Uterine Fibroids Treatment: What Works Best?

Let’s talk about something that’s way more common than most people realize: uterine fibroids. If you’ve ever felt a heavy, cramp-like ache or unusual pressure in your pelvis, fibroids could be part of the story. Many women only discover they have fibroids when they’re struggling to conceive — sometimes finding out that a large fibroid is interfering with pregnancy.

But here’s something important to know: you don’t have to be trying to get pregnant to check into fibroids. If you’re experiencing symptoms — heavy periods, pelvic pressure, bloating, or pain — you deserve answers, no matter your fertility goals. Fibroids can affect your quality of life even if you’re not currently thinking about children, and it’s absolutely okay to explore your options just for your own well-being.

In fact, anywhere from 20% to 80% of women will develop fibroids by the time they turn 50. If you’ve been diagnosed with uterine fibroids, understanding your treatment options is the first step toward feeling better and taking back control of your health. Let’s break down what fibroids are, the symptoms to watch for, and how to treat them so you can feel your best.

What are uterine fibroids?

Uterine fibroids are muscular tumors that develop in the uterine wall. They’re usually benign growths that vary in size. Some are as small as a seed, while others can grow large enough to press on other organs. You might have just one fibroid, or several at the same time.

For some women, fibroids don’t cause any symptoms, but for others, they can lead to a range of frustrating, uncomfortable, or painful symptoms that can disrupt everyday life.

Risk factors for developing uterine fibroids

While anyone with a uterus can develop fibroids, certain factors can increase your chances. These are called risk factors, and while they don’t guarantee you’ll get fibroids, they can increase your risk of developing them. Here are a few common ones to know:

• Age: Fibroids tend to show up more often as women get older, especially during their 30s and 40s, right up until menopause. The good news is that after menopause, fibroid risk decreases, and fibroids either shrink or disappear.
• Family history: If someone in your family (like your mom or sister) has fibroids, your risk of developing them increases.
• Ethnicity: African-American and Hispanic women are at a higher risk for fibroids compared to white women.
• Obesity: Being overweight increases your chances of developing fibroids.
• Eating habits: Too much red meat and ham are associated with a higher risk of fibroids. On the flip side, a diet rich in green vegetables seems to offer some protection.

Common symptoms of uterine fibroids

Some women are asymptomatic and may not know they have fibroids. But for others, fibroids can bring a range of uncomfortable and disruptive symptoms, such as:

• Heavy and painful periods
• Pelvic or rectal pressure or pain
• Frequent urination
• Abdominal bloating or swelling
• Pain during sex
• Infertility
• Miscarriage
• Complications during pregnancy and labor
• Anemia
• Constipation
• Lower back pain

How are fibroids diagnosed?

If your symptoms suggest fibroids, your doctor will likely begin with a pelvic exam to check your uterus, ovaries, and vagina. During this physical exam, they’ll feel for any abnormalities, including fibroids. If further testing is needed to confirm the diagnosis, your doctor may recommend one or more of the following:

• Ultrasound: A common, non-invasive test that uses sound waves to create an image of your uterus and detect fibroids.
• MRI: Provides detailed images to give your doctor a clearer view of the fibroids’ size and location.
• CT scan: A more detailed scan to help identify fibroids, especially when other imaging is unclear.
• X-ray: Though not commonly used for fibroids, an X-ray may sometimes be done to rule out other causes of symptoms.
• Hysterosalpingogram (HSG): This test involves injecting a special dye into the uterus and fallopian tubes to check for blockages or fibroids.
• Sonohysterogram: A type of ultrasound where a saline solution is injected into the uterus to get a better image of any fibroids.

In some cases, surgery may be needed to confirm the presence of fibroids. There are two main types of surgery used for this:

• Laparoscopy: A small, thin tube with a camera (laparoscope) is inserted through a tiny incision near the belly button, allowing your doctor to view the uterus and other organs on a monitor.
• Hysteroscopy: A long, thin tube with a light and camera is inserted through the vagina and cervix into the uterus. This allows your doctor to see inside the uterus without making any incisions, and they can check for fibroids or other issues like polyps.

Treatment options for uterine fibroids

Here’s the good news: you have options, and you’re in control of your treatment decisions. How your fibroids are treated depends on several factors, including their size, how many you have, the severity of your symptoms, and whether you want to have children in the future. There’s no one-size-fits-all approach, so take your time to explore what feels right for you.

Watchful waiting

If your fibroids aren’t causing significant symptoms, your doctor might recommend watchful waiting. This means keeping an eye on the fibroids without taking immediate action. If they’re small and not causing discomfort or complications, monitoring them over time might be enough. Regular check-ups and ultrasounds may be scheduled to track any changes.

Medications

There are several medications that can help manage fibroids and their symptoms. These include:

• Hormonal birth control: Pills, injections, or intrauterine devices (IUDs) can help shrink fibroids and control heavy bleeding by regulating your hormones.
• Gonadotropin-releasing hormone agonists (GnRH-a): These medications can temporarily shrink fibroids. However, these are typically used for short periods due to side effects.
• Pain relievers: Over-the-counter medications like ibuprofen can help alleviate pelvic pain or cramping associated with fibroids.

It’s important to have a conversation with your doctor about any medication you’re considering, as each option has its own benefits and potential side effects.

Procedures

For fibroids that are causing significant symptoms but aren’t responding to medication, there are several procedures available:

• Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE): This minimally invasive procedure involves blocking the blood vessels that supply blood to the fibroids. Without blood flow, the fibroids shrink and symptoms often improve. However, UAE is not recommended for women who wish to preserve their future fertility.
• MRI-guided focused ultrasound: This innovative procedure uses sound waves to heat and destroy fibroid tissue without the need for surgery. It’s non-invasive and can be done while you’re awake, though it’s not suitable for all types of fibroids.

Surgery

If other treatments haven’t worked or if your fibroids are large and causing severe symptoms, surgery may be necessary. There are two main surgical options:

• Myomectomy: This surgery removes the fibroids but leaves the uterus intact, making it a good option if you want to preserve your fertility. It’s typically recommended for women who still want to have children in the future.
• Hysterectomy: This procedure removes the uterus entirely, providing a permanent solution to fibroids. It’s often recommended when other treatments haven’t been effective, or if the woman no longer wishes to have children. Like UAE, hysterectomy is not a fertility-preserving option.

While UAE and hysterectomy can be effective treatments, they are not recommended for women who are hoping to preserve fertility. That said, these can be reasonable choices for women who are done with childbearing or who aren’t interested in future fertility. The key is finding a care team that will help you make the right choice for your body and your goals.

The good news? There are many ways to address fibroids — even if you’re not trying to get pregnant — and early evaluation can help you avoid more invasive interventions later on.

Your choice, your timing

Let’s be honest: dealing with fibroids isn’t just physical. It can affect your mood, your sex life, your self-esteem, and your relationship with your body. You might feel frustrated, exhausted, or like you’re missing out on life because of your symptoms. That’s completely valid.

But know this: your body is not broken, and you’re not weak for needing help or answers. You’re strong for advocating for yourself in a system that doesn’t always listen the first time. This is your reminder that your pain is real, your experience matters, and you deserve to feel better.

Dahlia Rimmon is freelance writer, editor, and registered dietitian. She writes for various publications and family-focused brands, covering everything from food and supplements to overall health and wellness. Her experience spans private practice, consulting, and working in the baby food industry. She lives in St. Louis with her family.