Uterine Fibroids in Women: Causes, Symptoms, Treatment Options and Effects on Fertility

Introduction

Imagine a woman who notices that her menstrual periods are becoming unusually heavy. She changes sanitary pads frequently, experiences painful cramps, and sometimes feels tired or dizzy.

At first, she assumes that these changes are simply part of being a woman.

However, after visiting a hospital and undergoing a pelvic ultrasound, she discovers that she has uterine fibroids.

For many women, this diagnosis raises immediate questions.

Will I need surgery? Can I still become pregnant? Are fibroids cancerous? Can medicines or natural remedies make them disappear?

Uterine fibroids are among the most common benign growths affecting the female reproductive system. They may develop during the reproductive years and vary considerably in size, number, and location.

Some women have fibroids without experiencing symptoms, while others develop heavy menstrual bleeding, pelvic discomfort, anaemia, or reproductive difficulties.

Understanding fibroids can help women seek appropriate treatment, avoid unnecessary fear, and make informed decisions about their reproductive health.

This article explains the causes, symptoms, diagnosis, treatment options, fertility implications, and important considerations for women in Nigeria.

What Are Uterine Fibroids?

Uterine fibroids, medically called leiomyomas or myomas, are usually noncancerous growths that develop from the smooth muscle and connective tissue of the uterus.

The uterus, also called the womb, is the reproductive organ where a baby develops during pregnancy.

Fibroids may grow:

• Within the muscular wall of the uterus
• Inside the uterine cavity
• On the outer surface of the uterus
• From the uterus on a stalk

Some fibroids are very small, while others become large enough to enlarge the abdomen.

A woman may have one fibroid or several.

Fibroids are not the same as ovarian cysts, and they do not automatically indicate cancer.

Types of Uterine Fibroids

Fibroids are commonly classified according to their location.

1. Intramural Fibroids

Intramural fibroids grow within the muscular wall of the uterus.

They are among the most common types.

Depending on their size and position, they may cause heavy menstrual bleeding, pelvic pressure, or enlargement of the uterus.

Some intramural fibroids may also affect fertility, especially when they distort the uterine cavity.

2. Submucosal Fibroids

Submucosal fibroids develop immediately beneath the inner lining of the uterus and may protrude into the uterine cavity.

They are particularly associated with heavy menstrual bleeding.

Because they can change the shape of the uterine cavity, they may interfere with embryo implantation or increase the risk of certain pregnancy complications.

Even relatively small submucosal fibroids can be clinically significant.

3. Subserosal Fibroids

Subserosal fibroids grow toward the outer surface of the uterus.

They may cause pressure symptoms when large, including frequent urination, constipation, or abdominal fullness.

They are generally less likely to affect fertility than fibroids that distort the uterine cavity.

4. Pedunculated Fibroids

Pedunculated fibroids are attached to the uterus by a stalk.

They may project into or outside the uterine cavity.

Occasionally, a stalk can twist, causing sudden severe pain that requires urgent medical evaluation.

What Causes Uterine Fibroids?

The exact cause of uterine fibroids is not completely understood.

Research suggests that several biological and environmental factors contribute to their development.

1. Estrogen and Progesterone

Estrogen and progesterone are reproductive hormones involved in regulating the menstrual cycle.

Fibroid growth is influenced by these hormones.

Fibroids commonly develop during reproductive years and may shrink after menopause, when hormone levels decline.

However, hormonal activity alone does not fully explain why some women develop fibroids while others do not.

2. Genetic Factors

Fibroids can run in families.

A woman whose mother or sister has fibroids may have an increased likelihood of developing them.

Researchers have also identified genetic changes in fibroid tissue that may influence growth.

3. Age

Fibroids are most frequently diagnosed during the reproductive years, particularly in women in their 30s and 40s.

They can occur at younger ages.

4. African Ancestry and Disparities in Risk

Studies show that fibroids are more frequently diagnosed, may develop earlier, and can be more severe among women of African ancestry.

