Uterine Fibroids: Does Every Fibroid Need Surgery?

Published: 5 October 2026 · Medically reviewed by: Op. Dr. Murat Alpay

What are uterine fibroids, which symptoms do they cause, which ones only need follow-up, and when is treatment needed? Medication, interventional and surgical options.

"You have a fibroid in your uterus" is a sentence that makes many women think of surgery and cancer right away. In reality, a fibroid is the most common benign (non-cancerous) mass of the uterus, and in many women it causes no symptoms at all. This article explains what a fibroid is, its types, when it is only followed up, and when it needs treatment. For irregular periods, you can also read our article on irregular bleeding, and for how we evaluate fibroids at the clinic, see our fibroid page.

What Are Uterine Fibroids and How Common Are They?

A fibroid (medically called a leiomyoma or myoma) is a benign mass that grows from the muscle layer of the uterus (the myometrium) and is made of muscle cells and fibrous (fiber-like) tissue. It starts from the multiplication of a single muscle cell.

• Fibroids are found in roughly 20-40% of women of reproductive age; in ultrasound-based screening studies this rate can reach 70-80%.
• Most fibroids cause no complaints, so many women learn about theirs by chance during an ultrasound done for another reason.

Who Gets Them More Often?

Long years of exposure to the hormones estrogen and progesterone play a big role in fibroid growth. Known risk factors include:

• Women of African descent have fibroids 2-3 times more often, and with more severe symptoms, than other women
• Never having given birth or having had few births (having given birth may be protective)
• A history of fibroids in first-degree relatives, such as a mother or sister
• Excess weight, high blood pressure, vitamin D deficiency, and a diet heavy in red meat and low in green vegetables
• Alcohol use

What Types of Fibroids Are There?

Fibroids are grouped by the layer of the uterus in which they sit:

• Intramural (within the uterine wall): Grows in the middle of the muscle wall of the uterus. This is the most common type.
• Subserosal (on the outer surface): Grows toward the outer lining of the uterus. Those attached to the uterus by a stalk are called pedunculated fibroids.
• Submucosal (in the uterine cavity): Extends toward the inner lining (endometrium) and the cavity of the uterus. It makes up about 5% of all fibroids but causes the most noticeable symptoms.
• Rare locations: Fibroids can also develop at the cervix or in the ligaments at the side of the uterus.

The location of a fibroid matters as much as its size: a small submucosal fibroid can cause more symptoms than a large subserosal one.

What Are the Symptoms?

• Heavy and long periods: Clotted, very heavy bleeding lasting for days; over time it can lead to anemia (low blood count), causing fatigue, dizziness and tiring easily.
• Pressure and fullness: Large fibroids can give a feeling of a mass or swelling in the lower abdomen.
• Urinary and bowel symptoms: If a fibroid presses on the bladder, it can cause frequent urination or leaking; if it presses on the bowel, constipation can occur.
• Pain: Ongoing pain in the groin and pelvis, severe period cramps, pain during intercourse. If the blood supply of a fibroid is disturbed (red degeneration), sudden severe pain can occur.
• Difficulty getting pregnant and miscarriages: Mostly seen with fibroids that distort the uterine cavity.

Which Fibroids Do Not Need Treatment?

Fibroids that cause no symptoms, are found by chance and raise no suspicion of cancer need neither medication nor surgery. A "watch and wait" approach is used:

• The number, size and growth rate of the fibroid are followed with regular gynecological exams and usually a yearly ultrasound.
• In women who still have periods, fibroids grow slowly; average growth is reported as about 1.2 cm over 2-3 years.
• After menopause, estrogen levels drop and fibroids usually shrink or stop growing.

In other words, having a fibroid is not by itself a reason for surgery. What decides the plan is how the fibroid affects quality of life.

When Is Treatment Needed?

• Very heavy periods that do not improve with medication and cause anemia
• Signs of pressure on organs, such as blocked urine flow, urinary leakage, swelling of the kidney (hydronephrosis) or severe constipation
• Persistent pelvic pain or pain during intercourse that seriously disrupts daily life
• Fibroids that distort the uterine cavity and make pregnancy difficult or are linked to repeated miscarriages
• Large masses, or suspicious fibroids that grow after menopause

What Are the Treatment Options?

Treatment is planned individually according to the type of symptoms, the size and location of the fibroid, age, and whether a future pregnancy is wanted.

