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Fibroids are surprisingly common — but you may not even know you have them. As many as 3 out of 4 people who can get pregnant will develop growths in their uterus, called fibroids.1 Many won’t have any symptoms. Others may have pelvic pain, abdominal pressure, or heavy periods.
Here’s what you need to know about fibroids — including your risks and treatment options.
What are uterine fibroids?
A fibroid is a growth of tissue that develops in, on, or around the wall of the uterus. People can have just one fibroid or several. They range in size from as small as a seed to as large as a melon.
Fibroids are benign, meaning they’re not cancerous. But depending on how many you have and their size, they can cause a range of physical problems — affecting your daily activities and even your ability to have a healthy pregnancy.
“There’s nothing benign about their impact on your quality of life,” says Andrea Jazbec Lake, MD, an ob-gyn at Kaiser Permanente in Denver, Colorado.
What causes fibroids? Can they be prevented?
The hormones estrogen and progesterone play a role in fibroid growth. But experts don’t know exactly what causes fibroids to develop or why they grow. Because of that, there’s no proven way to prevent them.
For example, people with low levels of vitamin D are more likely to develop fibroids. But that doesn’t mean the deficiency is the cause. And there’s little evidence that a vitamin D supplement will reduce your risk, says Dr. Jazbec Lake.
A diet rich in vegetables and fruits may help lower your risk of fibroids.2 If you have multiple risk factors, you may want to eat these foods in moderation:
- Red meat and pork
- Additives, like food colorings
- Alcohol
- Soy milk
Who is at risk of fibroids?
If you have a uterus, you can develop fibroids any time after puberty — from as young as 14 until you reach menopause.
Some people are more likely to get them. Common risk factors for fibroids include:
- Race — More common in Black people than in other racial groups.
- Age — Most often develop in your 30s and 40s. On average, Black people have symptoms about 5 years younger.
- Family history — Relatives on your mother’s side had fibroids.
- Pregnancy history — Never being pregnant.
- Weight — Being overweight.
- Menstruation — Starting your period before age 10.
- Vitamin D levels — Low levels of vitamin D.
What are the symptoms of fibroids?
Fibroid symptoms fall into 2 categories — bleeding or pressure. The amount of pressure you feel depends on how many fibroids you have, how big they are, and where they’re located. Race also plays a role. Black people tend to experience larger growths and more severe symptoms.
Symptoms can include:
- Heavy menstrual bleeding
- Painful period cramps
- Iron deficiency (anemia) and fatigue
- Pelvic pain or pressure (feeling full)
- Lower back pain
- Painful sex
- Bulging abdomen (looking like you’re pregnant)
- Frequent urination
- Constipation
- Nausea and vomiting
In extreme cases, uterine fibroids can limit your ability to exercise, move, sit comfortably, or roll over in bed, says Dr. Jazbec Lake.
It’s important to remember that many people who have fibroids won’t have any symptoms. Fibroids aren’t necessarily harmful. If your doctor finds a fibroid during a pelvic exam or pregnancy ultrasound, you likely won’t need to worry about it unless you start to have symptoms.
Do fibroids affect fertility?
Fibroids don’t usually cause infertility. But they can affect your ability to get pregnant or have a healthy pregnancy, depending on their location, size, and number. And pregnancy hormones can cause fibroids to grow larger.
In some people, fibroids may:
- Block implantation of the embryo
- Increase the risk of pregnancy loss
- Restrict the baby’s growth
- Prevent the baby from turning head-down (causing breech birth)
- Lead to preterm labor
If you know you have fibroids, try to talk to your doctor before you get pregnant. Treatment options during pregnancy are limited.
Either way, your doctor will closely monitor you and your baby during pregnancy. Ask your doctor about pain management and symptoms to watch out for, like nausea and fever.
How are fibroids treated? Do they need to be removed?
About 1 in 5 people with fibroids will need treatment.3 But there isn’t a one-size-fits-all approach. Fibroid treatment usually centers around relieving your symptoms — bleeding or pressure — to improve your quality of life. If your main goal is preserving fertility, you might have your fibroids removed. You and your doctor will work together to create a treatment plan based on your symptoms, age, and plans to build a family, says Dr. Jazbec Lake.
Medication
Hormonal contraception
Birth control pills can help treat bleeding symptoms by making periods lighter and lessening cramps. If you prefer lower-maintenance or estrogen-free contraception, the arm implant, birth control shot, or hormonal IUD can also help lessen bleeding.
Hormone supression
Medicine can lower your estrogen and progesterone levels to help shrink your fibroids and reduce bleeding. This is a temporary medical menopause. You can take the medicine for up to 2 years. If you have large fibroids, shrinking them can help make surgery safer and easier.
Embolization
Uterine fibroid embolization is a treatment to reduce the size of fibroids. It blocks their blood supply so they shrink or die. This helps reduce pain and bleeding.
This procedure usually isn’t recommended if you’re planning to have children. It may cut off blood to your uterus or make it harder to ovulate. But it is possible to have a healthy pregnancy after embolization, says Dr. Jazbec Lake.
Surgery
Remove your fibroids
With a myomectomy, your doctor removes the fibroids and repairs your uterus. The recovery can be painful — more so than removing the uterus itself, says Dr. Jazbec Lake.
A myomectomy can be done robotically, which is a minimally invasive surgery. If you have a lot of fibroids or they’re very large, you may need an open myomectomy. In open surgery, the doctor cuts into the abdomen, similar to a Cesarean section.
Surgery to remove fibroids is usually done only if you want to get pregnant soon — within 6 to 12 months, says Dr. Jazbec Lake. In most cases, the fibroids will come back after that. But if you’re young and your fibroids are especially painful, a myomectomy can be the best option to improve your quality of life.
Remove your uterus
A hysterectomy is the only treatment that guarantees fibroids won’t return. You may need it if you have severe bleeding that doesn’t respond to any other treatments. If you don’t have plans to have children or you’re near menopause, removing your uterus may be the right option for you.
Without a hysterectomy, fibroids can continue to cause bothersome symptoms even after menopause, says Dr. Jazbec Lake. They may get smaller, but they don’t go away, and they can get harder.
Removing your uterus when you’re younger won’t trigger menopause because you keep your ovaries. You also have the option to keep your cervix. If you do, you’ll continue to need Pap tests.
When to see a doctor
Heavy menstrual bleeding and severe period pain aren’t considered normal. If you have these or other symptoms of fibroids, talk to your doctor. Kaiser Permanente members can find an ob-gyn and make an appointment without a referral.