The reasons are complex and may involve genetic, environmental, social, and healthcare-related factors.

This makes fibroid awareness especially relevant in Nigeria.

5. Obesity and Metabolic Factors

Higher body weight is associated with increased fibroid risk in some studies.

Hormonal and metabolic pathways may contribute to this relationship.

However, women of any body size can develop fibroids.

6. Other Possible Factors

Researchers continue to investigate the roles of vitamin D status, reproductive history, dietary patterns, and environmental exposures.

These associations do not establish that a particular food, vitamin deficiency, or lifestyle habit directly causes fibroids.

Important: Fibroids are not caused by sexual intercourse, poor personal hygiene, or a woman's failure to become pregnant.

Common Symptoms of Uterine Fibroids

Many women have no symptoms.

When symptoms occur, they depend partly on the fibroids' size, number, and location.

1. Heavy Menstrual Bleeding

Heavy menstrual bleeding is one of the most common symptoms.

A woman may experience:

• Periods lasting longer than usual
• Frequent changes of sanitary pads
• Large menstrual blood clots
• Bleeding that interferes with daily activities

Persistent heavy bleeding can cause iron-deficiency anaemia.

2. Painful Menstrual Periods

Fibroids may contribute to menstrual cramps or pelvic discomfort.

However, severe period pain can also occur with conditions such as endometriosis and adenomyosis.

3. Pelvic Pressure or Fullness

Large fibroids may produce a sensation of heaviness in the lower abdomen.

Some women notice that their abdomen appears enlarged.

4. Frequent Urination

Fibroids that press against the bladder can cause frequent urination or difficulty emptying the bladder completely.

5. Constipation

Large fibroids may press on the rectum, contributing to constipation or difficulty passing stool.

6. Lower Back Pain

Some women experience dull lower back or pelvic pain.

This symptom is not specific to fibroids and should be evaluated in context.

7. Pain During Sexual Intercourse

Depending on their location, fibroids may contribute to discomfort during intercourse.

8. Difficulty Becoming Pregnant

Certain fibroids may interfere with fertility, particularly when they distort the uterine cavity.

However, most women with fibroids are not infertile.

Can Uterine Fibroids Cause Anaemia?

Yes.

Repeated heavy menstrual bleeding can reduce the body's iron stores and lead to iron-deficiency anaemia.

Symptoms may include:

• Persistent tiredness
• Dizziness
• Weakness
• Shortness of breath during activity
• Palpitations
• Pale skin or inner eyelids

Women experiencing heavy periods should be assessed for anaemia.

A full blood count is commonly recommended, and additional iron studies may be appropriate.

Treatment may include iron replacement alongside management of the bleeding.

Severe anaemia sometimes requires urgent hospital care.

How Are Uterine Fibroids Diagnosed?

Diagnosis begins with a medical history and appropriate clinical examination.

A healthcare professional may ask about menstrual bleeding, pelvic pain, urinary symptoms, pregnancy plans, and family history.

1. Pelvic Ultrasound

Ultrasound is usually the first imaging investigation for suspected uterine fibroids.

It can help determine:

• The number of fibroids
• Their approximate size
• Their location
• Whether the uterus is enlarged
• Whether other pelvic abnormalities are present

Ultrasound may be performed through the abdomen or through the vagina, depending on the clinical situation and the patient's consent.

2. Full Blood Count

A full blood count helps assess for anaemia when heavy menstrual bleeding is present.

3. Hysteroscopy

Hysteroscopy uses a thin instrument inserted through the cervix to examine the inside of the uterus.

It may be recommended when a submucosal fibroid or another abnormality inside the uterine cavity is suspected.

Some fibroids can also be removed during hysteroscopy.

4. Saline Infusion Sonography

This examination uses ultrasound after sterile fluid is introduced into the uterine cavity.

It can help identify fibroids that distort the uterine lining.

5. Magnetic Resonance Imaging (MRI)

MRI may be useful when ultrasound findings are unclear or detailed mapping is needed before certain treatments.

