Uterine Fibroids

If you’re experiencing heavy menstrual bleeding, pelvic pressure, or unexplained abdominal bloating, you may have uterine fibroids. These growths are common during their reproductive years and can cause significant discomfort and disruption to daily life. Our Gynaecology Specialist understands the impact fibroids can have on your wellbeing and offers comprehensive evaluation and treatment options tailored to your specific needs. Managing uterine fibroids has become more effective and less invasive with modern medical technology.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

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Overview Types Risks Symptoms When to See a Doctor Diagnosis Treatment Prevention FAQs

What are Uterine Fibroids?

Uterine fibroids, medically known as leiomyomas or myomas, are non-cancerous growths that develop in or on the wall of the uterus. These benign tumours consist of smooth muscle cells and fibrous connective tissue, varying greatly in size from tiny seedlings undetectable to the naked eye to large masses that can distort the uterus. Fibroids are particularly common among women of reproductive age between ages 30 and 40. While the exact cause is not fully understood, hormones such as oestrogen and progesterone are thought to play an important role in their development.

Types of Uterine Fibroids

Intramural Fibroids

Intramural fibroids grow within the muscular wall of the uterus. They can sometimes make the uterus feel enlarged during examination. This type may lead to heavy menstrual bleeding, pelvic pain, or a sense of pressure.

Subserosal Fibroids

Subserosal fibroids develop on the outer surface of the uterus and grow outward into the pelvic cavity. These can become quite large and can press on nearby organs, causing symptoms such as bloating, urinary frequency, or discomfort.

Submucosal Fibroids

Though less common, submucosal fibroids grow just beneath the inner lining of the uterus. Despite their smaller size, they often cause the most problematic symptoms, including heavy menstrual bleeding and fertility issues.

Pedunculated Fibroids

These fibroids grow on small stalks or stems, either inside or outside the uterus. They may twist on their stalks, which can cause sudden, severe pain that requires prompt medical evaluation.

Cervical Fibroids

Cervical fibroids develop in the cervix, the lower part of the uterus. Although rare, their position can affect both symptoms and the choice of treatment approach.

Causes

The exact cause of uterine fibroids is unknown, but several factors may contribute:

Hormonal influences: Oestrogen and progesterone stimulate fibroid growth
Genetic mutations: Alterations in genes controlling cell growth
Growth factors: Substances that help maintain tissues may affect fibroid development
Extracellular matrix (ECM): Increased ECM makes fibroids fibrous and stores growth factors

Risk Factors

Several factors can increase the likelihood of developing fibroids:

Age: Most common in women in their 30s and 40s
Family history: Having a close relative with fibroids
Ethnicity: Some populations may have higher prevalence or more severe fibroids
Obesity: Excess weight can increase risk
Diet: High red meat consumption and low vegetable consumption
Early menstruation: Starting periods before age 10 years old
Nulliparity: Never having given birth
Vitamin D deficiency: Low levels associated with increased risk
Alcohol consumption: Regular drinking may increase risk

Signs & Symptoms

Mild Symptoms

Slightly heavier menstrual flow than usual
Mild pelvic discomfort or pressure
Occasional bloating or fullness in lower abdomen
Minor increase in urination frequency
Slight fatigue during menstruation
Mild lower back discomfort

Moderate Symptoms

Prolonged menstrual periods lasting over 7 days
Significant pelvic pain or cramping
Noticeable abdominal enlargement
Increased urination disrupting daily activities
Constipation or difficulty with bowel movements
Pain during intercourse
Spotting between periods

Urogenital Symptoms

Extremely heavy bleeding requiring pad changes every hour
Passing large blood clots
Anaemia from blood loss
Inability to empty bladder completely
Severe pelvic pain unrelieved by medication
Significant abdominal distension resembling pregnancy
Infertility or repeated miscarriages

Many women with smaller fibroids may have no symptoms and only discover them during routine pelvic examinations. Symptom severity depends on the number, size, and location of fibroids rather than size alone.

Experiencing these symptoms? Don’t wait for them to worsen.

Schedule a consultation with our Gynaecology Specialist to review your condition and determine the most suitable management approach.

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When to See a Doctor

Seek immediate medical attention if you experience severe pelvic pain that comes on suddenly, excessive vaginal bleeding causing dizziness or weakness, or inability to urinate despite feeling the urge. These symptoms may indicate complications requiring urgent care.

Schedule a consultation if you notice persistent pelvic pain or pressure, periods lasting longer than a week, heavy menstrual bleeding affecting daily activities, or unexplained fatigue and weakness. Early evaluation allows for timely intervention before symptoms worsen.

During your first consultation, our Gynaecologist can discuss your symptoms, medical history, and perform a pelvic examination. You can expect a thorough evaluation including questions about your menstrual cycle, pain levels, and how symptoms impact your life. The consultation provides an opportunity to discuss your concerns and treatment preferences.

Seeking timely evaluation allows more treatment options, including less invasive approaches. Delaying assessment may limit options and increase the need for more extensive procedures.

