Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
What exactly are uterine fibroids, and are they dangerous?
Fibroids are benign (non-cancerous) tumours that arise from the smooth muscle cells of the uterine wall. They are not cancer, do not become cancer in the overwhelming majority of cases, and often cause no symptoms at all. A uterus may contain a single small fibroid or many fibroids of different sizes. Fibroids are oestrogen-sensitive and typically grow slowly during the reproductive years, then shrink after menopause when oestrogen levels fall.
In Marathi, fibroids are commonly referred to as गर्भाशयाच्या गाठी (uterine lumps or growths) — a term patients often hear in consultations in Vidarbha and northern Telangana.
The medical terms you may encounter: leiomyoma (the formal pathological name), myoma (common clinical shorthand), and fibroid uterus (used when multiple fibroids enlarge the uterus overall). These are all the same category of benign growth.
The single most clinically important question about any fibroid is: where is it located? Location — not size alone — determines whether a fibroid is likely to cause symptoms, affect fertility, or need treatment.
What are the different types of uterine fibroids, and why does location matter for fertility?
Fibroids are classified by where they sit relative to the layers of the uterus:
Submucosal fibroids — highest fertility impact
Submucosal fibroids are located just beneath the inner uterine lining (the endometrium) and project into the uterine cavity. They are the type with the clearest, most consistent negative effect on fertility and implantation. Even small submucosal fibroids can distort the cavity surface, impair the endometrial environment, reduce implantation rates, and increase the risk of early pregnancy loss. Submucosal fibroids are the primary type where removal is generally recommended before attempting IVF or embryo transfer.
Submucosal fibroids are further graded (FIGO classification) by how much of their volume projects into the cavity: Type 0 (entirely intracavitary), Type 1 (mostly intracavitary), and Type 2 (less than half intracavitary). The higher the intracavitary component, the greater the likely impact.
Intramural fibroids — moderate and debated fertility impact
Intramural fibroids are contained within the muscular wall of the uterus without protruding into the cavity or beyond the outer surface. Their effect on fertility is more complex. Small intramural fibroids that do not distort the uterine cavity are generally considered to have limited fertility impact. Larger intramural fibroids — particularly those that significantly bulge into the cavity or compress a fallopian tube opening — may affect implantation or gamete transport. The size threshold at which an intramural fibroid meaningfully impairs fertility is debated in the literature. The decision to treat is made individually, weighing the degree of cavity distortion, fibroid size, the patient's age, and the surgical risk of the proposed route.
Subserosal fibroids — least fertility impact
Subserosal fibroids project outward from the outer surface of the uterus. They are the type least likely to directly impair fertility, because they do not distort the uterine cavity. They more commonly cause pressure symptoms — bladder pressure, urinary frequency, pelvic heaviness, or constipation — due to their bulk. Very large subserosal fibroids are occasionally associated with reduced fertility, but this is the exception rather than the rule.
Pedunculated fibroids
Some fibroids are attached to the uterus by a stalk rather than a broad base. A pedunculated submucosal fibroid hangs into the cavity; a pedunculated subserosal fibroid projects outward. Pedunculated fibroids can rarely undergo torsion (twisting of the stalk), causing acute pain.
What symptoms do uterine fibroids cause?
Many fibroids are asymptomatic and discovered incidentally during a routine ultrasound. When symptoms do occur, they depend on fibroid location, size, and the number of fibroids present:
- Heavy menstrual bleeding (menorrhagia) — the most common symptom; particularly associated with submucosal fibroids; prolonged or very heavy periods can cause iron-deficiency anaemia
- Prolonged periods — cycles lasting more than 7 days
- Pelvic pressure or heaviness — a sense of fullness or weight in the lower abdomen, especially with larger fibroids
- Urinary symptoms — frequent urination or difficulty fully emptying the bladder, caused by fibroids pressing on the bladder
- Bowel symptoms — constipation or rectal pressure, particularly with posterior or subserosal fibroids
- Pelvic or lower back pain — especially with larger fibroids, fibroid degeneration, or pedunculated fibroid torsion
- Painful periods (dysmenorrhoea) — particularly associated with submucosal fibroids
- Difficulty conceiving or recurrent pregnancy loss — see the fertility section below
It is important to note that not all fibroids require treatment. Management decisions are guided by symptom severity, fibroid location and size, and whether you are planning a pregnancy. If you have heavy or irregular periods, a pelvic evaluation to check for fibroids is appropriate.
How do uterine fibroids affect fertility and pregnancy?
The impact of fibroids on fertility and pregnancy depends on location and extent of cavity involvement:
Submucosal fibroids have the clearest and best-documented negative effect. By distorting the cavity surface and altering the endometrial environment, they can impair embryo implantation and increase the risk of early pregnancy loss. For this reason, submucosal fibroids are generally removed before IVF or embryo transfer (see IVF treatment).
Intramural fibroids have a more variable and contested relationship with fertility. The evidence suggests that intramural fibroids that do not distort the cavity have less impact. Those that cause significant cavity distortion — either by bulging directly into it or by compressing a fallopian tube ostium — may impair implantation or sperm transport. The clinical decision is made on a case-by-case basis.