Not every woman with fibroids requires MRI.

Do All Uterine Fibroids Need Treatment?

No.

Fibroids that cause no symptoms may not require immediate treatment.

A clinician may recommend observation when:

• The fibroids appear benign
• Symptoms are absent or mild
• There is no significant anaemia
• There is no concerning pressure on nearby organs
• Fertility plans do not create a specific reason for intervention

Follow-up should be individualized.

The presence of a fibroid on ultrasound is not, by itself, a reason to undergo surgery.

Medical Treatment of Uterine Fibroids

Medicines can help control symptoms, particularly heavy menstrual bleeding and pain.

However, not every medicine shrinks fibroids.

1. Tranexamic Acid

Tranexamic acid can reduce menstrual blood loss.

It is generally taken during menstrual bleeding when prescribed.

It does not remove fibroids.

It may not be suitable for some patients with a history or increased risk of blood clots.

2. Nonsteroidal Anti-Inflammatory Drugs

Medicines such as ibuprofen or mefenamic acid may help relieve menstrual pain and reduce bleeding in selected patients.

They may be unsuitable for women with certain kidney, stomach, or cardiovascular conditions.

3. Hormonal Contraceptives

Certain hormonal contraceptives can help regulate bleeding and reduce menstrual discomfort.

Their suitability depends on medical history, blood pressure, and reproductive plans.

4. Levonorgestrel-Releasing Intrauterine System

A hormone-releasing intrauterine system may reduce heavy menstrual bleeding in appropriately selected women.

It is generally more suitable when fibroids do not significantly distort the uterine cavity.

It does not remove the fibroids themselves.

5. Gonadotropin-Releasing Hormone Medicines

Gonadotropin-releasing hormone (GnRH) agonists and antagonists can suppress hormonal pathways involved in menstruation and fibroid symptoms.

Some treatments temporarily shrink fibroids; others primarily reduce heavy bleeding.

These medicines may cause menopausal-type symptoms or affect bone health.

Specialist supervision is required, and treatment duration depends on the particular medicine and whether additional hormone therapy is used.

6. Iron Treatment for Anaemia

Iron supplementation may be recommended when iron deficiency is diagnosed.

Correcting anaemia is important, but the underlying bleeding also needs attention.

When Is Surgery Needed for Fibroids?

Surgery may be recommended when fibroids cause substantial symptoms or complications.

Reasons include:

• Heavy bleeding that causes significant anaemia
• Persistent symptoms despite appropriate medication
• Severe pelvic pain or pressure
• Urinary obstruction or other organ-related complications
• Certain fibroids affecting fertility
• Significant distortion of the uterine cavity
• Uncertain diagnosis requiring further investigation

Fibroid size alone does not automatically determine whether surgery is necessary.

A woman with a relatively small submucosal fibroid may require treatment because of heavy bleeding or fertility concerns, while another woman with a larger asymptomatic fibroid may be safely monitored.

Surgical Treatment Options

1. Myomectomy: Removing Fibroids While Preserving the Uterus

Myomectomy is an operation that removes fibroids while leaving the uterus in place.

It is often considered for women who wish to preserve the possibility of pregnancy.

Myomectomy can be performed through different approaches.

Hysteroscopic myomectomy

Used for selected fibroids projecting into the uterine cavity.

Laparoscopic myomectomy

Uses small abdominal incisions and specialized instruments.

Open abdominal myomectomy

May be appropriate for certain large, numerous, or technically complex fibroids.

The surgical approach depends on fibroid characteristics, available expertise, and individual circumstances.

Potential risks include bleeding, infection, adhesions, and recurrence of new fibroids.

Pregnancy after some types of myomectomy may require special obstetric planning, including consideration of caesarean delivery.

2. Hysterectomy: Removing the Uterus

Hysterectomy removes the uterus.

It provides definitive treatment for uterine fibroids because the uterus in which they develop is removed.

However, pregnancy is no longer possible afterward.

