Fibroids are non-cancerous growths that develop in or around the womb. They are extremely common, most cause no trouble at all, and when they do cause symptoms there is a good range of treatments. This page covers what they are, how they are found, and what can be done about them.

What fibroids are

A fibroid is a firm growth made of muscle and fibrous tissue that develops in the wall of the womb. They can be as small as a pea or, occasionally, large enough to be felt in the abdomen. Most women who have them have more than one.

Fibroids are not cancer, and having them does not increase your risk of cancer of the womb.

Their growth depends on oestrogen, which explains a good deal about their behaviour: they tend to appear during the reproductive years, may enlarge in pregnancy, and usually shrink after the menopause.

How common are they?

About 1 in 4 women develop fibroids that cause symptoms or are picked up because of them.1

The true figure is far higher. When women are scanned regardless of symptoms, fibroids are found in a very large proportion — cumulative studies suggest up to around 7 in 10 women by the age of 50.2 The difference between the two numbers is simply this: most fibroids never cause any problem, and most women who have them never know.

So if a scan has picked up a fibroid incidentally, that finding on its own is not a cause for alarm.

Symptoms

Fibroids cause symptoms depending mainly on where they sit rather than how big they are. A small fibroid bulging into the cavity of the womb can cause far more bleeding than a large one on the outer surface.

The common symptoms are:

  • Heavy periods, sometimes with clots, and periods that go on longer
  • Periods that are painful or that drag
  • Tiredness and breathlessness from anaemia caused by heavy bleeding
  • A feeling of pressure or fullness in the lower abdomen
  • Needing to pass urine more often, if a fibroid presses on the bladder
  • Constipation, if one presses backwards on the bowel
  • Discomfort during sex
  • Difficulty conceiving, or repeated miscarriage — uncommon, and only with certain fibroid positions

How they are diagnosed

Most fibroids are found in one of two ways: during an examination, or on an ultrasound scan.

  • Pelvic examination may suggest an enlarged or irregular womb.
  • Ultrasound scan is the main test. A scan through the vagina gives the clearest picture of the womb and of where each fibroid sits.
  • Hysteroscopy — a thin telescope passed into the womb — is used when a fibroid inside the cavity is suspected as the cause of heavy bleeding.
  • MRI is occasionally used before surgery when a detailed map is needed.

A blood count is also worth doing if your periods are heavy, because anaemia is common and easily missed.

Treatment options

The right treatment depends on your symptoms, your age, whether you want children in the future, and the size and position of the fibroids. There is rarely only one reasonable answer.

If there are no symptoms

No treatment is needed. Fibroids that are not causing problems can simply be left alone and reviewed if symptoms develop. Surgery is not performed on a fibroid just because it is there.

Medicines

Medicines do not make fibroids disappear, but they control symptoms well for many women — particularly heavy bleeding.3

  • Tranexamic acid, taken during the period, to reduce blood loss
  • Anti-inflammatory painkillers for pain and bleeding
  • Hormonal treatments, including the hormone-releasing coil (which is well suited to some women but not where fibroids distort the cavity of the womb) and hormonal pills
  • Iron tablets, if you are anaemic

Surgery

  • Myomectomy — removing the fibroids and leaving the womb in place. This is the option for women who want to keep the possibility of pregnancy. It can often be done through keyhole surgery — see our article on laparoscopic myomectomy.
  • Hysterectomy — removing the womb. This is the only treatment that guarantees fibroids will not come back, and it is an option for women who have completed their family. See laparoscopic hysterectomy.
  • Hysteroscopic removal — fibroids sitting inside the cavity of the womb can sometimes be removed through the vagina, with no cut at all.

Uterine artery embolisation

This is a non-surgical procedure in which the blood supply to the fibroids is blocked, causing them to shrink. It is a genuine option, but it is not widely available in Sri Lanka — it is offered only in selected centres, and requires referral. If it is something you would like to consider, do raise it and it can be discussed.

Fibroids and pregnancy

Most women with fibroids conceive normally and have straightforward pregnancies. Fibroids only interfere with fertility in particular circumstances — mainly when they distort the cavity of the womb.

In pregnancy, fibroids sometimes grow, and they can occasionally become painful (a condition called red degeneration). This settles with rest and simple painkillers. Depending on their position, they may affect how the baby lies or how delivery is planned, and your obstetrician will discuss this with you.

When to see a doctor

Please make an appointment if you have:

  • Periods heavy enough to disrupt your daily life — flooding, clots, changing protection very frequently
  • Bleeding between periods or after sex
  • Persistent pelvic pain or pressure
  • Tiredness, breathlessness or dizziness suggesting anaemia
  • Difficulty conceiving after a year of trying, or six months if you are over 35
  • Any bleeding after the menopause — this always needs assessment, whether or not you have fibroids

The takeaway

Fibroids are very common and usually harmless. If they are not troubling you, they can be left alone. If they are, the options run from simple tablets to keyhole surgery, and the right choice depends on your symptoms and your plans rather than on the size of the fibroid alone.

References

  1. NHS. Fibroids [Internet]. London: NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/conditions/fibroids/
  2. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–7. Available from: https://pubmed.ncbi.nlm.nih.gov/12548202/
  3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management (NG88) [Internet]. London: NICE; [cited 2026 Jul 22]. Available from: https://www.nice.org.uk/guidance/ng88