Uterine Fibroids: When to Watch, When to Act, and What Your Options Are

Fibroids are one of the most common gynaecological findings — by the age of 50, up to 70% of women will have developed at least one. Yet despite how common they are, there remains significant confusion about when fibroids need treatment and what the options actually look like in 2026.

What are fibroids?

Fibroids (also called leiomyomas) are non-cancerous growths of the muscle wall of the uterus. They can range from the size of a pea to the size of a melon, and you can have one or many. Their location matters as much as their size — a small fibroid inside the uterine cavity can cause significant bleeding, while a large one on the outer surface may cause no symptoms at all.

When do fibroids need attention?

Many fibroids are found incidentally on ultrasound and require no treatment. However, you should seek a specialist assessment if you are experiencing:

• Heavy menstrual bleeding that is affecting your quality of life or causing anaemia
• Pressure symptoms such as urinary frequency, difficulty emptying the bladder, or constipation
• Pelvic pain or a feeling of fullness in the lower abdomen
• Rapid growth of a fibroid on serial scans
• Difficulty conceiving, where a fibroid may be distorting the uterine cavity

What are the treatment options?

Treatment should always be tailored to your symptoms, your age, and whether you wish to preserve fertility:

• Medical management: Hormonal treatments including the Mirena coil, tranexamic acid, or GnRH analogues can help manage bleeding and reduce fibroid size temporarily.
• Uterine artery embolisation: A minimally invasive radiological procedure that cuts off the blood supply to fibroids, causing them to shrink.
• Myomectomy: Surgical removal of fibroids while preserving the uterus — the preferred option for women who wish to have children.
• Hysterectomy: Definitive treatment for women who have completed their families and have severe symptoms.