Uterine Fibroids · Newport Beach · 2026

Uterine Fibroids Treatment
Types, Symptoms & the Surgical Decision

Understanding your fibroids. Knowing your options. Making the right choice for your body.

Uterine fibroids are the most common benign tumors of the female reproductive tract, but not every fibroid needs treatment. This guide covers fibroid types and their clinical significance, when treatment is warranted, the full range of options from observation to surgery, and the critical decision between myomectomy and hysterectomy — including what matters most for fertility.

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◆ Short Answer

The Canonical Answer

Uterine fibroids (leiomyomas) are benign smooth muscle tumors that affect up to 70–80 percent of women by age 50, though only about 25 percent become symptomatic ACOG PB #228. The most common symptom is heavy menstrual bleeding, which can lead to iron deficiency anemia. Treatment depends on symptom severity, fibroid location and size, and the patient’s reproductive goals. Asymptomatic fibroids require only periodic monitoring. When treatment is needed, options range from medical management (hormonal therapy, tranexamic acid) to procedural interventions (uterine artery embolization) to surgery. The central surgical decision is myomectomy (fibroid removal, uterus preserved) versus hysterectomy (definitive treatment) ACOG PB #228; ACOG CO #701. Neither is inherently superior — the right choice depends on the patient’s goals, particularly regarding fertility and uterine preservation. Malignant transformation is extremely rare (<0.1%) Stewart 2015. At Broad Medical Group, Dr. Jennifer Broad provides individualized fibroid evaluation and treatment for patients in Newport Beach and Orange County.

Medically reviewed by Dr. Jennifer Broad, MD, FACOG Board-Certified Obstetrician-Gynecologist · Newport Beach, CA

Last reviewed: April 2026 Next review: October 2026

Dr. Broad consulting with a patient about fibroid treatment options at Broad Medical Group in Newport Beach

What Are Uterine Fibroids?

Uterine fibroids — also called leiomyomas or simply myomas — are benign (non-cancerous) tumors that arise from the smooth muscle cells of the uterine wall. They are the most common pelvic tumors in women of reproductive age, affecting an estimated 70 to 80 percent of women by age 50. Despite this extraordinary prevalence, only about 25 percent of women develop symptoms significant enough to seek medical care.

Fibroids range in size from tiny seedlings invisible to the naked eye to large masses that can distort the uterus to the size of a full-term pregnancy. They can be single or multiple — it is common to find several fibroids of varying sizes in the same uterus. Their growth is driven primarily by estrogen and progesterone, which is why fibroids typically develop during the reproductive years and tend to shrink after menopause when hormone levels decline.

The exact cause of fibroids remains incompletely understood, but risk factors include age (peak incidence in the 40s), African American race (2–3 times higher incidence and earlier onset), family history, obesity, and nulliparity (never having given birth). Early menarche (first period before age 10) is also associated with increased risk.

Key Fact

Fibroids are not cancer. Malignant transformation of a fibroid into a uterine sarcoma (leiomyosarcoma) is extremely rare — less than 0.1 percent. When uterine sarcomas are found, the current evidence suggests they arise independently rather than from degeneration of existing fibroids. The presence of fibroids should not create fear of cancer. However, any fibroid with unusual characteristics on imaging or rapid, unexplained growth warrants further evaluation.

Fibroids are managed within the broader context of gynecologic care, and when surgery is indicated, modern approaches favor minimally invasive techniques. For details on surgical approaches, technology, and recovery expectations, see our minimally invasive gynecologic surgery guide.

Types by Location

ACOG PB #228 FIGO Classification

The clinical significance of a fibroid depends more on where it is located than on its mere presence. A 2-centimeter submucosal fibroid distorting the uterine cavity can cause debilitating heavy bleeding and infertility, while a 6-centimeter subserosal fibroid may cause no symptoms at all. This is why classification by location is essential for treatment planning.

