Fibroids are among the most common conditions in gynecology and among the most under-treated. By age 50, a large majority of women will have developed at least one. Many never know. Others spend years planning their lives around a period they cannot leave the house for, having been told that fibroids are normal — which is true, and beside the point. Common does not mean you have to live with the symptoms.
What fibroids are
A fibroid, or leiomyoma, is a benign growth of the smooth muscle of the uterus. They range from a few millimeters to the size of a grapefruit or larger, and most women who have one have several. They are hormonally responsive — estrogen and progesterone drive their growth — which is why they tend to enlarge during the reproductive years and often shrink after menopause.
Where a fibroid sits matters far more than how big it is:
- Submucosal — bulging into the uterine cavity. The smallest of these can cause the heaviest bleeding, and they are the ones most likely to affect fertility.
- Intramural — within the muscular wall. The most common type; can cause both bleeding and bulk symptoms.
- Subserosal — on the outer surface. More likely to cause pressure on the bladder or bowel than heavy bleeding.
- Pedunculated — attached by a stalk, either inside or outside. Occasionally the cause of sudden pain if the stalk twists.
Fibroids are also more common, tend to appear earlier, and are more often severe in Black women — a disparity that is well documented and that too often translates into longer delays before anyone takes the symptoms seriously.
The symptoms that actually bring women in
- Heavy or prolonged bleeding — soaking through protection hourly, passing clots, periods lasting well beyond a week.
- Anemia and fatigue — often the first objective sign, and frequently the one that finally gets attention.
- Pelvic pressure or fullness — a heaviness low in the abdomen, or clothes fitting differently with no weight change.
- Urinary frequency — a fibroid pressing on the bladder.
- Constipation or rectal pressure from posterior fibroids.
- Pain with intercourse, depending on location.
- Back or leg pain when a larger fibroid presses on nerves.
- Bleeding through a pad or tampon every hour for several hours running.
- Lightheadedness, breathlessness on stairs, or a racing heart — signs of significant anemia.
- Sudden, severe pelvic pain.
- Any bleeding after menopause.
How they are evaluated
Evaluation usually begins with a pelvic exam and an ultrasound, which we perform in the office so you are not sent elsewhere and made to wait. Depending on what we find and what you need to decide, the next step may be saline infusion sonohysterography or hysteroscopy to see whether a fibroid involves the uterine cavity, or MRI for detailed mapping before a procedure. We also check a blood count and iron studies, because anemia from fibroid bleeding is common and very treatable in its own right.
The full range of treatment
Watchful waiting
A perfectly legitimate choice when fibroids are not causing symptoms. Monitoring rather than intervening is the right answer more often than most women are told.
Medical management
- Tranexamic acid — taken only on heavy days, reduces bleeding substantially without hormones.
- NSAIDs — modestly reduce flow and treat cramping.
- Hormonal contraception — can regulate and lighten cycles.
- A levonorgestrel IUD — one of the most effective medical treatments for heavy bleeding, and something we place in the office. Less suitable when the cavity is significantly distorted.
- GnRH antagonist therapy with add-back — newer oral options that reduce bleeding and fibroid size, typically used for a defined period.
- Iron repletion — not optional if you are anemic, whatever else you choose.
Procedural and surgical options
- Hysteroscopic myomectomy — removal of a submucosal fibroid through the cervix, with no incision.
- Uterine artery embolization — an interventional radiology procedure that cuts off fibroid blood supply.
- Radiofrequency ablation — laparoscopic or transcervical destruction of fibroid tissue with uterine preservation.
- Myomectomy — surgical removal of fibroids with the uterus preserved; the usual choice when future fertility matters.
- Hysterectomy — definitive, and the right answer for some women, but one of several options rather than the default.
Choosing between them
The decision turns on four questions, in roughly this order: which symptom is actually costing you the most, where the fibroids sit, whether you want to be pregnant in the future, and how you feel about surgery. Two women with identical imaging can reasonably make opposite choices. Anyone who tells you there is one right answer has not asked you enough questions.
Care at Altavida
We handle evaluation, in-office ultrasound, lab work, medical management, IUD placement and hysteroscopy here. When a surgical or interventional procedure is the right path, we coordinate that referral and stay involved rather than handing you off and disappearing.
If heavy bleeding or pressure has been shaping your calendar, book an evaluation or call 813-733-7300. We see women from Lutz, Wesley Chapel, New Tampa, Land O' Lakes and across Tampa Bay.
This article is for general education and is not a substitute for individual medical advice. Treatment decisions depend on your full history — please talk with your own provider.
