Fibroids (leiomyomas) are benign nodules made of the smooth muscle of the wall of the womb. They grow slowly, they do not spread, and they are neither cancer nor a precursor of cancer. They range in size from barely visible to as big as a grapefruit — but size says little about how much a fibroid will trouble you.¹
The reassuring part first. Fibroids are among the commonest incidental findings at a routine gynaecological check. Without symptoms, a fibroid as a rule needs no treatment — not even when the report makes it sound large. What gets treated is symptoms, not ultrasound images.
There is a reason for that restraint: fibroids depend on hormones. They grow under oestrogen and progesterone and usually shrink again once hormone production falls away after the menopause. The point of treatment is to make the time until then bearable, not to remove every nodule.
The main conditions to tell them apart from are endometriosis and adenomyosis. Both can be present as well — which explains why some women are not free of symptoms after treatment for fibroids.
2. Where a fibroid sits: the types compared
For symptoms, position matters more than size: a small fibroid beneath the lining can make bleeding dramatically heavier, while a larger one on the outer surface can go unnoticed for years.¹,²
Type
Position
Typical symptoms and what stands out
Submucosal fibroids
Beneath the lining, bulging into the cavity of the womb
Heavy, prolonged bleeding, bleeding between periods, anaemia. Often very troublesome even when small, and the most relevant type if you want to become pregnant
Intramural fibroids
In the middle of the muscle wall
Heavier bleeding, cramping pain, a feeling of pressure. The commonest type
Subserosal fibroids
Growing outwards towards the abdominal cavity
Pressure on the bladder and bowel, bleeding often normal. Fibroids on a stalk can rarely twist — which causes acute pain
Cervical fibroids
In the neck of the womb
Pressure symptoms, pain during sex, rarely obstruction of urine flow. Uncommon, and more demanding to operate on
Table scrolls to the right
Where there are several fibroids, this is called a uterus myomatosus. One rule of thumb covers all the types: the closer to the cavity of the womb, the more it affects bleeding.
3. Symptoms and consequences
The typical symptoms
Heavier and longer periods — bleeding for more than seven days, soaking through a pad or tampon in under two hours, larger clots.
Pressure on the bladder and bowel — needing to pass water often, a feeling that the bladder has not emptied, passing water at night, constipation.
Lower abdominal pain — from a dull feeling of heaviness through to cramping abdominal pain; acute, very severe pain can point to a disturbance of the blood supply within a fibroid.
Difficulty conceiving, or miscarriage — above all with submucosal fibroids.
Why the bleeding is the real problem
Many women take a heavy period to be normal, because they have never known anything else. But chronic blood loss empties the iron stores, and the body gets used to a low haemoglobin level so gradually that the exhaustion ends up being put down to stress. That is why heavy bleeding always calls for a full blood count with ferritin: understanding blood values.
When you should not wait and see. Very heavy bleeding with dizziness or a feeling that you might faint, and sudden severe lower abdominal pain, need medical help straight away. Bleeding after the menopause and a rapidly growing fibroid belong promptly in a gynaecological assessment.
4. Causes and risk factors
Why a muscle cell starts multiplying into a fibroid has not been finally explained. Genetic changes play a part, and the growth is driven by hormones.²,³
Hormones — oestrogen and progesterone encourage growth; that is why fibroids grow during the fertile years and shrink afterwards.
Age and predisposition — they become more common up to the end of the fertile years, and they run in families.
Ethnic background — women of African descent are affected more often and often earlier; the reasons are unclear.
Body weight — being overweight is regarded as contributing. There is no reliable evidence for any “fibroid diet”.
Pregnancy as a protective factor — pregnancies carried to term go with a lower risk.
The medication angle. On current understanding, the contraceptive pill does not cause fibroids. On hormone replacement therapy, by contrast, existing fibroids can grow again a little — a reason for check-ups, but usually not a reason to go without.
5. Diagnosis: ultrasound rather than surgery
The diagnosis is usually made without any procedure: a vaginal ultrasound reliably shows the number, size and position of the fibroids.¹
History and examination: how long and how heavy the bleeding is, pressure symptoms, whether you want to have children, current medicines; the size and shape of the womb.
Vaginal ultrasound: number, size, position and distance from the cavity of the womb.
Full blood count and ferritin: a must with heavy bleeding, so that anaemia and empty iron stores are not missed.
Hysteroscopy: where a submucosal fibroid is suspected; small fibroids can often be removed during the same procedure.
And then the question that comes up almost every time: could this be malignant? Malignant muscle tumours of the womb are very rare, and on current understanding a fibroid does not turn into one. What makes doctors take a closer look is rapid growth, and growth after the menopause.
