Fibroids: when they need treatment – and when they don't
Uterine fibroids: symptoms, treatment, is surgery needed? – gynaecologist Basel
FMH Gynecology
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SGGG
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Colposcopy diploma
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Spalenvorstadt 3
4051 Basel
Fibroids are benign nodules of muscle and connective tissue in the wall of the uterus. They are hormone-dependent, grow during the fertile years and usually shrink after menopause. Whether a fibroid causes symptoms depends less on its size than on its location.
The diagnosis «fibroid» often causes more fear than the finding deserves. Very many fibroids stay silent for life. At the same time, fibroids are operated on more often than necessary.
By the age of 50 a large proportion of women have at least one fibroid – most of them never know.
Key facts
At a glance.
- Fibroids are benign; malignant change is a rarity.
- Without symptoms, follow-up is the right treatment, not surgery.
- Location decides the symptoms, not size alone.
- Heavy bleeding and iron deficiency are the most common consequences needing treatment.
- Medical and uterus-preserving options exist before any hysterectomy.
- After menopause fibroids usually shrink – growth after menopause needs assessment.
Causes
Background and risk factors.
Fibroids arise from a single muscle cell of the uterine wall and grow under the influence of oestrogen and progesterone. By location we distinguish submucosal fibroids (bulging into the cavity – causing the heaviest bleeding and interfering with implantation), intramural fibroids (within the wall) and subserosal fibroids (growing outwards – causing pressure rather than bleeding).
Risk factors
- Family history
- Early first period
- No pregnancies
- Overweight
- African ancestry (more frequent and earlier)
Frequency
Fibroids are among the most common benign tumours in women. The majority cause no symptoms.
Symptoms & findings
How does it present?
Typical symptoms
- Heavy or prolonged periods, clots
- Bleeding between periods
- Fatigue and reduced performance from iron deficiency
- Pressure in the lower abdomen, bloating
- Frequent urination or constipation with large fibroids
- Pain during intercourse
Common incidental findings
- Incidental ultrasound finding without any symptoms
- Palpable finding on examination
When to assess promptly
Rapid growth, new pain, growth after menopause or bleeding after menopause need prompt assessment. Acute severe pain may indicate fibroid infarction or torsion.
Diagnostics
How the diagnosis is made.
Transvaginal ultrasound is the decisive examination
it shows number, size and – more importantly – the location of the fibroids relative to the uterine cavity. With heavy bleeding we add a full blood count and ferritin. Hysteroscopy clarifies submucosal fibroids and the endometrium. MRI is needed only in selected cases, for example before planned embolisation or with unclear findings.
Examinations
- Consultation and bleeding history
- Transvaginal ultrasound
- Full blood count and ferritin
- Hysteroscopy if a submucosal fibroid is suspected
- MRI only for specific questions
What do the findings mean?
A fibroid on its own is not a diagnosis that must be treated. Symptoms are treated. For symptom-free fibroids, a check in six to twelve months is usually enough.
Treatment
Possible approach.
Watchful waiting
Symptom-free fibroids are observed. That is not a compromise but the evidence-based recommendation: there is no benefit in removing a silent fibroid, and every uterine operation carries risk. After menopause fibroids usually shrink.
Medication
- For heavy bleeding, tranexamic acid and NSAIDs work on bleeding days
- A hormonal IUD markedly reduces blood loss if the cavity is not too distorted. Iron deficiency is treated specifically – with tablets or an infusion. Medication shrinks fibroids only temporarily
- After stopping they usually grow again
Surgery
Submucosal fibroids can often be removed by hysteroscopy. Larger intramural fibroids may be suitable for myomectomy (uterus-preserving) or embolisation. Hysterectomy is effective but final and should only be discussed once uterus-preserving options have been considered.
Important for you
we do not operate on fibroids – our contribution is assessment, interpretation and an independent second opinion, followed by targeted referral.
Prevention
What you can do yourself.
- Have ferritin measured with heavy bleeding instead of accepting fatigue
- Have symptom-free fibroids checked annually
- Before proposed surgery, have the fibroid's location and the alternatives explained
- With a wish for children, clarify the relation to the uterine cavity
- Always assess bleeding after menopause
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
Related topics
Keep reading.
- Premium check-up with ultrasound
Sizing and follow-up with high-resolution ultrasound.
- What we deliberately don't do
- Heavy periods
- Endometriosis & adenomyosis
- Gynaecological ultrasound
Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
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