Uterine Fibroids: Do They Always Need Surgery?

Medically reviewed by Dr Manan Boob — MBBS (KEM), MS ObGyn (Gold Medalist), DNB, Consultant Gynaecologist & Laparoscopic Surgeon, Shubham Hi-Tech Hospital and Test Tube Baby Centre, Amravati.

A sonography report lands in someone’s hand and one word does all the damage: fibroid. By the time she reaches my room she has read a dozen pages on her phone, decided she needs an operation, and worked out who will look after the children while she is in hospital.

Then I ask what symptoms she has, and very often the answer is: none.

That conversation happens most weeks, so let me put the important part first. A fibroid is a finding, not a decision to operate. Many women carry one for years without ever needing surgery, and some never learn they had one at all.

What a fibroid actually is

A fibroid — myoma, or the gaanth most patients call it — is a firm, non-cancerous growth arising from the muscle wall of the uterus. Fibroids are hormone-sensitive, which is why they show up in the reproductive years, can grow during pregnancy, and usually shrink quietly after menopause.

Two things about them surprise people. They are almost always benign, and turning cancerous is genuinely rare. And having one does not mean you will ever get symptoms from it.

Position matters far more than size

This is the part that gets lost, and it changes everything.

What a fibroid does to you depends much less on its diameter than on where it sits in the wall of the uterus.

• Submucosal — bulging into the cavity, where a pregnancy would sit. These are the troublemakers. Even a small one can cause heavy bleeding or get in the way of conception.
• Intramural — within the muscle wall itself. The commonest type. Small ones are often silent; larger ones bring heaviness, pressure and pain.
• Subserosal — growing outwards from the outer surface. These can reach a surprising size while doing nothing worse than pressing on the bladder or bowel.

So when a report says “4 cm fibroid” and you feel perfectly well, that number on its own tells us very little. I would far rather know what your periods have been doing.

“My report says 5 cm. My neighbour had surgery for a 3 cm one. Why is mine being left alone?”

Because her 3 cm fibroid was probably sitting inside the cavity and flooding her every month, while yours is in the outer wall minding its own business. Two fibroids with the same measurement can need completely different answers. Comparing reports with friends and relatives causes a great deal of unnecessary fear.

When watching really is the right answer

If the fibroid was found by accident, your periods are normal, you have no pain or pressure and you are not struggling to conceive, the honest recommendation is usually observation — a repeat scan after some months, and an open door if symptoms appear.

That is not neglect. Operating on a fibroid that is causing no trouble takes on the risks of surgery for no gain. Closer to menopause the case for leaving it alone is stronger still, because falling hormone levels often do the shrinking for us.

When it does need treating: a quick self-check

Book an appointment if any of these fit you:

• Periods heavy enough to soak through protection hourly, or clots larger than a rupee coin
• Bleeding lasting more than about a week, or coming between cycles
• Tiredness, breathlessness or palpitations — the quiet signs of low haemoglobin
• Constant pelvic pressure, a swollen lower abdomen, or pain during intimacy
• Passing urine very frequently, or difficulty emptying the bladder or bowels
• A year of trying to conceive without success, or repeated early pregnancy loss
• Rapid growth of a known fibroid, or any bleeding after menopause

The third one is the one women dismiss for years. Slow blood loss month after month drains iron so gradually that exhaustion starts to feel like ordinary life. Treating the fibroid and correcting the anaemia often hands back energy a woman had forgotten she was missing. If your cycle has become unpredictable as well, our guide to irregular periods covers the other causes worth ruling out.

What comes before surgery

There is a whole ladder here, and the operating theatre sits at the top of it, not the bottom.

Medicines. Tranexamic acid and anti-inflammatories taken during your period can meaningfully reduce the bleeding. Iron treats the anaemia that has usually built up alongside it.

Hormonal treatment. A hormone-releasing IUD placed inside the uterus controls heavy bleeding well in selected women, particularly where the cavity is not distorted. Hormone tablets have a role too.

Hysteroscopic removal. For a fibroid bulging into the cavity, a telescope passed through the natural passage can shave it away with no cuts on the abdomen at all, usually as a day procedure. Our diagnostic and operative hysteroscopy page explains how that works.

Myomectomy. Removing the fibroids and keeping the uterus. This is the operation for a woman who wants to conceive, or who simply wants to keep her uterus, and by the keyhole route it means small incisions and a quick return to normal life — see laparoscopic myomectomy.

Hysterectomy. Removing the uterus ends the problem permanently and is a fair choice when the family is complete and symptoms are severe. It should be a considered decision, never a first suggestion. Our guide to hysterectomy and the laparoscopic option goes through it properly.

“I haven’t had children yet. Will the fibroid stop me, and will surgery damage my uterus?”

Most fibroids do not prevent pregnancy. The ones that interfere are usually those distorting the cavity, and those are precisely the ones worth removing before you start trying. As for damage — a myomectomy is repair work, done to give the uterus a better chance, and stitching the muscle back securely is the part we take the most care over. What I will not do is remove a fibroid sitting harmlessly in the outer wall and call it fertility treatment.

Myth versus fact

Myth: Fibroids turn into cancer if you leave them. Fact: Malignant change is rare. What we do keep an eye on is unusually rapid growth, or growth after menopause — that is what the follow-up scan is for.

Myth: A particular diet or oil will dissolve them. Fact: Nothing eaten or applied has been shown to shrink a fibroid. Eating well and correcting anaemia will make you feel considerably better, which is worth doing, but it is not removing anything.

Myth: Once you have fibroids, hysterectomy is only a matter of time. Fact: For most women it never comes to that.

What to expect at your appointment

Bring your previous scans and a rough note of your last few cycles — how many days, how heavy, whether you are passing clots. It helps far more than people expect. A recent haemoglobin report is useful too.

We will examine you and usually repeat or review a pelvic ultrasound, because we need to see the position of each fibroid rather than only a measurement. Then we talk about what your symptoms are actually costing you: sleep, work, travel, the days each month you write off. That, much more than the size printed on the report, decides what happens next.

Plenty of women leave that consultation with a plan involving no surgery at all. If you have been handed a scan report with the word fibroid on it and nobody has explained what it means for you, the gynaecology team at Shubham Hi-Tech Hospital and Test Tube Baby Centre in Amravati will sit down and go through it with you. Call +91-8668954915 or reach us through our contact page.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.