6. Treatment: waiting, treating, operating
Treatment follows how much you are suffering, where the fibroids sit, your age and whether you want children — not the number of centimetres in the report. The decision is always made by the treating practice together with you, and it may come in stages: the gentlest option first, more later.
First lineWaiting and watching
Monitoring instead of treatment
Where there are no symptoms or only mild ones, this is a full option in line with the guideline — not a makeshift. Ultrasound checks at agreed intervals are usual.
A bleeding diary
So that “watching” does not mean guesswork at the next appointment: note down bleeding days, how heavy they were, and pain.
Second lineMedication: getting the bleeding under control
The hormonal coil (levonorgestrel IUS)
For many women the most effective option with medication: it keeps the lining thin and markedly reduces the amount of blood lost. It does not make the fibroids smaller, and it does not sit securely if the cavity is badly distorted.
Tranexamic acid
Taken on bleeding days only, it markedly reduces the amount of blood lost. It is not hormonal and does nothing for pain. Caution where there is a tendency to thrombosis.
NSAIDs (e.g. ibuprofen, naproxen)
They work in two ways: against period pain and, to a lesser extent, against the amount of blood lost. According to the product information, for as short a time and at as low a dose as possible.
Iron supplements
These treat the consequence: the empty iron stores.
Third lineProcedures: organ-preserving ones first
Fibroid removal, embolisation, focused ultrasound
Where medicines are not enough. All three preserve the womb, but they differ in how demanding they are, in recovery time and in how often fibroids come back.
Removal of the womb (hysterectomy)
It ends fibroids for good — a final step, and only once family planning is complete.
What actually steers the decision. Three questions help more than any measurement: what bothers you most — bleeding, pressure or pain? Do you want to become pregnant? And how far away are you from the menopause?
7. Medicines for fibroids
The honest starting point: there is no medicine that makes fibroids disappear for good. Medicines treat the symptoms — above all the bleeding — or prepare the ground for an operation. For many women that is exactly enough.
For bleeding and pain
The hormonal coil works for years without your having to think about it daily. Tranexamic acid is taken on bleeding days only and does not interfere with your hormones — often the right choice if you would rather avoid them. The pill, too, makes bleeding more predictable, but it does not shrink fibroids. Ibuprofen and naproxen ease the cramps and reduce the amount of blood lost somewhat; they do not, however, belong in months of continuous use, because the stomach, the kidneys and blood pressure all react sensitively — see side effects of medications.
For the anaemia
Where iron deficiency has been confirmed, iron supplements are used, and in marked cases given as an infusion. Patience matters here: the stores fill up over months, not days — and treatment is often stopped too early. There is practical advice in the guide iron deficiency.
GnRH analogues: powerful, but only for a limited time
GnRH analogues put the body into an artificial menopausal state for a while: fibroids shrink noticeably and the bleeding usually stops — but at the cost of hot flushes, sleep problems and, with longer use, loss of bone density. That is why they are as a rule used only for a limited period, to prepare for an operation; afterwards the fibroids usually grow again.¹,²
Ulipristal acetate: only in narrowly defined exceptions. After reports of severe liver damage, the European Medicines Agency severely restricted its use: it only comes into question where surgery and other procedures are unsuitable, and it requires close monitoring of liver values. If your skin or eyes turn yellow, your urine goes dark or you have pain in the upper abdomen, discuss it with a doctor immediately.
Do not change anything on your own. Do not stop a hormonal coil, a contraceptive or a GnRH analogue off your own bat — what an orderly withdrawal looks like is described in stopping medications. If you have very heavy bleeding with dizziness, a racing heart or a feeling that you might faint, please go to an emergency department straight away.
Iron supplement, painkiller, hormonal coil — all in one place
brite reminds you to take them and shows you the pattern over months.
Hysterectomy is the only method after which no new fibroids can form — but it is rarely the only possible route.¹,⁴
Procedure
Principle
The womb
An honest assessment
Myomectomy (hysteroscopic)
Removal through a hysteroscopy, without an incision
Preserved
The procedure of choice for submucosal fibroids; short recovery, very good effect on bleeding
Myomectomy (laparoscopic/open)
Shelling the fibroid out by keyhole surgery or through an incision
Preserved
First choice if you want children; new fibroids can grow back
Fibroid embolisation (UAE)
A catheter blocks off the vessels supplying the fibroid
Preserved
No incision, short recovery; several days of cramping pain are typical. Judged with caution if you want children
Focused ultrasound (MRgFUS)
Bundled waves heat the fibroid under MRI guidance
Preserved
No incision and no anaesthetic, but only for selected positions; rarely available, and often not covered by statutory health insurance
Hysterectomy
Removal of the womb, usually leaving the ovaries
Removed
Final: no bleeding, no new fibroids. A bigger operation, and only once family planning is complete. If the ovaries stay, the menopause does not start early
Table scrolls to the right
One point that often gets lost: with all the organ-preserving procedures, new fibroids can form — and the younger you are and the more nodules there were, the more likely that is.
