What are uterine fibroids?

Uterine fibroids (also called leiomyomas or myomas) are benign (non-cancerous) tumours of the uterus — formed from smooth muscle cells of the uterine wall. They are the most common benign tumour in women: approximately 70-80% of women will develop at least one fibroid by age 50, though only approximately 25% will have symptoms. Fibroids range in size from a grain of rice to a melon; they can be solitary or multiple. They are classified by location: submucosal (inside the uterine cavity — most symptomatic); intramural (within the uterine wall — most common); subserosal (on the outer surface). Fibroids are oestrogen-dependent — they grow during the reproductive years and shrink after menopause.

What are the symptoms?

Symptoms depend on size, number and location: Heavy menstrual bleeding (HMB): the most common symptom — caused particularly by submucosal fibroids distorting the endometrial cavity. HMB can cause iron-deficiency anaemia. Pelvic pressure/pain: large fibroids or multiple fibroids cause a sensation of pelvic heaviness, bloating, back pain. Urinary symptoms: pressure on the bladder → urinary frequency, urgency, incomplete emptying. Bowel symptoms: pressure on the rectum → constipation. Dysmenorrhoea (painful periods). Subfertility: submucosal and some intramural fibroids impair implantation and early pregnancy; associated with recurrent miscarriage and preterm birth.

What non-surgical treatments are available?

Medical treatments: GnRH antagonists + add-back (relugolix/Oriahnn, elagolix/Ryelsza — FDA/EMA approved 2021-22): oral once-daily; reduces blood loss by approximately 70-80% and fibroid volume by approximately 30-40%; suitable for 12-24 months of use. GnRH agonists (leuprorelin, goserelin — older; injections): highly effective but limited to 3-6 months due to bone loss; used pre-surgically to shrink fibroids. Levonorgestrel-IUS (Mirena): reduces menstrual blood loss by 70-90% without reducing fibroid size (can be used for HMB control in suitable fibroid anatomy). Tranexamic acid/NSAIDs: reduce HMB by approximately 30-50% without affecting fibroid size.

What are the surgical options?

Myomectomy: surgical removal of fibroids while preserving the uterus — the definitive fibroid treatment for women who wish to retain fertility or avoid hysterectomy. Approaches: hysteroscopic (for submucosal — no incision, fastest recovery); laparoscopic (minimally invasive, quicker recovery); open (for very large/multiple). Recurrence rate: approximately 30% at 5 years. Hysterectomy: definitive cure — no fibroid recurrence. Appropriate when childbearing is complete and other treatments have failed. Uterine artery embolisation (UAE): radiological, uterus-sparing; suitable if no future pregnancy planned. MR-HIFU: non-invasive ultrasound ablation.

Can fibroids affect fertility and pregnancy?

Yes — fibroids can affect fertility in several ways: Submucosal fibroids (inside the cavity): directly impair implantation and embryo development — removal by hysteroscopic myomectomy significantly improves pregnancy rates. Large intramural fibroids distorting the uterine cavity: may reduce fertility and increase miscarriage risk. During pregnancy: fibroids rarely cause significant complications (most are asymptomatic) but can increase risk of: preterm labour; placenta abruption; malpresentation; postpartum haemorrhage; emergency caesarean. IVF outcomes are significantly impaired by submucosal or cavity-distorting intramural fibroids — hysteroscopic myomectomy is recommended before IVF in such cases.

How does GMJ News cover uterine fibroids?

GMJ News covers WHO fibroid data, racial health disparities (2-3× burden in Black women), GnRH antagonist approvals 2021-22, submucosal fibroid fertility impact, UAE as uterus-sparing option, hysteroscopic myomectomy, levonorgestrel IUS, and the post-menopausal regression. Uterine fibroids — the most common benign tumour in women — are directly relevant to PHIG's women's health programme and Georgian gynaecology practice.

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Uterine Fibroids

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Uterine fibroids (leiomyomas) — benign smooth muscle tumours of the uterus present in approximately 70-80% of women by age 50 and symptomatic in approximately 25%, causing heavy menstrual bleeding (HMB), pelvic pressure, dysmenorrhoea, urinary frequency and subfertility — are the most common benign tumour in women globally and the leading indication for hysterectomy in premenopausal women in high-income countries, yet are systematically under-recognised as a major public health issue despite their profound impact on quality of life, work productivity and fertility (WHO). Women of African descent bear a disproportionate burden — 2-3 times more likely to develop fibroids, with earlier onset, larger tumours and more severe symptoms — making uterine fibroids a significant health equity issue, while newly approved GnRH antagonist regimens (relugolix, elagolix with oestrogen add-back — FDA/EMA 2021-2022) offer the first effective long-term oral medical therapy.

Key messages

Most common benign tumour in women — 70-80% by age 50

Uterine fibroids (leiomyomas) are present in approximately 70-80% of women by age 50. Approximately 25% are symptomatic. They are the leading indication for hysterectomy in premenopausal women in HICs and a major cause of heavy menstrual bleeding, pelvic symptoms and subfertility (WHO).

Black women 2-3× more affected — major health equity issue

Women of African descent develop fibroids at 2-3 times the rate of White women, with earlier onset, larger and more numerous tumours, and more severe symptoms. This racial disparity — driving higher rates of hysterectomy and reduced fertility — represents one of the most significant health equity issues in women's health.

