Uterine Fibroids: Non-Surgical & Surgical Treatment Options

What are uterine fibroids?

A fibroid is a benign (non-cancerous) growth that develops within the muscular wall of the uterus. It usually begins from a single muscle cell, which continues to multiply and expand, eventually forming a mass with a characteristic whorled pattern.

Fibroids can vary widely in their number, size, and location within the uterus. Some women may have a single fibroid, while others may develop multiple growths of different sizes.

It is important to note that fibroids are not the same as cancer. Many people mistakenly associate them with malignant changes, but the risk of a fibroid becoming cancerous is extremely low—less than 0.4%.

Fibroids are the most common non-cancerous growths that occur in the uterus. They are not rare at all, and in fact, Indian women are especially prone to developing them. At any given time, around 10–15% of women may have at least one fibroid in their uterus. Many don’t even realize it, because fibroids don’t always cause symptoms.

Now, not all fibroids behave the same way—their location in the uterus makes a big difference:

• Submucous fibroids—These are fibroids that grow inside the inner lining of the uterus (the endometrium). They are the ones most likely to cause problems, and no matter how small they are, they usually require surgery. That’s because even tiny submucous fibroids can interfere with periods, fertility, or cause heavy bleeding.

• Fibroids in the myometrium—These grow inside the muscle wall of the uterus. Most of the time, they don’t need any surgery. However, if they start distorting the uterine lining, that’s when surgical treatment is usually recommended.

One of the most common concerns women have is about pregnancy. The truth is, many women with fibroids do get pregnant and go on to have healthy babies. But during pregnancy, fibroids can change in size:

• About 33% of fibroids increase in size.

• Another 33% remain the same.

• And the last 33% actually shrink.

This is why regular monitoring during pregnancy is important if you already have fibroids.

If you’re dealing with uterine fibroids and looking for the right care, you can consult Dr. Jay Mehta, an experienced fibroid surgeon in Mumbai, India, along with his dedicated team. Our team of expert gynecologists specializes in the diagnosis and treatment of fibroids, including advanced fibroid removal surgery, offering you comprehensive and personalized care.

Fibroids, much like endometriosis, are linked to estrogen excess and a supportive microenvironment in the uterus that allows abnormal tissue to grow rapidly into a solid mass.

Some groups of women are more prone to developing fibroids than others. Indian women and African women tend to have a higher risk compared to women from other racial backgrounds.

Fibroids can appear at any point during a woman’s reproductive years, but they are seen more often in the second half of this phase. In simple terms, women over the age of 25 are more likely to be diagnosed with fibroids.

Interestingly, the incidence of fibroids is almost the same in urban and rural populations. Lifestyle differences don’t seem to make much of a change in this risk.

In India, many women actually discover they have fibroids by chance—often during routine health check-ups arranged by their workplaces. They may not have any obvious symptoms, yet an ultrasound or pelvic exam may reveal the presence of fibroids.

Fibroids are usually divided into three main types, based on where they grow in the uterus:

• Submucous fibroids—These develop inside the cavity of the uterus, just beneath the inner lining.
• Intramural fibroids—These grow within the muscular wall of the uterus.
• Subserous fibroids—These form on the outer surface of the uterus.

This is the basic classification we commonly use to explain fibroids. However, for medical and surgical purposes, there is a much more detailed system called the FIGO Classification. In this system, fibroids are divided into types 0 through 7, depending on their exact location and how they relate to the uterine musculature.

Why does this matter? Because this detailed mapping is extremely useful when planning surgery. In our practice, we use advanced ultrasound software that allows us to accurately map fibroids based on the FIGO system.

An MRI scan of the pelvis can also be used for fibroid mapping, and it usually doesn’t require contrast.

However, in our experience, ultrasound-based fibroid mapping is often more valuable than MRI, especially when done by an expert who understands the fine details. Ultimately, it is the skill and expertise of the reporting doctor, more than the imaging method itself, that determines how accurate and useful the diagnosis will be.

