Being told that you have fibroids can raise a lot of questions very quickly.

Do they need to be removed?
Will they get bigger?
Will I need surgery?
Could they affect fertility?

But having fibroids does not automatically mean you need treatment.

Some fibroids cause no symptoms at all and may simply be monitored. Others can cause heavy bleeding, pain, pressure, anaemia or fertility concerns and may need treatment.

So the real question is not just:

“Do I have fibroids?”

It is:

“How are these fibroids affecting me?”

If they are not causing problems, treatment may not be needed

Fibroids are sometimes found by chance during an ultrasound or another examination.

You may not have heavy periods, pelvic pain or any noticeable symptoms.

In that situation, your healthcare professional may recommend monitoring rather than treatment.

This can feel surprising, especially if you have just been told that there is a growth in your womb. But fibroids are benign growths, and if they are not causing symptoms or affecting your health, there may be no benefit in treating them immediately.

The important thing is knowing what symptoms to look out for and when to go back for review.

Treatment should be guided by your symptoms

Fibroids are more likely to need treatment when they begin to interfere with your health or daily life.

Symptoms can include:

• heavy or prolonged periods
• painful periods
• pelvic pain or pressure
• frequent urination
• constipation or bowel pressure
• pain or discomfort during sex
• anaemia caused by heavy bleeding
• fertility or pregnancy concerns

Not every woman with fibroids will experience these symptoms, and symptoms can vary considerably from one person to another.

This is why the diagnosis alone does not tell the whole story.

A woman with several fibroids may have very few symptoms, while another woman with a smaller fibroid may experience significant bleeding or pain.

If your periods are so heavy that you are changing pads or tampons very frequently, avoiding certain clothes, worrying about leaking, missing work or social activities, or repeatedly becoming anaemic, that is important information for your healthcare professional.

You do not have to wait until symptoms become unbearable before asking about treatment.

Size is only part of the picture

People often focus on the size of a fibroid.

“How many centimetres is it?”

That information is useful, but it is not the only factor used when deciding whether treatment is needed.

Healthcare professionals will also consider:

• where the fibroid is located
• how many fibroids are present
• whether they are affecting the shape of the womb
• the symptoms you are experiencing
• your age and general health
• whether you are hoping to become pregnant
• your own treatment preferences

A relatively small fibroid in certain parts of the womb can cause significant bleeding, while a much larger fibroid elsewhere may cause few symptoms.

So treatment decisions should not be based on the measurement on an ultrasound report alone.

Treatment does not automatically mean surgery

One of the biggest concerns women often have after a fibroid diagnosis is the possibility of surgery.

But there are different treatment options.

Depending on your symptoms and circumstances, treatment may include medication to reduce heavy bleeding or pain, hormonal treatments, procedures that reduce the blood supply to fibroids, procedures that remove particular fibroids, or surgery.

Not every option is suitable for every woman.

And there is rarely one treatment that is automatically “the best” for everyone.

The right approach depends on what the fibroids are doing, how much they are affecting you and what you want from treatment.

Your future plans are part of the decision

This is particularly important if you are considering pregnancy.

Some fibroid treatments preserve the womb and may be more suitable for women hoping to become pregnant in the future. Other treatments may not be appropriate if future pregnancy is a priority.

This is why two women with similar fibroids can reasonably choose very different treatment options.

One woman may mainly want to control heavy periods.

Another may be trying to conceive.

Another may want to avoid surgery.

Another may have lived with significant symptoms for years and want to discuss a more definitive option.

Those conversations should be individual.

The best treatment is not simply the one that removes a fibroid. It is the one that fits your symptoms, your health, your priorities and your plans for the future.

What should you ask at your appointment?

If you have been diagnosed with fibroids, you do not need to leave the appointment understanding every medical term.

But there are a few useful questions you can ask:

Where are my fibroids located?

How large are they and how many are there?

Could they explain the symptoms I am experiencing?

Do I need treatment now, or can they be monitored?

What treatment options are available to me?

How could those options affect future pregnancy?

What changes or symptoms should bring me back for review?

These questions can help move the conversation beyond simply being told that you “have fibroids.”

So, do fibroids always need treatment?

No.

If they are not causing symptoms or affecting your health, treatment may not be necessary.

But if you are experiencing heavy bleeding, pain, pressure, anaemia, fertility concerns or symptoms that are disrupting your everyday life, it is reasonable to ask what can be done.

Fibroids are common, but that does not mean every symptom associated with them should simply be accepted.

Your scan gives useful information.

But the decision about treatment should also reflect what you are experiencing, how those symptoms are affecting your life and what you want for your health going forward.

By Dr. Obianuju Ivy Ilonzo