The FIGO (International Federation of Gynecology and Obstetrics) classification system categorizes fibroids from type 0 through type 8 based on their relationship to the uterine cavity, myometrium, and serosal surface. In clinical practice, the four primary location categories are:

Type	Location	Primary Symptoms
Submucosal	Projects into the uterine cavity (FIGO 0–2)	Heavy menstrual bleeding, infertility — most symptomatic relative to size
Intramural	Within the uterine muscle wall (FIGO 3–5)	Heavy bleeding, pelvic pressure, bulk symptoms — most common type
Subserosal	Outer surface of the uterus (FIGO 6–7)	Pelvic pressure, bladder or bowel compression — may be asymptomatic
Pedunculated	Attached to uterus by a stalk (submucosal or subserosal)	Torsion risk (acute pain), pressure symptoms, or cavity distortion

Anatomical diagram showing fibroid types by location - submucosal, intramural, subserosal, and pedunculated fibroids in cross-section of the uterus — FIGO classification of uterine fibroids by location. Submucosal fibroids cause the most symptoms relative to their size because they distort the uterine cavity.

In practice, many women have fibroids in multiple locations simultaneously. A patient might have a large intramural fibroid causing bulk symptoms alongside a small submucosal fibroid causing heavy bleeding. The treatment plan must account for the entire fibroid burden, not just the largest or most obvious fibroid. Pelvic ultrasound is the first-line imaging study; MRI provides superior detail when surgical planning requires precise mapping of fibroid number, size, and location.

Symptoms: When Fibroids Become a Problem

It bears repeating: most fibroids are asymptomatic. Many women learn they have fibroids incidentally — during a routine pelvic exam or an ultrasound performed for another reason — and never experience a single symptom. However, when fibroids do cause symptoms, those symptoms can range from mildly annoying to severely life-disrupting.

Heavy Menstrual Bleeding (Menorrhagia)

This is the most common symptom of uterine fibroids. Submucosal and large intramural fibroids disrupt the normal contractile ability of the uterine muscle and increase the surface area of the endometrial lining, both of which contribute to heavier and prolonged menstrual flow. Women with fibroid-related menorrhagia often describe periods lasting 7–10 days or longer, soaking through a pad or tampon every hour, passing large blood clots, and needing to use double protection (pad and tampon simultaneously).

Iron Deficiency Anemia

Chronic heavy menstrual bleeding leads to iron deficiency anemia — a condition in which the body’s iron stores are depleted faster than they can be replenished. Symptoms of anemia include fatigue, weakness, shortness of breath with exertion, lightheadedness, and difficulty concentrating. Many women attribute these symptoms to stress or aging rather than recognizing them as a consequence of their heavy periods. Anemia related to fibroid bleeding is one of the clearest indications that treatment — not continued observation — is warranted.

Pelvic Pressure and Bulk Symptoms

Large fibroids, particularly subserosal and intramural types, can cause a sensation of pelvic fullness, heaviness, or pressure. Depending on the fibroid’s position, bulk symptoms include:

Urinary frequency or urgency — fibroid compressing the bladder, reducing its capacity
Difficulty emptying the bladder completely — obstruction of the urethra or bladder neck
Constipation — fibroid compressing the rectum
Lower back pain — large posterior fibroids pressing on spinal nerves
Abdominal distention — very large fibroids (or a significantly enlarged uterus) causing visible enlargement of the abdomen

Pain

Fibroids are not typically painful in the way that endometriosis is painful, but pain can occur in specific scenarios: degeneration (when a fibroid outgrows its blood supply and the tissue begins to break down, causing acute pain), torsion of a pedunculated fibroid (the stalk twists, cutting off blood flow — this is a surgical emergency), and dysmenorrhea (painful periods associated with large intramural fibroids).

Infertility

Submucosal fibroids that distort the uterine cavity are most clearly associated with reduced fertility and increased miscarriage risk. The distortion interferes with embryo implantation and early pregnancy maintenance. This topic is discussed in detail in the fibroids and fertility section below.

Patient Tip

Track your symptoms before your appointment. A menstrual diary — recording the duration of your period, the number of pads or tampons used per day, whether you pass clots, and any associated pain or pressure — gives Dr. Broad objective data to assess the severity of your symptoms and guide treatment decisions. Two to three cycles of tracking is ideal.

Do Fibroids Need Treatment?

Not every fibroid needs treatment. This is one of the most important points to understand. The presence of fibroids on an ultrasound report does not automatically mean you need surgery, medication, or any intervention at all. The decision to treat is driven by symptoms and their impact on quality of life, not by the mere existence of fibroids.

The following framework guides treatment decisions:

Observation (No Treatment)

Asymptomatic fibroids are managed with periodic monitoring, typically an annual pelvic exam and ultrasound to track size and growth. Many women live their entire lives with fibroids that never require intervention. After menopause, declining estrogen levels often cause fibroids to shrink on their own.