Hysterectomy may be considered for women with severe symptoms who do not wish to preserve fertility, particularly when other treatments are ineffective or unsuitable.

Removal of the uterus does not always mean removal of the ovaries.

The benefits, risks, and alternatives should be fully discussed before surgery.

Nonsurgical Procedures for Fibroids

Uterine Artery Embolization

Uterine artery embolization (UAE), also called uterine fibroid embolization, is a minimally invasive procedure performed by an interventional radiologist.

Tiny particles are introduced into blood vessels supplying the fibroids.

This reduces blood flow to the fibroids, causing them to shrink over time.

UAE can improve heavy bleeding and pressure symptoms in many women.

However, some patients require further treatment later.

Pregnancy is possible after UAE, but its effects on future fertility and pregnancy outcomes remain uncertain.

Women actively planning pregnancy should discuss this carefully with a gynaecologist and interventional radiologist.

Radiofrequency Ablation

Radiofrequency ablation uses controlled heat to destroy fibroid tissue.

It may be suitable for selected fibroids.

Long-term fertility and pregnancy data are less established than for some other treatments.

Focused Ultrasound Treatment

Some specialist centres offer focused ultrasound procedures that target fibroids without traditional surgical incisions.

Availability, suitability, effectiveness, and pregnancy outcomes vary.

Not every fibroid can be treated using these methods.

Uterine Fibroids and Fertility: Can You Still Become Pregnant?

Yes.

Many women with uterine fibroids conceive naturally and have successful pregnancies.

Fibroids do not automatically cause infertility.

Their effects on fertility depend mainly on location, size, number, and whether they distort the uterine cavity.

How Fibroids May Affect Fertility

Certain fibroids may:

• Distort the uterine cavity
• Interfere with embryo implantation
• Affect the normal structure of the uterus
• Contribute to some pregnancy complications

Submucosal fibroids are particularly important because they extend into the uterine cavity.

Intramural fibroids may also affect fertility in some circumstances, especially when they distort the cavity.

Subserosal fibroids generally have less effect on fertility.

Can Myomectomy Improve Fertility?

Removing selected fibroids, particularly those distorting the uterine cavity, may improve reproductive outcomes in some women.

However, surgery does not guarantee pregnancy.

Other possible causes of infertility, including ovulation disorders, fallopian tube problems, and male-factor infertility, should also be investigated.

Should Every Woman Trying to Conceive Remove Her Fibroids?

No.

The decision depends on:

• Fibroid location and size
• Uterine cavity distortion
• Symptoms
• Age
• Previous pregnancy history
• Duration of infertility
• Other fertility factors

A reproductive specialist or gynaecologist can help determine whether treatment is likely to be beneficial.

Uterine Fibroids During Pregnancy

Many women with fibroids experience uncomplicated pregnancies.

However, some fibroids may increase the risk of:

• Pregnancy-related pain
• Miscarriage in certain circumstances
• Abnormal fetal position
• Preterm birth
• Caesarean delivery
• Postpartum haemorrhage

These complications are not inevitable.

Pregnancy monitoring should be based on the size, location, and clinical significance of the fibroids.

Fibroid removal during pregnancy is generally avoided unless there are exceptional clinical reasons.

Can Fibroids Become Cancerous?

Uterine fibroids are benign tumours.

A rare cancer called uterine leiomyosarcoma can occur in the uterus, but it is generally considered a separate malignancy rather than the usual transformation of an ordinary fibroid into cancer.

It is not possible to reliably distinguish every unusual uterine mass using symptoms or imaging alone.

New or concerning symptoms, especially bleeding after menopause, require medical evaluation.

Women should not assume that every growing fibroid is cancerous.

Can Diet and Lifestyle Changes Shrink Fibroids?

A healthy lifestyle supports general reproductive and metabolic health.

However, no specific food or herbal mixture has been proven to reliably eliminate established uterine fibroids.

