How to Tell If You Have Uterine Fibroids

What are uterine fibroids?

Fibroids — also called uterine leiomyomas or myomas — are benign (noncancerous) muscular growths that develop in or around the wall of the uterus. They range from the size of a pea to, in rare cases, much larger. Some people have one; others have several. They are extremely common: a systematic review found the cumulative incidence of fibroids reaches 70% or higher in white women by age 50, and over 80% in Black women, who are diagnosed earlier and experience more severe symptoms 2Ref 2Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R (2017).Epidemiology of uterine fibroids: a systematic review.Cumulative incidence of uterine fibroids: >80% in Black women and ~70% in white women by age 50; earlier onset and more severe symptoms in Black women.

Fibroids are not cancer and do not increase cancer risk. A very small number of uterine growths turn out to be malignant (uterine sarcoma), but that is rare and typically shows a different pattern on imaging.

What symptoms suggest fibroids?

Not all fibroids cause symptoms — many are found only when a clinician looks for them. When symptoms do occur, the most common ones are:

Heavy menstrual bleeding — soaking through a pad or tampon in an hour or less, passing clots larger than a quarter, or having periods that last longer than seven days. This is the symptom most likely to prompt evaluation and is a key clinical indicator of heavy menstrual bleeding warranting workup 1Ref 1American College of Obstetricians and Gynecologists (2019).Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG Committee Opinion, Number 785.Heavy menstrual bleeding — soaking through a pad or tampon in an hour, clots, prolonged periods — as a key clinical indicator warranting evaluation for underlying causes including fibroids.

Pelvic pressure or a sense of fullness — particularly in the lower abdomen, sometimes described as a constant low-grade pressure that does not go away between periods.

Bloating or an enlarged lower abdomen — larger fibroids can cause the abdomen to appear or feel swollen, separate from normal weight.

Frequent urination or difficulty emptying the bladder — fibroids near the front of the uterus can press on the bladder.

Constipation or rectal pressure — fibroids near the back of the uterus may press on the bowel.

Pelvic or low-back pain — more of a dull ache than a sharp pain; can worsen during menstruation.

Anemia (low iron) from ongoing heavy bleeding is a secondary effect that can cause fatigue, pallor, and shortness of breath 3Ref 3American College of Obstetricians and Gynecologists (2021).Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228.Fibroid symptom classification, diagnostic workup (ultrasound as first-line imaging), location-based symptom effects, and full spectrum of evidence-based treatment options including medical, procedural, and surgical approaches.

How do fibroids differ from a normal heavy period?

Heavy bleeding has many causes. The features that make fibroids more likely than simply a heavy-but-normal period include:

• Bleeding that is noticeably heavier than it used to be — a change from your own baseline
• Periods that now last longer than they used to
• Clots larger than a quarter
• Pelvic pressure or abdominal fullness that persists outside of your period
• Frequent urination that is new

Other conditions — such as PCOS, a bleeding disorder, a thyroid problem, or polyps inside the uterus — can also cause heavy periods. That is why symptoms alone cannot distinguish fibroids from these other causes. An ultrasound is the usual first step 3Ref 3American College of Obstetricians and Gynecologists (2021).Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228.Fibroid symptom classification, diagnostic workup (ultrasound as first-line imaging), location-based symptom effects, and full spectrum of evidence-based treatment options including medical, procedural, and surgical approaches.

How are fibroids diagnosed?

A gynecologist or OB-GYN will typically:

1. Take a full menstrual history — how heavy, how long, any pelvic pain 2. Do a pelvic exam — a larger uterus or irregular contour may be palpable 3. Order a transvaginal or pelvic ultrasound — the standard first-line imaging tool that can identify fibroids, estimate their size and location, and distinguish them from ovarian cysts or polyps 3Ref 3American College of Obstetricians and Gynecologists (2021).Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228.Fibroid symptom classification, diagnostic workup (ultrasound as first-line imaging), location-based symptom effects, and full spectrum of evidence-based treatment options including medical, procedural, and surgical approaches

In some cases, sonohysterography (saline infused into the uterine cavity during ultrasound) or an MRI is used to get more detail — for example, before surgical planning. Blood tests to check hemoglobin or iron may be ordered if heavy bleeding has been ongoing.

There is no blood test or urine test that detects fibroids. Self-diagnosis from symptoms alone is not reliable.

Does location matter?

Where a fibroid sits largely determines what symptoms it causes:

| Location | Term | Common effect | |---|---|---| | Inside the uterine cavity | Submucosal | Most likely to cause heavy bleeding and affect fertility | | Within the uterine wall | Intramural | Pelvic pressure, heavy bleeding if large | | On the outer surface of the uterus | Subserosal | Pressure on bladder or bowel | | On a stalk outside the uterus | Pedunculated | Can twist, causing acute pain |

Small submucosal fibroids often have an outsized effect on bleeding; large subserosal ones may cause pressure without affecting periods much at all 3Ref 3American College of Obstetricians and Gynecologists (2021).Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228.Fibroid symptom classification, diagnostic workup (ultrasound as first-line imaging), location-based symptom effects, and full spectrum of evidence-based treatment options including medical, procedural, and surgical approaches.

What are the treatment options?

Treatment depends on symptoms, fibroid size and location, desire for future pregnancy, and proximity to menopause (fibroids often shrink after menopause when estrogen levels fall). ACOG Practice Bulletin 228 outlines a range of evidence-based options 3Ref 3American College of Obstetricians and Gynecologists (2021).Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228.Fibroid symptom classification, diagnostic workup (ultrasound as first-line imaging), location-based symptom effects, and full spectrum of evidence-based treatment options including medical, procedural, and surgical approaches:

Watchful waiting — appropriate for fibroids that are not causing significant symptoms.

Hormonal medications — certain GnRH agonists and antagonists can temporarily reduce fibroid size and bleeding; combined hormonal contraceptives and progestin-releasing IUDs can help control heavy bleeding.

Non-hormonal medications — tranexamic acid and NSAIDs taken during menstruation can reduce bleeding volume without affecting hormones.

Minimally invasive procedures — uterine fibroid embolization (cutting off blood supply to fibroids), radiofrequency ablation, or focused ultrasound can treat fibroids without open surgery.

Surgery — myomectomy (removing fibroids while keeping the uterus) or, in some circumstances, hysterectomy. These are typically considered when other options have not worked or when fibroids are very large or numerous.

No single treatment is right for everyone. A gynecologist will review the full picture — including whether you are planning a pregnancy — before recommending an approach.