Fibroids and pregnancy often raise a lot of concerns, but it’s important to know that many women with fibroids—even large or multiple ones—do go on to have successful pregnancies. Still, depending on their type and location, fibroids can sometimes increase the risks during pregnancy.

Fibroids That Affect Fertility Most

The type of fibroid that most strongly affects fertility is a submucous fibroid—this is when the fibroid grows inside the inner cavity of the uterus (endometrial cavity). Even a very small submucous fibroid can make it difficult to conceive and is also linked to a higher chance of early miscarriage, since the embryo doesn’t get enough space or support to grow properly.

Women with submucous fibroids often experience heavy periods and irregular spotting, and an ultrasound scan is the best way to detect them.

Fibroids During Pregnancy

Women with fibroids can become pregnant naturally, but large fibroids can sometimes cause:

• Preterm labor (early contractions)

• Growth restriction of the baby

• Pain and bleeding during pregnancy

One specific complication is called red degeneration of the fibroid. This happens when a fibroid outgrows its blood supply and causes severe abdominal pain. It often requires hospital admission, close monitoring, and care under a high-risk obstetric team.

How Fibroids Change in Pregnancy?

During pregnancy, fibroids don’t behave in the same way for everyone:

• About 33% of fibroids increase in size

• About 33% stay the same

• About 33% shrink

There is no fixed rule, which is why regular monitoring with ultrasound is very important.

Mode of Delivery

Having fibroids does not automatically mean a cesarean section is required. Both vaginal delivery and cesarean birth can be safe, depending on the situation.

Sometimes, if fibroids are large and cause problems during cesarean delivery, doctors may perform a cesarean myomectomy—removing the fibroid at the same time as delivering the baby. This needs careful planning because it can lead to more blood loss and a slightly longer recovery time. One possible side effect after this procedure is paralytic ileus, which causes bloating and temporary difficulty in bowel movements.

Risks with Multiple Fibroids

When there are multiple fibroids, they may distort the lining of the uterus (endometrium). This can make it difficult for the baby to grow properly inside the womb and increases the risk of complications.

Why Early Check-Ups Matter?

In India, many women tend to ignore health problems or rely on advice from people who are not trained in gynecology. Because of this, fibroids are often neglected until they cause serious pregnancy complications—complications that could have been prevented with timely care.

This is why it is strongly recommended that women have a pelvic evaluation at least once a year, even if they feel healthy. Early detection of fibroids can make treatment easier and pregnancy outcomes safer.

Fibroids can be diagnosed either when a woman experiences symptoms or during routine investigations such as an ultrasound. One of the unique challenges with fibroids is that in more than 50% of cases, they are completely asymptomatic. This means a woman may have fibroids—even large ones—without experiencing any obvious problems.

Because of this, many women delay seeking treatment, thinking that “no symptoms” means “no problem.” But even symptomless fibroids can sometimes interfere with fertility or cause complications if ignored for too long.

Common Symptoms of Fibroids

1. Submucous fibroids (inside the inner lining of the uterus)

These often cause irregular spotting and heavy menstrual bleeding. They are also closely linked to infertility and early miscarriages if left untreated.

2. Intramural fibroids (within the muscular wall of the uterus)

Symptoms depend on their size. Once they grow larger than 4 cm, they may cause:

• • Painful periods (dysmenorrhea)

  • Heavy bleeding

  • Difficulty conceiving (due to distortion of the uterine lining)
    In such cases, surgical removal is usually recommended.

3. Large fibroids

When fibroids become very large, women may notice:

• • Abdominal bloating

  • Heaviness or pressure in the lower abdomen

  • A palpable mass that can sometimes be felt through the abdomen
    At this stage, surgery is almost always required.

Why Timely Diagnosis Matters?

In India, many women delay proper treatment because of:

• Alternative therapies that claim to shrink fibroids (but have no scientific backing).

• Doctor shopping and conflicting advice can leave patients confused.

• Fear of surgery, often based on myths such as “needing 6 weeks of bed rest.”