Diagnosis & Testing Methods

Diagnosis begins with a comprehensive pelvic examination, where the gynaecologist may detect an enlarged or irregularly shaped uterus. Imaging tests provide more detailed information about fibroid size, location, and number.

Transvaginal Ultrasound: This primary diagnostic tool uses sound waves to create images of your uterus. A small probe inserted into the vagina provides clear visualisation of fibroids. The procedure takes 15-30 minutes and requires no special preparation.
Pelvic MRI: Magnetic resonance imaging offers detailed images, particularly useful for surgical planning. MRI precisely maps fibroid locations and distinguishes them from other conditions. The scan takes 30-45 minutes and involves lying still in the MRI machine.
Hysterosonography: This specialised ultrasound involves injecting saline into the uterus to enhance visualisation of the uterine cavity. It’s particularly helpful for detecting submucosal fibroids. The procedure takes about 30 minutes and causes minimal discomfort.
Hysteroscopy: A thin, lighted telescope inserted through the cervix allows direct visualisation of the uterine cavity. This procedure can diagnose and sometimes treat small submucosal fibroids simultaneously. Local anaesthesia makes the 15-30 minute procedure comfortable.
Blood Tests: Complete blood count checks for anaemia from heavy bleeding. Hormone levels may be assessed to rule out other conditions. Results typically available within 24-48 hours.

Treatment Options Overview

Hormonal Medication

Hormonal medications are typically the first line of management. Combined oral contraceptives help regulate menstrual cycles and reduce heavy bleeding, though they don’t actually shrink fibroids. Progesterone-releasing intrauterine devices, such as Mirena, can also lessen menstrual flow for up to five years and are ideal for women with mild to moderate symptoms who wish to preserve fertility.

For more significant fibroid reduction, gonadotropin-releasing hormone (GnRH) agonists can be used to temporarily induce a menopause-like state, shrinking fibroids and easing symptoms. These are often prescribed for 3–6 months before surgery to lower surgical risks. However, side effects like hot flashes and bone density loss limit their long-term use.

Non-Hormonal Medications

Non-hormonal medications provide symptom relief without altering hormone levels. Tranexamic acid, taken only during menstruation, can cut blood loss by up to 40%, while non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain and slightly reduce bleeding. Iron supplements may also be recommended to manage anaemia from chronic blood loss.

A newer option, selective progesterone receptor modulators (SPRMs), directly target fibroid tissue to reduce size and control bleeding. Typically prescribed in three-month treatment cycles with breaks in between, SPRMs offer an effective alternative for women who cannot tolerate hormonal therapy or prefer to avoid surgery.

Uterine Artery Embolisation

This minimally invasive procedure blocks blood supply to fibroids, causing them to shrink. Performed by interventional radiologists, it involves inserting tiny particles through a catheter in the groin. Recovery takes 1-2 weeks with preservation of the uterus.

Focused Ultrasound Surgery

MRI-guided focused ultrasound uses high-frequency sound waves to heat and destroy fibroid tissue. This non-invasive outpatient procedure requires no incisions and allows immediate return to normal activities. Suitable for specific fibroid types and locations, it offers an innovative approach for selected patients.

Hysteroscopic Myomectomy

For submucosal fibroids, this procedure removes fibroids through the vagina and cervix using a specialised scope. No abdominal incisions are needed, allowing quick recovery within days. The procedure effectively treats heavy bleeding and may improve fertility outcomes.

Laparoscopic Myomectomy

Keyhole surgery removes fibroids through small abdominal incisions while preserving the uterus. Modern techniques including robotic assistance enable precise fibroid removal with minimal tissue trauma. Recovery typically takes 2-4 weeks with good cosmetic results.

Abdominal Myomectomy

Open surgery remains necessary for multiple large fibroids or complex cases. Through an abdominal incision, surgeons can remove numerous fibroids and reconstruct the uterus. While recovery takes 4-6 weeks, this approach handles challenging cases effectively.

Hysterectomy

Surgical removal of the uterus provides definitive treatment for women who’ve completed childbearing. Options include preserving ovaries to maintain hormone production or removing them based on individual circumstances. Various surgical approaches exist including vaginal, laparoscopic, and abdominal routes.

If you are experiencing heavy bleeding, pain, or fertility difficulties, it may be related to uterine fibroids. Book a consultation to explore treatment approaches suited to your needs.

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Complications if Left Untreated

Untreated fibroids can lead to chronic anaemia from ongoing heavy menstrual bleeding. This results in persistent fatigue, weakness, and reduced quality of life. Severe anaemia may require blood transfusions and can affect heart function over time.

Large fibroids may cause hydronephrosis by compressing the ureters, potentially damaging kidney function. Bladder compression leads to incomplete emptying and recurrent urinary tract infections. Bowel compression can cause chronic constipation and bloating.

Fertility complications include difficulty conceiving, increased miscarriage risk, and pregnancy complications. Submucosal fibroids particularly affect implantation and early pregnancy. During pregnancy, fibroids may cause preterm labour, abnormal foetal position, or need for caesarean delivery.