When Treatment Is Indicated

Symptoms affect quality of life — heavy bleeding that disrupts daily activities, pelvic pressure that interferes with exercise or daily function, or urinary symptoms that affect sleep
Causing iron deficiency anemia — chronic heavy bleeding has depleted iron stores to the point where the patient is symptomatic or laboratory values are abnormal
Contributing to infertility — specifically, submucosal fibroids distorting the uterine cavity in a woman trying to conceive
Rapid growth raises concern — while rapid growth alone is not diagnostic of malignancy, a fibroid that increases significantly in size over a short period warrants further evaluation with imaging (typically MRI) and clinical discussion

Important

Rapid growth of a fibroid warrants evaluation, not panic. While uterine sarcoma (leiomyosarcoma) is extremely rare, rapid or unexpected growth — particularly in a postmenopausal woman when fibroids should be shrinking — is a reason to pursue further imaging and possibly tissue diagnosis. This is a conversation to have with your gynecologist, not a reason to assume the worst.

Treatment Options: The Decision Framework

When fibroid symptoms warrant treatment, the options span a spectrum from medical management to minimally invasive procedures to surgery. The right approach depends on the patient’s age, symptom severity, desire for fertility, fibroid characteristics (number, size, location), and personal preference. There is no single “best” treatment — there is the best treatment for you.

A. Observation (Watchful Waiting)

As discussed above, asymptomatic fibroids do not require treatment. Monitoring with periodic pelvic exam and ultrasound is the appropriate management. This is not “doing nothing” — it is an active decision supported by evidence that most fibroids never require intervention.

B. Medical Management

Medical therapy does not eliminate fibroids. It controls symptoms, primarily heavy bleeding, while avoiding or delaying surgical intervention. Options include:

Hormonal contraceptives (combined oral contraceptive pills, progestin-only pills, hormonal IUD) — reduce menstrual bleeding and cramping. The levonorgestrel IUD (Mirena) is particularly effective for bleeding reduction in women with fibroids, though it does not shrink them.
GnRH agonists (leuprolide/Lupron) — create a temporary medically induced menopause, causing fibroids to shrink by 30–50 percent. Used primarily as preoperative therapy for 3–6 months before myomectomy to reduce fibroid size, decrease blood loss at surgery, and correct anemia. Not suitable for long-term use due to bone density loss and menopausal side effects.
GnRH antagonists (elagolix/Oriahnn, relugolix/Myfembree) — newer oral medications that reduce heavy menstrual bleeding associated with fibroids. Unlike GnRH agonists, they are combined with low-dose hormonal add-back therapy to minimize bone loss and menopausal symptoms, allowing longer-term use (up to 24 months in clinical trials).
Tranexamic acid (Lysteda) — a non-hormonal antifibrinolytic agent taken during menstruation to reduce heavy bleeding. It does not affect fibroid size or hormonal status. A reasonable option for women who want to avoid hormonal therapy.
Iron supplementation — not a treatment for fibroids, but an essential component of management when heavy bleeding has caused anemia. Oral iron or, in severe cases, intravenous iron infusion may be needed to restore iron stores before surgery.

C. Procedural Interventions

These approaches fall between medical management and surgery:

Uterine artery embolization (UAE) — a minimally invasive procedure performed by an interventional radiologist. Small particles are injected into the uterine arteries to block blood flow to the fibroids, causing them to shrink over the following months. UAE preserves the uterus and avoids the recovery of open surgery. However, UAE is generally not recommended for women who desire future pregnancy, as its effects on uterine blood flow and ovarian reserve are not fully established. Potential complications include post-embolization syndrome (pain, fever, nausea) and, rarely, premature ovarian insufficiency.
MRI-guided focused ultrasound (MRgFUS) — uses high-intensity focused ultrasound waves guided by MRI to heat and destroy fibroid tissue. Non-invasive (no incision), but limited availability, strict size and number restrictions (typically a single fibroid <10cm), and variable long-term outcomes limit its use. Not widely recommended as a first-line option.

D. Surgical Treatment

When fibroids require definitive intervention, the surgical decision centers on two procedures: myomectomy and hysterectomy.

