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Fibroids (leiomyomas)

Fibroids are non-cancerous growths of the uterine muscle. By age 50, most women have them. Many never cause a problem, but fibroids are one of the most common causes of heavy periods.

By the AUB editorial teamUpdated September 2026PALM-COEIN: AUB-L

How common they are

In a large ultrasound study, fibroids were found by age 50 in about 70% of white women and more than 80% of Black women. Black women tend to develop fibroids earlier, with more and larger fibroids and more severe symptoms.

Location matters

Fibroids are described by where they sit. Submucosal fibroids bulge into the uterine cavity and are the most likely to cause heavy bleeding. They can also affect fertility. Intramural fibroids sit within the wall, and subserosal fibroids grow on the outside, where they mainly cause pressure symptoms.

Symptoms

  • Heavy or prolonged periods, sometimes with clots
  • Pelvic pressure, a swollen belly, or back pain
  • Frequent urination or constipation
  • Iron deficiency from ongoing blood loss

Diagnosis

A pelvic ultrasound is the usual first test. A saline infusion ultrasound or hysteroscopy shows fibroids inside the cavity. MRI helps map fibroids before some procedures.

Treatment

Fibroids that cause no symptoms can simply be watched. Options for symptoms include:

  • Medications for bleeding: tranexamic acid and NSAIDs, hormonal options including the levonorgestrel IUD when the cavity is not distorted, and GnRH antagonist combination therapy
  • Procedures that keep the uterus: hysteroscopic myomectomy for fibroids inside the cavity, laparoscopic, robotic, or open myomectomy, uterine artery embolization, and radiofrequency ablation
  • Hysterectomy: the definitive treatment for people who have finished childbearing

The right choice depends on fibroid size and location, your symptoms, and whether you want a future pregnancy.

Fibroids that grow after menopause are unusual and should be evaluated, since a rare cancer called leiomyosarcoma can look similar.

Sources

  1. American College of Obstetricians and Gynecologists. Practice Bulletin No. 228: Management of symptomatic uterine leiomyomas. Obstet Gynecol. 2021;137(6):e100–e115.
  2. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–107.
  3. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408.

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