Fibroids are common enough that most women will have one by the time they reach menopause, whether or not they ever cause a symptom. What varies enormously is how they show up: some fibroids never need more than watching, while others reshape a woman’s periods, pelvic comfort, or fertility plans enough to need real treatment. Rosa Gynecology’s providers walk through what your fibroids are actually doing before recommending what to do about them.
What Are Fibroids?
Fibroids (leiomyomas) are noncancerous growths of muscle and fibrous tissue that develop in or on the uterus. Because they are estrogen-sensitive, they typically grow during your reproductive years when hormone levels peak and shrink naturally after menopause as hormone levels drop. They are extremely common, affecting a large share of women—and Black women in particular, who tend to develop them earlier and more frequently. Crucially, fibroids are entirely benign and are not a form of, or a step toward, uterine cancer.
A fibroid’s location often matters just as much as its size:
- Submucosal Fibroids: Grow into the uterine cavity and are the most likely to cause heavy bleeding
- Intramural Fibroids: develop directly within the muscular wall of the uterus itself
- Subserosal Fibroids: grow on the outer surface, making them far more likely to cause pelvic pressure, bulk, or bloating rather than heavy bleeding.
Recognizing the Signs of Fibroids
Many fibroids cause no symptoms at all and are found incidentally during a routine exam or ultrasound. When fibroids do cause symptoms, the most common are:
Heavy or Prolonged Periods
Heavy or prolonged bleeding is often the first sign that something has changed and stands as the most common symptom of uterine fibroids.
Pelvic Pressure or Fullness
A constant feeling of pelvic pressure, heaviness, or persistent bloating that doesn’t resolve.
Pelvic Pain
Discomfort can range from mild aching to sharper pain, particularly if a fibroid outgrows its blood supply.
Frequent Urination
As fibroids grow, they can press against the bladder, creating a frequent or urgent need to urinate even when your bladder isn’t full.
Backache or Leg Pain
Though less common, larger fibroids press against nerves in the lower back and pelvis, causing backaches or pain that radiates down into the legs.
Fertility and Pregnancy Problems
Depending on their size and location, fibroids can sometimes interfere with how an egg implants, block the fallopian tubes, or cause complications during pregnancy and delivery.
How Fibroids Are Diagnosed
Diagnosing fibroids typically begins with a routine pelvic exam, where your provider may detect an enlarged or irregularly shaped uterus. To confirm these findings, an ultrasound is performed to precisely map each fibroid’s size, number, and location. In some cases, additional imaging like an MRI may be used to create a more detailed map before planning certain surgical procedures, though it isn’t necessary for every patient.
Your Treatment Options
Treatment depends on your symptoms, the size and location of your fibroids, and whether you’re hoping to preserve fertility, not just on the fact that fibroids are present. Watching and waiting is a legitimate choice for fibroids that aren’t causing problems.
- Watchful Waiting: If fibroids are small, stable, and not causing symptoms, monitoring with periodic exams or ultrasound is often all that’s needed.
- Medication: Hormonal birth control, an IUD, or other medications can help manage bleeding and pain without shrinking or removing the fibroids themselves.
- Laparoscopic Radiofrequency Ablation: A minimally invasive, outpatient procedure that uses controlled heat delivered through a thin probe to shrink fibroid tissue from within, without removing the uterus. ACOG’s updated guidance on symptomatic fibroids recognizes this approach as a uterine-preserving option for appropriately selected patients.
- Myomectomy: Surgical removal of the fibroids themselves, performed laparoscopically or, less often, through an open abdominal incision, while leaving the uterus in place. This is typically the recommended path for women who want to preserve fertility.
- Uterine Artery Embolization: A radiology-performed procedure that cuts off a fibroid’s blood supply, causing it to shrink, without surgery on the uterus itself.
- Hysterectomy: Complete removal of the uterus, the only treatment that eliminates fibroids permanently and guarantees they won’t return. This is a major surgery reserved for women who have completed childbearing or whose symptoms and fibroid burden haven’t responded to other options.
When to Call Us: Symptoms That Shouldn’t Wait
Most fibroid symptoms build gradually and can wait for a scheduled visit. A few things are worth calling about sooner:
- Bleeding heavy enough to soak through protection every hour or two, or that leaves you lightheaded or unusually fatigued.
- Sudden, severe pelvic pain, which can occur if a fibroid outgrows its blood supply.
- Rapid abdominal swelling or a fast-growing fibroid, particularly after menopause, since fibroids are expected to shrink, not grow, once estrogen drops.
- Any bleeding after menopause, even light spotting, which warrants prompt evaluation regardless of a known fibroid history.
Choose the Women Who Know: Care From Providers Who Specialize in Fibroids Diagnosis & Treatment
At Rosa Gynecology, Drs. Mironda Williams, Deanna Guthrie, and Karen Greene provide expert care for women navigating uterine fibroids. Working directly alongside our physicians, our nurse practitioners, Mary Corbitt, APRN, and Brittany Bulger, APRN ensure you have accessible, ongoing support at every step. Because our entire team is made up of women, we bring both medical expertise and personal understanding to every conversation—caring for you not just as patients, but as fellow women who truly get it.
Call us at 770-487-9604 to schedule your consultation.
Frequently Asked Questions
Do all fibroids need to be treated?
No. Many fibroids cause no symptoms and are simply monitored over time. Treatment becomes a conversation when fibroids cause bleeding, pain, pressure, or fertility concerns that affect your quality of life.
Can fibroids turn into cancer?
No. Fibroids are benign growths, not a form of cancer, and they don’t become cancerous over time. A rare cancer called leiomyosarcoma can resemble a fibroid on imaging, which is one reason your physician monitors any fibroid that’s growing quickly or behaving unusually.
Will my fibroids come back after treatment?
It depends on the treatment. Hysterectomy eliminates fibroids permanently. Myomectomy, radiofrequency ablation, and embolization remove or shrink existing fibroids, but new fibroids can develop afterward since the underlying tendency to grow them hasn’t changed.
Can I still get pregnant if I have fibroids?
Many women with fibroids conceive and carry pregnancies without complications. Depending on a fibroid’s size and location, though, it can occasionally affect fertility or pregnancy, which is worth discussing with your physician if you’re planning a pregnancy.
What's the difference between fibroids and heavy menstrual bleeding?
Fibroids are a structural growth and one of several possible causes of heavy bleeding. Heavy menstrual bleeding is a symptom that can come from fibroids or from other causes entirely, like hormonal imbalance or polyps.
Do fibroids shrink after menopause?
Often, yes. Because fibroids are estrogen-sensitive, they commonly shrink once estrogen levels drop after menopause. A fibroid that grows after menopause is a reason to call your physician promptly rather than wait.
Is surgery always required?
No. Watchful waiting, medication, and less invasive procedures like radiofrequency ablation or embolization are all real alternatives to surgery, depending on your specific fibroids and symptoms.