Myomectomy removes the fibroids while preserving the uterus. The surgical approach depends on fibroid characteristics:

Hysteroscopic myomectomy — for submucosal fibroids (FIGO 0–1, some type 2). A camera is passed through the cervix into the uterine cavity; no abdominal incision. The fibroid is resected from inside the uterus. Outpatient procedure with rapid recovery.
Laparoscopic myomectomy — for subserosal and intramural fibroids that are accessible laparoscopically. Small abdominal incisions, minimally invasive, faster recovery than open surgery. May be performed with robotic assistance.
Open (abdominal) myomectomy — for very large fibroids, a large number of fibroids, or fibroids in locations not safely accessible laparoscopically. Requires a larger abdominal incision (similar to a cesarean section) and longer recovery.

Hysterectomy removes the uterus and is the only treatment that guarantees fibroids will not recur. ACOG Committee Opinion No. 701 recommends that when hysterectomy is indicated, a minimally invasive approach (laparoscopic or vaginal) should be used whenever feasible. Open abdominal hysterectomy should be reserved for cases where minimally invasive approaches are not safe or appropriate. For details on surgical approaches and recovery expectations, see our minimally invasive surgery guide.

Clinical Illustration â€" Treatment decision flowchart: Asymptomatic (observe) vs Symptomatic (medical management first, then procedural or surgical based on fertility goals and fibroid characteristics)

Fibroid treatment decision framework. The pathway from observation to intervention depends on symptoms, reproductive goals, and fibroid characteristics.

Myomectomy vs Hysterectomy: The Decision

This is the decision that most patients find most difficult, and it is the one that Dr. Broad spends the most time discussing. Both myomectomy and hysterectomy are effective treatments for symptomatic fibroids, but they represent fundamentally different approaches with different implications.

Neither procedure is “better.” The right choice depends entirely on the patient’s circumstances, values, and goals. Dr. Broad’s role is to ensure you understand both options completely so you can make a decision that aligns with your life.

When Myomectomy Is Preferred

Fertility is desired — myomectomy preserves the uterus, making future pregnancy possible
Patient wants uterine preservation — for personal, cultural, or psychological reasons, independent of fertility goals
Fibroids are surgically accessible — number, size, and location are amenable to complete removal
Patient accepts the possibility of recurrence — fibroid recurrence after myomectomy is approximately 15 to 30 percent within 5 years, meaning that a second procedure may eventually be needed

When Hysterectomy Is Preferred

Childbearing is complete — no future pregnancies are desired
Recurrent fibroids after prior myomectomy — the patient has already undergone fibroid removal but new symptomatic fibroids have developed
Coexisting adenomyosis — a condition in which endometrial tissue grows into the uterine muscle wall, causing pain and heavy bleeding that myomectomy cannot address
Patient prefers definitive treatment — wants the certainty that fibroids will not recur
Massive or numerous fibroids — the uterus is so heavily affected that myomectomy would leave inadequate uterine tissue or carry unacceptable surgical risk

Recurrence After Myomectomy

One of the most important counseling points is that myomectomy is not necessarily a permanent solution. Studies report that 15 to 30 percent of women will develop new fibroids or experience growth of residual fibroids within 5 years of myomectomy. The recurrence rate is higher when multiple fibroids were present at the time of surgery. Some women with recurrence remain asymptomatic, while others may eventually require a second myomectomy or proceed to hysterectomy.

This is not a reason to avoid myomectomy — it is a reason to go into the decision with realistic expectations. For women who need uterine preservation, myomectomy is the right choice even knowing that future intervention may be needed.

ACOG Guideline

ACOG Committee Opinion No. 701 recommends that minimally invasive hysterectomy (laparoscopic, robotic-assisted, or vaginal) should be performed whenever feasible, as it is associated with shorter hospital stays, fewer complications, less postoperative pain, and faster return to normal activity compared to open abdominal hysterectomy. The same minimally invasive principles apply to myomectomy when fibroid characteristics permit.

Fibroids and Fertility

The relationship between fibroids and fertility is nuanced. Not all fibroids affect the ability to conceive or carry a pregnancy — the critical factor is whether the fibroid distorts the uterine cavity.

Which Fibroids Affect Fertility?

