Uterine Fibroids: Do You Really Need Surgery? Symptoms, Treatment Options and When to Act
Quick answer: Uterine fibroids are non-cancerous growths of the muscle of the womb. They are very common, and many women have them without any symptoms. Fibroids that cause no problems usually need only monitoring. Treatment is advised when fibroids cause heavy or painful periods, anaemia, pressure on the bladder or bowel, or affect fertility. Options range from medicines and a hormonal intrauterine device to keyhole surgery that removes only the fibroids (laparoscopic or hysteroscopic myomectomy) and, for women who have completed their family, hysterectomy. The right choice depends on the fibroid's size and position, your symptoms, your age and whether you want children in future.
The ultrasound report says "fibroid uterus" and suddenly the word "operation" is being discussed at home.
Take a breath. Fibroids are one of the most common findings in women's health, and most are harmless. Many women go through life with fibroids they never knew they had. What matters is not just whether you have a fibroid, but where it is, how big it is, and whether it is causing problems.
What are fibroids?
Fibroids (also called myomas or leiomyomas) are benign growths that develop from the muscle wall of the uterus. They can be as small as a seed or larger than a grapefruit, and you can have one or many. They are most common between the ages of 30 and 50 and usually shrink after menopause, because they depend on oestrogen.
Fibroids are almost never cancerous. A rare cancer called leiomyosarcoma exists, but it is a separate condition and is very uncommon.
Types of fibroids, and why location matters
Type | Where it grows | Typical effect |
Submucosal | Just under the lining of the womb, bulging into the cavity | Heavy bleeding, difficulty conceiving, miscarriage, even when small |
Intramural | Within the muscle wall | Heavier or painful periods, enlarged uterus |
Subserosal | On the outer surface of the womb | Pressure on bladder or bowel, often few period problems |
Pedunculated | Attached by a stalk inside or outside the womb | Can twist and cause sudden pain (rare) |
A small submucosal fibroid can cause more trouble than a large subserosal one. That's why the ultrasound details matter as much as the size.
Symptoms of fibroids
Heavy periods, passing clots, or periods lasting more than seven days
Bleeding between periods
Tiredness, breathlessness or pale skin from anaemia
Pelvic pain, period pain or a feeling of heaviness
Frequent urination or difficulty emptying the bladder
Constipation or bloating
A swelling in the lower abdomen
Pain during intercourse
Difficulty getting pregnant or repeated miscarriages (in some cases)
Many women simply get used to heavy periods and anaemia. Needing to change pads every hour or two, or waking at night to change, is not normal and deserves a check-up.
How fibroids are diagnosed
Pelvic examination
Ultrasound (abdominal and/or transvaginal), the main test, which shows size, number and location
Haemoglobin test to check for anaemia
Hysteroscopy or saline sonography if a fibroid inside the cavity is suspected
MRI occasionally, to plan surgery for large or multiple fibroids
Do all fibroids need treatment?
No. Treatment is advised based on symptoms and plans, not just the presence of a fibroid.
Watchful waiting is often enough if: the fibroid is small, you have no or mild symptoms, your haemoglobin is normal, and the fibroid isn't affecting fertility. An ultrasound every 6 to 12 months keeps an eye on growth.
Treatment is usually advised if you have: heavy bleeding or anaemia, significant pain or pressure, rapid growth, a fibroid distorting the womb cavity while you are trying to conceive, or repeated pregnancy loss linked to fibroids.
Fibroid treatment options
1. Medicines
Tranexamic acid and anti-inflammatory painkillers, taken during periods, can reduce bleeding and pain.
Hormonal treatments, including the hormonal intrauterine system (LNG-IUS) and certain tablets, can control heavy bleeding, especially when fibroids don't distort the cavity.
Short-term hormone therapy to shrink fibroids (such as GnRH-based medicines) may be used before surgery or as a bridge to menopause. These are not long-term solutions.
Iron supplements to correct anaemia.
Medicines manage symptoms; they don't remove fibroids, and symptoms may return when they are stopped.
2. Myomectomy: removing the fibroids, keeping the uterus
Myomectomy is the preferred surgery for women who want to keep their uterus or plan a pregnancy.
Hysteroscopic myomectomy: for submucosal fibroids inside the cavity. A thin telescope passes through the cervix, so there are no cuts on the abdomen. Usually a day-care procedure.
Laparoscopic myomectomy: keyhole surgery through a few small cuts for intramural and subserosal fibroids. Less pain, a shorter hospital stay and faster recovery than open surgery.
Open myomectomy: sometimes needed for very large or numerous fibroids.
After myomectomy, women planning pregnancy are usually advised to wait a few months before trying, and your obstetrician will discuss whether a future delivery should be by C-section depending on the depth of the surgery.
3. Hysterectomy
Removal of the uterus is the only permanent cure for fibroids. It is considered for women who have completed their family and have severe symptoms, or when other treatments haven't worked. It can often be done laparoscopically. It should always be your informed choice, never the only option offered.
4. Other procedures
Uterine artery embolisation, done by an interventional radiologist, blocks the blood supply to fibroids so they shrink. It suits selected women who want to avoid surgery and are not planning pregnancy.
Fibroids and pregnancy
Most women with fibroids have healthy pregnancies. Fibroids can sometimes grow in early pregnancy and cause pain, and depending on location they may slightly raise the chance of miscarriage, preterm labour, the baby lying in an unusual position, or a C-section. If you have fibroids and are planning a pregnancy, a pre-pregnancy consultation helps decide whether anything needs treating first. Submucosal fibroids are the ones most often removed before trying to conceive.
Fibroid care with Dr. Ajita Mishra Digga in Kolkata
Dr. Ajita Mishra Digga is a gynaecologist in Kolkata with more than 10 years of experience, including hysteroscopic and laparoscopic surgery. Her approach is to treat the symptoms you have, protect your fertility wherever possible, and recommend surgery only when it clearly helps. Every option is explained with its benefits, risks and recovery time, so you and your family can decide calmly.
Have a fibroid on your report or troublesome periods? Call +91 91470 67691 or book a consultation. Chinar Park, Rajarhat, Kolkata.
Frequently Asked Questions
Can fibroids go away on their own?
Fibroids don't usually disappear on their own before menopause, but many stay small and harmless. After menopause, they usually shrink as oestrogen levels fall.
What size of fibroid needs surgery?
There's no single size. A small fibroid inside the womb cavity may need removal if it causes heavy bleeding or affects fertility, while a large fibroid on the outside may need only monitoring if it causes no symptoms.
Can fibroids be treated without surgery?
Yes. Medicines, a hormonal intrauterine device and iron supplements can control symptoms for many women. Uterine artery embolisation is a non-surgical procedure for selected cases.
Is laparoscopic myomectomy safe?
In experienced hands, laparoscopic myomectomy is a safe keyhole operation with less pain, a shorter hospital stay and faster recovery than open surgery. Suitability depends on the size, number and position of the fibroids.
Can I get pregnant with fibroids?
Many women with fibroids conceive and have healthy pregnancies. Fibroids that distort the inside of the womb can affect fertility and may need to be removed first.
Do fibroids turn into cancer?
Fibroids are benign and almost never turn into cancer. A rare cancer of the uterine muscle exists, but it is a different condition and is very uncommon.
Will I need a hysterectomy for fibroids?
Not necessarily. Hysterectomy is one option for women who have completed their family and have severe symptoms. Many women are treated with medicines or myomectomy and keep their uterus.
Can fibroids come back after myomectomy?
Yes, new fibroids can develop after myomectomy, particularly in younger women with multiple fibroids. Regular check-ups help catch them early.
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