Helpful general measures include:

• Eating a balanced diet
• Maintaining an appropriate body weight
• Participating in regular physical activity
• Managing diagnosed metabolic conditions
• Attending recommended medical appointments

Women with heavy menstrual bleeding should also be assessed for iron deficiency.

Nigerian Foods That Can Support General Health

Nutritious foods may include:

Vegetables: Ugu, okra, ewedu, cabbage, and other leafy vegetables.

Protein: Fish, eggs, beans, and appropriate portions of poultry or meat.

Whole grains and fibre-rich foods: Oats, brown rice, millet, and other suitable staples.

Fruits: Oranges, guava, pawpaw, and other whole fruits.

Iron-containing foods: Beans, leafy vegetables, meat, and fish can contribute to dietary iron intake.

Vitamin C-rich foods can improve absorption of non-haem iron from plant sources.

Diet alone may not adequately treat significant iron-deficiency anaemia caused by heavy bleeding.

Can Herbal Remedies Dissolve Fibroids?

Many herbal products are advertised as natural fibroid cures.

Claims may include promises to dissolve fibroids completely, cleanse the womb, or restore fertility within a few weeks.

Such claims should be approached cautiously.

There is insufficient high-quality clinical evidence that commonly marketed herbal mixtures reliably remove fibroids or replace established medical treatment.

Some products may also contain undeclared substances or interact with prescribed medicines.

Women should avoid delaying appropriate care while using unverified remedies.

Uterine Fibroids in Nigeria: Why Early Diagnosis Matters

Fibroids are an important women's health concern in Nigeria.

Some women experience years of heavy menstrual bleeding or pelvic discomfort before seeking professional evaluation.

Others may discover fibroids while investigating infertility.

Challenges can include the cost of ultrasound examinations, limited access to specialist services, fear of surgery, and misinformation about treatment.

Social pressure surrounding fertility can also make a fibroid diagnosis emotionally difficult.

It is important to remember that having fibroids does not determine a woman's worth or mean that she cannot become a mother.

Women with persistent symptoms should seek assessment from a qualified healthcare professional.

A general hospital, teaching hospital, or appropriately equipped specialist clinic may provide pelvic ultrasound and gynaecological assessment.

When surgery is recommended, patients should ask about uterine preservation, fertility implications, surgical risks, and the experience of the treating team.

A second specialist opinion may be helpful when major surgery is proposed and the patient is uncertain about the options.

When Should You Seek Urgent Medical Care?

Seek urgent assessment if you experience:

• Very heavy bleeding with dizziness or fainting
• Severe or sudden pelvic pain
• Severe weakness or breathlessness associated with bleeding
• Inability to pass urine
• Severe abdominal pain during pregnancy

Heavy bleeding may cause dangerous anaemia or blood loss.

Sudden pelvic pain may have causes other than fibroids, including ovarian torsion or ectopic pregnancy.

These symptoms should not be managed solely with home remedies.

Frequently Asked Questions

Can fibroids disappear without surgery?

Some fibroids shrink naturally, particularly after menopause. Others remain stable or grow. Treatment depends on symptoms and individual circumstances.

Can a woman with fibroids get pregnant?

Yes. Many women with fibroids conceive naturally.

Which fibroids are most likely to affect fertility?

Submucosal fibroids and some intramural fibroids that distort the uterine cavity are more likely to affect fertility.

Does every fibroid require surgery?

No. Many fibroids can be monitored or managed without surgery.

Can fibroids return after myomectomy?

Yes. Removed fibroids do not grow back, but new fibroids may develop.

Does hysterectomy cure fibroids?

Removing the uterus provides definitive treatment for uterine fibroids, but pregnancy is no longer possible.

Can fibroids cause miscarriage?

Certain fibroids may increase miscarriage risk, particularly when they distort the uterine cavity. However, many pregnancies involving fibroids progress normally.

Can fibroids cause frequent urination?

Yes. Large fibroids may press on the bladder and increase urinary frequency.

Can fibroids cause anaemia?