Submucosal fibroids (cavity-distorting) — the strongest evidence links submucosal fibroids to reduced conception rates and increased miscarriage risk. These fibroids alter the endometrial surface where embryo implantation occurs, and may disrupt the normal vascular and biochemical environment needed for early pregnancy.
Large intramural fibroids (>4cm) — may affect fertility even without directly protruding into the cavity, particularly when they distort the uterine contour or obstruct the fallopian tube ostia. The data are less definitive than for submucosal fibroids, but many reproductive endocrinologists consider removal when intramural fibroids exceed 4 centimeters in a woman with otherwise unexplained infertility.
Subserosal fibroids — on the outer surface of the uterus. Generally do not affect fertility unless they are very large and causing significant compression or distortion.

Does Removing Fibroids Improve Pregnancy Rates?

For cavity-distorting fibroids, the evidence supports removal. Studies consistently show that removing submucosal fibroids via hysteroscopic myomectomy improves pregnancy rates and reduces miscarriage rates. For intramural fibroids, the evidence is more mixed but suggests benefit when fibroids are large (>4cm) or when no other cause of infertility is identified.

Planning: From Myomectomy to Conception

When myomectomy is performed for fertility purposes, the typical timeline is:

Myomectomy — performed via hysteroscopy (submucosal) or laparoscopy/laparotomy (intramural)
Waiting period — typically 3 to 6 months after surgery before attempting conception, to allow the uterus to heal fully. The waiting period is longer for open or laparoscopic myomectomy (where the uterine wall was entered) than for hysteroscopic myomectomy.
Conception attempts — natural or assisted (IVF) as appropriate for the patient’s overall fertility picture

Delivery After Myomectomy

Whether a cesarean delivery is recommended after myomectomy depends on the depth of myometrial entry during the surgery. If the myomectomy involved a deep incision into the uterine wall (particularly a full-thickness entry into the uterine cavity), most providers recommend cesarean delivery due to the theoretical risk of uterine rupture during labor. Hysteroscopic myomectomy, which does not involve incision through the outer uterine wall, does not typically require cesarean delivery. This is discussed with each patient at the time of myomectomy so that delivery planning can begin early.

Key Takeaways

Uterine fibroids affect up to 70–80% of women by age 50, but only about 25% become symptomatic. They are benign, and malignant transformation is extremely rare (<0.1%).
Location determines clinical significance — submucosal fibroids cause the most symptoms relative to size; subserosal fibroids may cause none at all.
Not every fibroid needs treatment. Asymptomatic fibroids are monitored with periodic exams and imaging. Treatment is driven by symptoms and quality of life, not by size alone.
Medical management controls symptoms but does not eliminate fibroids. Hormonal therapies, GnRH agonists/antagonists, and tranexamic acid are first-line for bleeding control.
The central surgical decision is myomectomy vs hysterectomy. Myomectomy preserves the uterus (and fertility) but carries 15–30% recurrence within 5 years. Hysterectomy is definitive.
Submucosal fibroids have the clearest impact on fertility. Removal of cavity-distorting fibroids improves pregnancy rates. After myomectomy, a 3–6 month waiting period before conception is typical.
ACOG recommends minimally invasive approaches for both myomectomy and hysterectomy when feasible, with faster recovery, fewer complications, and less postoperative pain.

References & Clinical Sources

American College of Obstetricians and Gynecologists. Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas. Obstetrics & Gynecology, 137(6), e100–e115. 2021.
American College of Obstetricians and Gynecologists. Committee Opinion No. 701: Choosing the Route of Hysterectomy for Benign Disease. Obstetrics & Gynecology, 129(6), e155–e159. 2017. Reaffirmed 2021.
Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Human Reproduction Update, 22(6), 665–686. 2016.
Stewart EA. Uterine fibroids. New England Journal of Medicine, 372(17), 1646–1655. 2015.
AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Submucous Leiomyomas. Journal of Minimally Invasive Gynecology, 19(2), 152–171. 2012.
Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertility and Sterility, 91(4), 1215–1223. 2009.

Related Resources

Uterine Fibroids. Understood and Treated.

Living with fibroid symptoms or facing a treatment decision? Dr. Broad provides individualized fibroid evaluation — from initial imaging through treatment planning and surgical care — for patients in Newport Beach and Orange County.

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Broad Medical Group — Newport Beach, California

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Consult Dr. Jennifer Broad or your healthcare provider for guidance specific to your situation. Current as of April 2026. If you are experiencing a medical emergency, call 911 immediately.