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Bleeding & pressure

Uterine fibroids

Extremely common, almost always benign — and only worth treating when they are actually causing you trouble.

123
  1. 1Submucosal — inside the cavity — the heaviest bleeding
  2. 2Intramural — within the muscle wall
  3. 3Subserosal — on the outer surface — pressure rather than bleeding

Position matters far more than size.

01

What it actually is

Fibroids are growths of the muscular wall of the uterus. They are not cancer, and the overwhelming majority never become cancer. Many women have them and never know.

What matters is not that a fibroid exists, but where it sits and how big it is. A small fibroid pressing into the cavity of the uterus can cause heavy bleeding and fertility problems, while a much larger one on the outer surface may cause nothing at all. That is why the plan depends on position, not just size on a report.

Fibroids are very common and become more so with age — a substantial proportion of women develop at least one by their late forties. Most cause no symptoms whatsoever.

Pea1 cmPlum4 cmGrapefruit10 cm
A pea sitting inside the cavity can bleed far more than a grapefruit on the outer wall. Position matters more than size.

For general understanding only. These are drawings, including the ultrasound view — they are built from typical measurements to explain the idea, and are not real scan images or a picture of your own baby.

02

What you might notice

  • Heavy periods, flooding, or passing large clots
  • Periods that last longer than they used to
  • Tiredness, breathlessness or pallor from iron deficiency caused by the bleeding
  • A feeling of pressure, heaviness or bloating low in the abdomen
  • Needing to pass urine frequently, or difficulty emptying the bladder
  • Constipation or discomfort opening the bowels
  • Pain during sex, depending on the fibroid's position
  • Difficulty conceiving, or repeated pregnancy loss, with certain positions

Don't wait for an appointment if…

  • Soaking through a pad or tampon every hour for several hours
  • Bleeding heavily enough to cause dizziness or breathlessness
  • Rapid increase in abdominal size
  • Any bleeding after menopause
03

The tests that are actually useful

Not everyone needs every test. This is what each one is for, so you know why it was ordered — or why it wasn't.

A blood testHormones, thyroid and iron — the numbers no scan can show.
An ultrasoundThe shape of the uterus, the thickness of the lining, and the follicles on each ovary.
A camera, sometimesA keyhole look inside, offered only when it would change the plan.

Not everyone needs all three. Each answers a different question — which is why a test you were not offered is often the right call.

Pelvic examinationGives an immediate sense of the size and mobility of the uterus.
Transvaginal ultrasoundThe main tool — maps how many fibroids there are, how big, and crucially where each one sits.
Saline infusion sonography or hysteroscopyUsed when a fibroid may be pushing into the cavity, which is the position that most affects bleeding and fertility.
MRIFor detailed mapping before surgery, particularly with multiple or large fibroids.
Haemoglobin and ferritinHeavy bleeding causes iron deficiency long before it causes anaemia. Both are worth knowing and both are treatable.
04

Treatment, in the order it's usually tried

  1. Start simpleLifestyle, pain relief, or a tablet — whatever is least disruptive to your life.
  2. Add if neededA hormonal option or a longer course, if the first step has not settled things.
  3. A procedureDay-case surgery when medicine cannot fix the structure causing the problem.
  4. Specialist routeFertility treatment or a referral, planned with you rather than sprung on you.

You move up a rung only if the one below it has not done the job — and you can stop at any step you are happy with.

Watchful waiting

No treatment, with a review.

Entirely appropriate for fibroids that are not causing symptoms. Not every finding on a scan needs an intervention.

Managing the bleeding

Tranexamic acid, anti-inflammatories, or a hormonal intrauterine system.

Often enough on its own, and always worth trying before surgery where the main problem is bleeding.

Shrinking before surgery

GnRH analogues for a defined period.

Used to reduce size and correct anaemia before an operation, not as a long-term solution.

Hysteroscopic resection

Removal through the cervix, with no cuts on the abdomen.

The right operation for fibroids sitting inside the cavity. Day-case, quick recovery.

Laparoscopic myomectomy

Keyhole removal of fibroids with the uterus left in place.

Preserves the uterus and fertility. This is minimal access surgery done in-house rather than referred out.

Hysterectomy

Removal of the uterus.

A definitive option, considered only where symptoms are severe, the family is complete, and uterus-preserving options have been properly discussed first.

05

What you were probably told that isn't true

Fibroids are a form of cancer.
They are benign growths of muscle tissue. Cancerous change is rare, and your doctor will tell you if any feature needs a closer look.
Every fibroid has to come out.
Fibroids are treated when they cause symptoms or affect fertility. A fibroid that is doing nothing usually needs nothing.
Fibroids always mean a hysterectomy.
Most women have uterus-preserving options, including keyhole removal.
They will definitely stop you getting pregnant.
It depends entirely on position. Many women with fibroids conceive and carry without difficulty.
Next step

Bring this to someone who has time.

A 25–40 minute consultation, on video, with a doctor who will explain what applies to you specifically — and what doesn't.

This page is general information, not medical advice. Nothing here can diagnose you or replace an assessment of your own history, examination and results. If something here matches what you are experiencing, the next step is a consultation — not a conclusion. If you are in severe pain, bleeding heavily, or feel unwell, seek urgent care rather than waiting for an appointment. Awaiting final clinical review before publication.