Subserosal fibroids are not generally considered a primary fertility-limiting factor. Unless very large and distorting overall uterine anatomy, they do not typically require removal before attempting conception.
During pregnancy, existing fibroids can occasionally grow in the first trimester in response to elevated oestrogen and progesterone. Submucosal fibroids or those positioned near the placenta may be associated with a higher risk of miscarriage, preterm labour, or placental complications, though many pregnancies with fibroids proceed without complication. Management decisions during pregnancy are made by the obstetric and fertility team together.
The right approach depends on your individual fibroid characteristics, your fertility history, and your planned treatment path. A fertility assessment with Dr. Shweta Agarwal is the appropriate starting point.
How are uterine fibroids diagnosed?
Pelvic and transvaginal ultrasound
Ultrasound is the primary and most widely used diagnostic tool for fibroids. It identifies the number, approximate size, and location of fibroids. A transvaginal ultrasound (TVS) gives better resolution of submucosal fibroids and their relationship to the cavity compared with a transabdominal scan.
Saline infusion sonography (SIS / saline sonography)
Sterile saline is instilled into the uterine cavity during ultrasound, outlining the cavity walls precisely. This significantly improves the detection and grading of submucosal fibroids and is a simple, well-tolerated office procedure.
Hysteroscopy
Hysteroscopy is direct visual inspection of the uterine cavity using a thin camera passed through the cervix. It is the most accurate way to confirm the presence, location, and grade of submucosal fibroids, and allows simultaneous biopsy or treatment of smaller lesions at the same sitting. Hysteroscopy is the reference standard for submucosal fibroid assessment.
MRI
Magnetic resonance imaging provides the most precise three-dimensional mapping of fibroid size, number, location, and relationship to the uterine cavity and other structures. MRI is particularly useful for surgical planning when multiple or complex fibroids are present — for example, before deciding on the route and extent of myomectomy.
What are the management options for uterine fibroids?
Decisions are always individualised based on your symptoms, fibroid characteristics, reproductive goals, and overall health. This page provides an overview of the options; the procedures themselves are described in dedicated pages.
Watchful waiting (active monitoring)
For fibroids that are asymptomatic, small, and not distorting the uterine cavity — particularly in women not actively trying to conceive — observation with periodic ultrasound monitoring is often the most appropriate plan. Many fibroids remain stable or grow very slowly.
Medical and symptom management
Medical treatments address symptoms rather than removing fibroids:
- Hormonal contraception (combined oral contraceptive pill, progesterone-only methods, or the levonorgestrel intrauterine system) can reduce heavy menstrual bleeding but does not significantly shrink fibroids.
- Tranexamic acid reduces menstrual blood loss without hormonal effects and is useful for women who do not wish hormonal contraception.
- GnRH analogues (e.g., leuprolide) temporarily reduce oestrogen and can shrink fibroids before surgery — a common pre-operative strategy — but are not suitable for long-term use due to bone density effects, and fibroids typically return to their original size once the medication is stopped.
- NSAIDs can relieve fibroid-associated dysmenorrhoea.
Medical management is generally not the primary strategy for women actively trying to conceive.
Surgical removal — myomectomy (routing to treatment page)
Myomectomy removes fibroids while preserving the uterus intact, making it the surgical option of choice for women who wish to maintain fertility. The surgical route depends on fibroid type and location:
- Hysteroscopic route — for submucosal fibroids projecting into the cavity; performed via hysteroscopy without any incision; typically a day-case procedure.
- Laparoscopic route — for intramural or subserosal fibroids; minimally invasive, using key-hole incisions; see laparoscopy.
- Open (abdominal) route — for very large, multiple, or anatomically complex fibroids.
The detail of how myomectomy is performed, recovery, and outcomes is covered on the dedicated myomectomy treatment page.
Fibroids and IVF
When submucosal fibroids or cavity-distorting intramural fibroids are identified during the work-up for fertility treatment, their removal before embryo transfer is generally recommended. This is to optimise the uterine cavity environment before attempting implantation. The timing and sequence — fibroid removal first, then IVF, or IVF in select cases where fibroids are not distorting the cavity — is decided by Dr. Shweta Agarwal based on your individual profile. See IVF treatment for more on the full IVF pathway.
Final cost depends on individual clinical evaluation — see Costs & EMI for current pricing.
When should I seek an evaluation for uterine fibroids?
Consult Dr. Shweta Agarwal if:
- Your periods have become significantly heavier, more prolonged, or are accompanied by clots — especially if they are affecting daily life or causing symptoms of anaemia (fatigue, breathlessness, dizziness).
- You have pelvic pressure, heaviness, or urinary frequency that you have been told may be related to fibroids.
- You are trying to conceive and have been told you have fibroids — understanding the fibroid type and its cavity relationship before starting fertility treatment is important.
- You have unexplained infertility or have experienced recurrent early pregnancy loss and fibroids have not been systematically evaluated.
- You have been told you have fibroids and want to understand whether they need treatment or can be monitored.
A free fertility assessment is the appropriate first step. Fibroids that are not currently causing symptoms or distorting the cavity may simply need periodic monitoring — not every fibroid requires intervention.