Ask specific questions — and take your time. Fibroids are almost never an emergency. Three questions are worth asking: which symptom is the procedure meant to get rid of? Which organ-preserving alternatives come into question for the fibroids I have? And what happens if I wait? Before a planned hysterectomy a second opinion is expressly usual — see preparing for a doctor's appointment.
9. Fibroids, wanting a child, and the menopause
If you want to become pregnant
Most fibroids do not stand in the way of a pregnancy. What matters above all are submucosal fibroids that distort the cavity of the womb — removing them demonstrably improves the chances. With intramural fibroids that do not touch the cavity, the benefit of an operation is less clear; here the decision is made individually, often at a fertility centre.
What happens at the menopause
As ovarian function declines the hormonal stimulus falls away — and fibroids usually shrink and stop causing symptoms. That is exactly what the wait-and-see approach from the mid-forties onwards is aiming at: sometimes it makes more sense to control the bleeding with medication for another two or three years than to operate. If you take hormones afterwards, fibroids can grow slightly again; the trade-off is described in hormone replacement therapy.
Bleeding after the menopause is never normal. Any bleeding more than a year after your last period belongs promptly in a gynaecological assessment — whether or not fibroids are known about.
10. Everyday life with fibroids: keeping bleeding and iron levels in view
The biggest lever in everyday life is an unspectacular one: writing things down. Fibroids change slowly, symptoms vary from cycle to cycle, and nobody remembers six months precisely in the consulting room. Bring numbers with you and you get a better decision.
Keep a bleeding diary — bleeding days, how heavy (the number of pads or tampons changed per day), clots, soaking through at night. That turns “quite heavy” into something solid.
Collect your iron levels over time — note haemoglobin and ferritin with the date. Only the series shows whether the treatment is working: understanding blood values.
Take iron consistently — keep going for weeks, not just on bad days. Tips for tolerating it are in the guide iron deficiency.
Take exhaustion seriously — persistent tiredness or breathlessness when climbing stairs is not a question of character but often a laboratory finding.
If you take several preparations, it is worth a look at interactions — iron goes badly with thyroid hormones taken at the same time.
Six months of bleeding records instead of “quite heavy”
With brite you bring numbers rather than memories to your next appointment.
No. A fibroid without symptoms is as a rule an incidental finding that is watched rather than treated — even when it is on the larger side. What gets treated is symptoms such as heavy bleeding, pressure on the bladder or bowel, and pain. The decision is made by the treating practice together with you.
Usually not completely, but they do as a rule shrink markedly, because the hormonal stimulus falls away; symptoms often ease as a result. That is why, shortly before the menopause, the usual approach is to wait at first and treat only the bleeding.
There is no medicine that makes fibroids disappear for good. GnRH analogues make them shrink temporarily, but because of the side effects they are mostly used only for a limited period to prepare for an operation; afterwards the fibroids usually grow again. All the other medicines mainly treat the bleeding.
In most cases yes. The problematic ones are above all fibroids that distort the cavity of the womb — removing them improves the chances. With fibroids in the muscle wall that do not touch the cavity, the decision is made individually, often together with a fertility centre.
It is rarely the only option. It comes into consideration once family planning is complete, the symptoms remain severe and organ-preserving procedures are unsuitable or have not worked. Because the step is final, thorough discussion and, where appropriate, a second opinion make sense.
Heavy blood loss over many months empties the iron stores and leads to anaemia. Tiredness, breathlessness on exertion, pallor and palpitations are typical. That is why a heavy period calls for a full blood count and a ferritin level — not just an ultrasound.
German S2k guideline on the diagnosis and treatment of uterine fibroids (DGGG/OEGGG/SGGG, AWMF reg. no. 015-070) — German source. awmf.org
Gesundheitsinformation.de, German Institute for Quality and Efficiency in Health Care (IQWiG): Uterine fibroids. Accessed 2026 — German source. gesundheitsinformation.de
gesund.bund.de, the national health portal of the German Federal Ministry of Health: Fibroids of the womb. Accessed 2026 — German source. gesund.bund.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Very heavy bleeding with dizziness or circulatory weakness, and sudden severe lower abdominal pain, need immediate medical help — in an emergency call 112 (emergency services in Germany); any bleeding after the menopause belongs promptly in a gynaecological assessment. The choice of medicine and its dose is always decided individually by the treating practice. Last updated: August 2026.