GnRH antagonists — new oral long-term medical therapy (2021-22)

Relugolix (combined with oestrogen + progestogen add-back, Oriahnn) and elagolix (with oestrogen/progestogen add-back, Oriahnn/Ryelsza) were FDA/EMA approved in 2021-2022 as the first effective oral medical therapies suitable for longer-term use, reducing menstrual blood loss by approximately 70-80%.

Submucosal fibroids — most impact on fertility

Location determines clinical impact: submucosal (inside the uterine cavity — the most symptomatic; most impact on fertility and implantation; treated with hysteroscopic myomectomy); intramural (within the uterine wall — the most common; impairs fertility if distorting the cavity); subserosal (on the outer surface — causes bulk/pelvic pressure but less impact on bleeding or fertility).

Uterine artery embolisation — uterus-sparing alternative

Uterine artery embolisation (UAE) — a radiological procedure blocking the blood supply to fibroids — shrinks fibroids by approximately 50% and reduces bleeding by approximately 80%. Evidence shows equivalent outcomes to myomectomy for symptom control at 5 years, with shorter recovery. Not recommended if future pregnancy is desired.

Fibroids regress after menopause

Fibroids are oestrogen-dependent — they grow during the reproductive years and regress spontaneously after menopause as oestrogen levels fall. This is why GnRH agonists (creating a temporary hypo-oestrogenic state) have been used pre-surgically to shrink fibroids and reduce intraoperative blood loss.

Key statistics

70-80%

of women develop uterine fibroids by age 50

WHO

2-3×

higher fibroid prevalence in Black/African descent women

WHO/ACOG

indication for hysterectomy in premenopausal women in HICs

WHO/ACOG

70-80%

menstrual blood loss reduction with GnRH antagonist medical therapy

FDA/NEJM

2021-22

year GnRH antagonist combinations (relugolix, elagolix) FDA/EMA approved

FDA/EMA 2021-22

~80%

menstrual blood loss reduction with UAE (uterine artery embolisation)

RCOG/WHO

Uterine fibroid location and clinical impact (WHO/FIGO classification)

Source: WHO/FIGO. Submucosal fibroids have greatest fertility and bleeding impact; subserosal cause bulk symptoms.

Glossary of key terms

Leiomyoma/uterine fibroid
WHOBenign monoclonal smooth muscle tumours of the myometrium — arising from a single myometrial cell that undergoes somatic mutation (most commonly in MED12, HMGA2 or HMGA1 genes). Oestrogen and progesterone promote growth; thus fibroids are uncommon before menarche and regress after menopause. Range in size from a few millimetres to 20+ cm; may be single or multiple (often tens or hundreds of small fibroids present).

GnRH antagonists for fibroids
FDA/EMA 2021-22Gonadotrophin-releasing hormone receptor antagonists (elagolix, relugolix) block GnRH receptors in the pituitary → suppress FSH and LH → suppress ovarian oestrogen production → fibroid shrinkage and reduced bleeding. Combined with low-dose oestrogen/progestogen add-back to prevent hypo-oestrogenic side effects (bone loss, vasomotor symptoms). Approved for approximately 12-24 months of use (unlike GnRH agonists which are limited to 3-6 months). Reduces menstrual blood loss by approximately 70-80% and fibroid volume by approximately 30-40%.

Hysteroscopic myomectomy
WHO/RCOGRemoval of submucosal fibroids via hysteroscopy (operating telescope inserted through the cervix into the uterine cavity) — without abdominal incision. The treatment of choice for submucosal fibroids. Can restore fertility by eliminating the physical barrier to implantation or embryo development from a cavity-distorting fibroid. Day surgery; fast recovery.

Uterine artery embolisation (UAE)
WHO/RCOGA radiological (interventional) procedure: bilateral uterine artery catheterisation (via femoral artery) and embolisation with microspheres → devascularisation of fibroids → ischaemic necrosis and shrinkage (approximately 30-50% volume reduction) → symptom improvement. Advantages: no general anaesthesia, no surgical incision, shorter recovery. Post-procedure pain (transient ischaemia) is universal and usually managed with PCA. Not recommended if future pregnancy is desired (impaired uterine vascularity may affect implantation and placentation).

Focused ultrasound (MR-HIFU)
WHOMRI-guided high-intensity focused ultrasound (MR-HIFU): a non-invasive treatment using focused ultrasound energy to ablate fibroid tissue while monitoring with MRI in real time. No incision, no radiation, outpatient procedure. Effectiveness: good for small-medium fibroids; limited for large or multiple fibroids. Limitation: not all fibroids are suitable (depth, proximity to bowel/sacral nerves); limited NHS/international availability.

Fibroid racial disparity
WHO/NEJMWomen of African descent: 2-3× higher fibroid prevalence; fibroids appear on average 5-10 years earlier; larger at presentation; more numerous; more symptomatic; higher rates of hysterectomy. Possible contributing factors: genetic predisposition; vitamin D deficiency; hair product exposure (chemical relaxers — some evidence); higher rates of high-parity and earlier menarche; racial bias in referral for fibroid-preserving treatments (UAE, myomectomy) vs hysterectomy. This disparity contributes to higher rates of fertility impairment in Black women.