Yes. Heavy menstrual bleeding associated with fibroids can lead to iron-deficiency anaemia.

Is fibroid embolization better than surgery?

Neither approach is best for every woman. Treatment selection depends on symptoms, fibroid characteristics, fertility plans, and individual risks.

Questions to Ask Your Gynaecologist

If you have been diagnosed with fibroids, consider asking:

1. How many fibroids do I have, and where are they located?
2. Are they distorting my uterine cavity?
3. Could they explain my heavy bleeding or pain?
4. Do I have anaemia?
5. Is monitoring appropriate?
6. What medicines could help my symptoms?
7. Do I need surgery?
8. Can my uterus be preserved?
9. How could treatment affect my future fertility?
10. What are the risks of recurrence or further treatment?

Key Takeaways

Uterine fibroids are usually benign growths of the uterus.

Many women with fibroids have no symptoms.

Heavy menstrual bleeding, pelvic pressure, painful periods, and anaemia are possible complications.

Ultrasound is commonly used to diagnose and assess fibroids.

Not every fibroid requires surgery.

Myomectomy preserves the uterus, while hysterectomy removes it.

Certain fibroids can affect fertility, but many women with fibroids become pregnant successfully.

Treatment should reflect the woman's symptoms, medical circumstances, and reproductive preferences.

Conclusion

Uterine fibroids are common, but their effects vary greatly from one woman to another.

For some women, fibroids remain small and cause no problems. For others, they contribute to heavy bleeding, anaemia, pelvic discomfort, or difficulties with pregnancy.

A fibroid diagnosis should not automatically lead to fear of cancer, infertility, or surgery.

The most important steps are obtaining an accurate diagnosis, understanding the fibroids' location and clinical significance, and discussing appropriate treatment options with a qualified healthcare professional.

Early assessment can help prevent complications and support informed decisions about fertility and reproductive health.

Wellness by Flora encourages every woman to understand her body, seek timely medical care, and make informed decisions based on reliable health information.

Medical References

1. American College of Obstetricians and Gynecologists (ACOG). Uterine Fibroids.
   https://www.acog.org/womens-health/faqs/uterine-fibroids
2. National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management — Guideline NG88.
   https://www.nice.org.uk/guidance/ng88/chapter/Recommendations
3. ACOG. Uterine Artery Embolization.
   https://www.acog.org/womens-health/faqs/uterine-artery-embolization
4. National Health Service (NHS). Fibroids.
   https://www.nhs.uk/conditions/fibroids/
5. National Institute of Child Health and Human Development (NICHD). Uterine Fibroids.
   https://www.nichd.nih.gov/health/topics/uterine
6. American Society for Reproductive Medicine (ASRM). Removal of Myomas in Asymptomatic Patients to Improve Fertility and/or Reduce Miscarriage Rate: A Guideline.
   https://www.asrm.org/practice-guidance/practice-committee-documents/removal-of-myomas-in-asymptomatic-patients-to-improve-fertility-andor-reduce-miscarriage-rate-a-guideline-2017/

About the Author

Uche Flora Okonkwo, MPH in Community Health, is the founder and writer of Wellness by Flora, a public health education platform focused on women's health, diabetes awareness, preventive healthcare, nutrition, and healthy living.

Her work aims to improve health literacy and help individuals and families make informed healthcare decisions through accessible, evidence-informed education.

Wellness by Flora — Inspiring Healthier Living Every Day

Website: https://wellnessbyflora.com/

Medical Disclaimer

This article is intended for general health education and does not replace professional medical advice, diagnosis, or treatment.

Uterine fibroids vary in size, location, symptoms, and effects on fertility. Investigations and treatment decisions should be individualized by qualified healthcare professionals.

Do not begin hormonal medicines, discontinue prescribed treatment, or use unverified herbal remedies to treat fibroids without appropriate medical guidance.

Seek urgent medical attention for severe pelvic pain, excessive bleeding, fainting, or other potentially serious symptoms.