diagnosis and Treatment.” American Family Physician. 2017 Jan 15;95(2):100-107.
HJ Lee, ER Norwitz, & J Shaw. “Contemporary management of fibroids in pregnancy.” Reviews in Obstetrics & Gynecology. Winter 2012. 3(1), 20–27. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. “Uterine fibroids: When is treatment with hormones considered?” Updated Mar 24 2020.
USA Fibroid Centers. “Uterine Fibroid Embolization (UFE).” 2021. Accessed January 20, 2021.

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