Quality of life impacts extend beyond physical symptoms. Chronic pain, heavy bleeding, and frequent bathroom visits affect work productivity, social activities, and intimate relationships.

Prevention

While complete prevention isn’t possible due to genetic and hormonal factors, certain lifestyle modifications may reduce risk. Maintaining healthy body weight through regular exercise and balanced nutrition helps regulate hormone levels.

Dietary choices play a role in fibroid development. Increasing consumption of green vegetables, fruit, and fish while reducing red meat intake may lower risk. Vitamin D supplementation, particularly in deficient individuals, shows promise in prevention strategies.

Managing reproductive factors where possible includes considering earlier childbearing if circumstances allow, as pregnancy appears protective. Hormonal contraceptive use may provide some protective benefit, though individual responses vary.

Regular gynaecological check-ups enable early detection when fibroids are small and asymptomatic. Early identification allows for monitoring and timely intervention if needed, potentially avoiding more invasive treatments later.

Frequently Asked Questions (FAQ)

Can fibroids turn into cancer?

Uterine fibroids are benign growths with extremely low malignant transformation risk. A rare cancer called leiomyosarcoma can occur in the uterus but doesn’t develop from existing fibroids. Rapid growth or post-menopausal growth warrants evaluation, but fibroids remain non-cancerous throughout a woman’s life. Regular monitoring helps ensure any unusual changes are detected early.

Will fibroids affect my ability to get pregnant?

Most women with fibroids conceive naturally without difficulty. Submucosal fibroids and large intramural fibroids may affect fertility by distorting the uterine cavity or blocking fallopian tubes. Location matters more than size for fertility impact. If you’re planning pregnancy, discussing fibroid management with our Gynaecologist helps optimise your chances. Many women successfully conceive and deliver healthy babies despite having fibroids.

Do fibroids always require surgery?

Many fibroids require no treatment, especially if they’re small and asymptomatic. Treatment decisions depend on symptom severity, fibroid size and location, fertility plans, and proximity to menopause. Medical management effectively controls symptoms for many women. Surgical options are reserved for cases where conservative treatment fails or complications arise. Our Gynaecologist may discuss all options to find the most appropriate approach for your situation.

What happens to fibroids after menopause?

Fibroids typically shrink after menopause due to decreased oestrogen and progesterone levels. Many women experience symptom relief naturally as hormone production declines. Fibroids don’t always disappear completely. Hormone replacement therapy may cause continued growth. Post-menopausal women should continue monitoring, especially if fibroids were large pre-menopause or if new symptoms develop.

How long is recovery after fibroid surgery?

Recovery time varies significantly based on the procedure performed. Hysteroscopic procedures allow return to normal activities within 2-3 days. Laparoscopic surgery typically requires 2-4 weeks recovery. Open abdominal surgery needs 4-6 weeks for full recovery. Uterine artery embolisation patients usually resume activities within 1-2 weeks. Your surgeon can provide specific guidelines based on your procedure and individual healing.

Can fibroids grow back after treatment?

Fibroids can return after treatments such as myomectomy or medication. Younger women are more likely to develop new fibroids over time due to remaining reproductive years. Medical treatments manage symptoms, but fibroids may regrow once medication is stopped. Only hysterectomy fully prevents recurrence. Regular follow-up allows timely detection and management of any new growths.

Conclusion

Uterine fibroids are common and benign, but they can affect quality of life through heavy bleeding, pain, and fertility concerns. Early evaluation allows for appropriate diagnosis and a personalised treatment plan tailored to symptoms, fertility considerations, and lifestyle. A range of treatments, from medications to minimally invasive procedures, can provide symptom relief and help maintain daily functioning. Seeking timely assessment ensures the most suitable management approach for your individual needs.

Concerned about heavy periods or pelvic discomfort?

Schedule a consultation with a gynaecologist to discuss your symptoms and explore suitable treatment options.

Book Appointment

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Harvard Lin is renowned for his expertise in female pelvic medicine and reconstructive surgery.

Dr. Lin’s journey in medicine began at the prestigious National University of Singapore, where he earned his Bachelor of Medicine and Bachelor of Surgery (MBBS). His commitment to excellence led him to further his education by becoming a Member of the Royal College of Obstetricians and Gynaecologists (MRCOG) through the Royal College of Obstetricians and Gynaecologists in the United Kingdom. He also holds a Master of Medicine (Obstetrics and Gynaecology) from the National University of Singapore.

As the Chief Coordinator of Gynaecologic Services at the National University Health System (NUHS), Dr. Lin plays a pivotal role in ensuring the highest quality care for women’s health. His leadership is also evident in his position as the Deputy Clinical Director of Obstetrics and Gynaecology at NUHS, where he contributes to shaping gynaecologic practices and growth across the cluster including Ng Teng Fong Hospital, Alexandra Hospital and Jurong Medical Centre.

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