Uterine fibroids: do you always need surgery?
No. A uterine fibroid is a growth of the womb's own muscle, and fibroids are almost always benign (non-cancerous). Many cause no symptoms and simply need watching with occasional scans. Treatment is considered when a fibroid causes heavy periods, pain or pressure, or matters for your pregnancy plans, and even then medicine often comes first.
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What is a fibroid?
If you have just been told you have a fibroid, it is natural to feel worried: does this mean an operation, or is it something dangerous? Take a breath. In most cases, the news is far less frightening than it sounds.
Your uterus, or womb, is made of muscle. A fibroid is simply a growth of that same muscle tissue — think of it as a firm knot that forms in the wall of the uterus. Doctors also call fibroids myomas or leiomyomas. The most important thing to understand is that fibroids are almost always benign, which means non-cancerous. They are one of the most common things we see in women's health. So if you are carrying a fear that this is something sinister, please set that fear down. In the vast majority of cases, it is not.
Do all fibroids cause problems?
No, and this surprises many patients. A large number of fibroids are completely silent. They cause no pain and no symptoms at all, and they are often discovered by accident during a routine scan done for something else.
If a fibroid is not troubling you, in many situations the wisest thing to do is simply keep an eye on it. We call this watchful waiting: occasional check-ups and scans, and nothing more unless the fibroid starts to cause trouble. Not every fibroid needs to be removed.
Which fibroid symptoms deserve attention?
Some fibroids do cause symptoms, and those deserve a proper look:
- Heavy periods. This is the most common one. Periods can become so heavy that they leave you tired and low in iron (anaemic).
- Pain or heaviness. Some women feel pelvic pain or a dragging heaviness low in the tummy.
- Pressure on nearby organs. Depending on its size and position, a fibroid can press on the bladder, so that you pass urine more often, or press on the bowel.
- Effects on pregnancy. In some cases, fibroids can make it harder to conceive or can affect a pregnancy.
These are worth getting properly evaluated. An ultrasound scan usually shows how many fibroids there are, how big they are and exactly where they sit, and if your periods are heavy, a simple blood test checks whether you have become anaemic. Very heavy bleeding with dizziness, fainting or breathlessness should not wait for a routine appointment: go to the nearest hospital the same day. Read more about heavy and abnormal uterine bleeding.
How do we decide whether a fibroid needs treatment?
There is no single answer that fits every woman. We look at four things together:
- Your symptoms. Are they genuinely affecting your daily life, your work or your comfort?
- The size of the fibroid.
- Its location. This matters a great deal. A small fibroid in one part of the uterus behaves very differently from one in another part.
- Your own plans, especially whether you are hoping to have a baby.
A fibroid left alone in one woman might need attention in another, simply because of her plans for a family. The right decision is a personal one, made after understanding your particular situation.
Can fibroids affect getting pregnant?
The key is location. Fibroids that grow on the outside of the uterus, or deep within the muscle wall away from the cavity, often do not interfere with getting pregnant. But a fibroid that pushes into the inner cavity of the uterus, the space where a pregnancy grows, can sometimes make it harder to conceive or to carry a pregnancy. So when a baby is part of the plan, we pay very close attention to exactly where the fibroid is, not just how big it is.
Fibroids are sometimes confused with adenomyosis, in which tissue like the womb lining grows into the muscle wall itself, and the two can exist together; see adenomyosis and fertility. Painful periods can also come from endometriosis.
What are the treatment options for fibroids?
The good news is that surgery is not always the starting point. Beyond watchful waiting, there are two main routes.
Medicines
For many women, medical management comes first. Medicines can help control heavy bleeding or ease symptoms, which may allow you to avoid or delay any procedure. For a lot of patients, this is enough.
Keyhole procedures that keep the uterus
When a procedure is truly needed, modern techniques are far gentler than most people imagine. Removing the fibroid while keeping the uterus is called a myomectomy, and it is often the preferred choice for women who wish to preserve their fertility. It can frequently be done by one of two keyhole approaches:
- Laparoscopic myomectomy. The fibroid is removed through a few very small cuts on the tummy, using a camera and fine instruments. This usually means less pain and a quicker recovery. See laparoscopic (keyhole) surgery.
- Hysteroscopic myomectomy. A fibroid sitting inside the cavity of the uterus can be removed through the natural passage, with no cut on the tummy at all.
Keyhole surgery does not suit every fibroid; very large or numerous fibroids sometimes need an open operation. The right approach depends on the size, number and location of the fibroids and on your goals, and deserves an unhurried conversation with your doctor. For some women who have completed their family and whose fibroids keep causing trouble, removing the womb may also be discussed; see hysterectomy types and recovery.
The reassurance to hold on to
Fibroids are extremely common, almost always benign, and not all of them need surgery. There is a path for every situation, from a watchful eye to medicine to a keyhole procedure that protects your fertility wherever possible, and you do not have to work it out alone.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre, so your scans, any procedure and your stay are handled in one place, by one team. Free patient transport is available from across Goa and nearby areas.
Getting started
If you have been diagnosed with a fibroid, or you have heavy periods, pain or any worry about your fertility, come and talk it through calmly. For questions, message us on WhatsApp at +91 77989 73345, with any scan reports you already have. Your first online consultation is free (one session). Consultations at the hospital are by appointment; to book one, call +91 77989 73345, or +91 95459 20817, or +91 75582 52088. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Are fibroids cancerous?
Almost never. Fibroids are growths of the womb's own muscle and are almost always benign, which means non-cancerous. They are one of the most common findings in women's health, and many women have them without ever knowing.
Does every fibroid need to be removed?
No. Many fibroids cause no symptoms and are simply watched with occasional check-ups and scans. Treatment is considered when a fibroid is troubling you, or when its size or position matters for your plans to have a baby.
Can a fibroid stop me from getting pregnant?
It depends mainly on where the fibroid is. Fibroids on the outside of the womb, or deep in the wall away from the cavity, often do not interfere, while one that pushes into the inner cavity can make it harder to conceive or to carry a pregnancy. Your scan shows which kind you have.
Can fibroids be treated without surgery?
Often, yes. For many women, medicines that control heavy bleeding or ease symptoms are enough to avoid or delay a procedure. Surgery is considered when symptoms continue despite treatment, or when the size or position of the fibroid calls for it.
What is the difference between laparoscopic and hysteroscopic fibroid removal?
Laparoscopic removal uses a camera and fine instruments through a few small cuts on the tummy. Hysteroscopic removal is for a fibroid inside the cavity of the womb and is done through the natural passage, with no cut on the tummy at all. Both remove the fibroid while keeping the womb.
Or call +91 75582 52088 · 0832 251 3641
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.