Medication: Medicines do not remove the fibroid completely; they are used to control bleeding, correct anemia or temporarily shrink the fibroid before surgery.

• Hormone-releasing intrauterine device: thins the inner lining of the uterus and reduces bleeding.
• Tranexamic acid: a non-hormonal medicine that helps blood clot during periods.
• Birth control pills and progestin medicines: help reduce the amount of bleeding and period pain.
• Medicines that temporarily suppress the menstrual cycle (GnRH group): create a temporary menopause-like state and can shrink the fibroid by roughly 40-50% and stop bleeding. They are used for short periods, such as 3-6 months before surgery; the effect does not last once the medicine is stopped.

Non-surgical interventional methods:

• Blocking the blood vessels of the uterus (uterine artery embolization): through a thin tube (catheter) inserted via the groin, very small particles are delivered into the vessels feeding the fibroid. Its blood flow is cut off and it shrinks. It is not recommended for women planning a future pregnancy because of the risk of miscarriage and placenta (afterbirth) problems.
• Destroying fibroid tissue with sound waves or heat under magnetic resonance (MR) guidance.

Surgical options:

• Myomectomy (removing only the fibroid and keeping the uterus): Used for women who want to have children or want to keep the uterus. Fibroids inside the uterine cavity can be removed without any incision, through the vagina with a camera (hysteroscopy). Other fibroids can be removed with a closed method through small holes in the abdomen (laparoscopic surgery), or with open surgery when there are many or very large fibroids. With the closed method, recovery is usually quicker and blood loss and pain are lower.
• Hysterectomy (removal of the uterus): Considered for women who have completed their family, have severe symptoms and want a permanent solution. It is the method after which fibroids cannot grow back.

Do Fibroids Turn into Cancer?

Fibroids are almost always benign. Turning into a malignant muscle tumor (leiomyosarcoma), or a mass thought to be a fibroid actually being malignant, is extremely rare; the reported rate is roughly between 1 in 1,000 and 1 in 400. Even so, there are situations in which a doctor should be suspicious:

• A fibroid that suddenly and quickly grows instead of shrinking, especially after menopause
• Irregular blood supply, a mixed appearance and areas of tissue death (necrosis) on ultrasound or MR imaging
• Uncontrolled bleeding and pain that do not respond to hormonal treatment

Fibroids and Pregnancy

• Effect on getting pregnant: Submucosal fibroids that distort the uterine cavity can make it harder for the embryo to implant and can increase miscarriage risk. Intramural fibroids larger than 4-5 cm can also lower the success of pregnancy and IVF. Subserosal fibroids usually do not harm the chance of pregnancy.
• During pregnancy: With rising estrogen and blood flow, fibroids can grow, especially in the first three months; if their blood supply is disturbed, severe abdominal pain (red degeneration) can occur.
• Pregnancy risks: In pregnant women with fibroids, the risk of preterm birth, early separation of the placenta, a baby lying in a breech position, cesarean delivery and bleeding after birth may be higher. For this reason, pregnant women with fibroids are followed more closely.
• Surgery during pregnancy: Because of bleeding risk, fibroid surgery is generally not performed during pregnancy; it is considered only in very special emergencies such as twisting of a pedunculated fibroid.

When Should You See a Doctor?

See an obstetrician-gynecologist without delay if any of the following apply:

• Clotted, very heavy periods that cause dizziness and weakness
• A rapidly growing mass, swelling or fullness in the lower abdomen or groin
• Being unable to urinate, urinary leakage or severe constipation
• Sudden, severe pelvic and groin pain
• New vaginal bleeding after menopause, or a known fibroid found to have grown
• Not getting pregnant despite unprotected intercourse, or repeated pregnancy losses

Frequently Asked Questions

I have a fibroid. Do I definitely need surgery?

No. Fibroids that cause no symptoms and raise no suspicion of cancer do not need surgery; follow-up with regular exams and ultrasound is enough. Treatment is planned according to whether the fibroid affects quality of life.

Does a fibroid go away completely with medication?

No. Medicines do not remove fibroids. They are used to reduce bleeding, correct anemia or shrink the fibroid before surgery.

What happens to fibroids after menopause?

Because estrogen levels drop, fibroids usually shrink or stop growing. A fibroid that grows after menopause, however, is a situation that calls for seeing a doctor.

Do fibroids prevent me from getting pregnant?

Most do not. Fibroids that distort the uterine cavity and large intramural fibroids can make it harder to get pregnant; this is assessed with an exam and imaging.