Unfortunately, these delays often allow fibroids to grow much larger, making treatment more complex. I’ve personally seen women who postponed surgery for two years while trying alternative remedies, only to return with fibroids that had doubled in size.

The Truth About Surgery

Modern laparoscopic and robotic surgeries for fibroid removal are minimally invasive.

• Most women can go home within 36 hours of the procedure.

• They are usually able to resume normal activities within 4–5 days, not six weeks as commonly feared.

This is why timely consultation and evidence-based treatment make such a big difference in outcomes.

Fibroids can be managed in different ways—through medications, non-surgical procedures, or surgery. But it is very important to understand what each option truly offers and what its limitations are.

Medical Treatment (Non-Surgical Methods)

Medical management of fibroids is always temporary. No medicine can cure fibroids permanently.

Unfortunately, in India, many women are prescribed drugs with the false promise that “medicines will make fibroids disappear.” This is not scientific and is often recommended by doctors who may not have surgical training.

The most common drugs used are

✅ Ulipristal Acetate

• • Promoted widely in India.

  • At best, it can shrink fibroids by about 15–20%, but the effect is short-lived.

  • Once the drug is stopped, fibroids usually return to their original size within 2–3 months.

  • Side effects include elevated liver enzymes, dizziness, and bloating.

  • If prescribed, the patient must be closely monitored and counselled properly.

✅ Mifepristone

• May temporarily reduce the size of fibroids, but again, no permanent benefit.

Medications are usually used only for short-term relief (for example, before surgery to reduce bleeding), not as a cure.

Non-Surgical Treatment for Fibroids

Some newer procedures are marketed as “alternatives” to surgery. The two most common are

• Uterine Artery Embolization (UAE):

  • Done by interventional radiologists, who may not specialize in fertility or gynecology. Non-Surgical.

  • Blocks the blood supply to fibroids so they shrink.

  • Not suitable for women who want to preserve fertility.

  • It should only be considered in women unfit for surgery or anesthesia.

• High-Intensity Focused Ultrasound (HIFU):

  • A technology that uses ultrasound waves to shrink fibroids.

  • It often appears in support groups and online discussions.

  • In reality, it has technical challenges, limited availability, and low long-term success rates.

If these methods were genuinely effective, they would be the global standard. The truth is, they are not a substitute/replacement for surgery.

Women considering these must be very cautious. Always take multiple medical opinions and insist on receiving the pros, cons, and long-term results in writing before deciding.

Surgical Management of Fibroids

For fibroids that cause significant symptoms, surgery is the gold standard treatment.

• Whenever fibroids cause symptoms or fertility issues, surgery is the only permanent solution.

• Minimally invasive surgery (laparoscopic or robotic) is far superior to open surgery in terms of recovery, safety, and results—even for large or multiple fibroids.

Why Surgical Technique Matters?

The most important part of fibroid surgery is the way the uterine cavity is repaired after removal.

• The space left behind must be completely and properly closed.

• If closure is not done correctly, a hematoma (blood collection) can form inside, which may heal poorly and cause scarring (fibrosis).

• This weakens the uterine wall and can create complications during future pregnancies.

This is why surgery must be done by an experienced fibroid surgeon using the right technique.

Even after surgery, fibroids can sometimes return. The chance depends on the number of fibroids removed:

• Single fibroid: less than 0.5%

• Up to 5 fibroids: less than 1%

• More than 5 fibroids: ~5%

• More than 10 fibroids: ~10%

• More than 15 fibroids: ~20%

Recovery after minimally invasive fibroid surgery is usually quick and smooth:

• Most patients are discharged within 36 hours.

• You can usually return to office work within 7 days.

• Light activities are allowed after 2 days.

• Gym and heavy exercise can usually be resumed after 12 days.

There is no need for long bed rest. Modern surgical techniques ensure faster healing and minimal disruption to daily life.

Bottom Line:

• Medicines and non-surgical methods are only temporary.

• Surgery—preferably minimally invasive—is the most effective long-term treatment for fibroids.

• With expert care, women recover quickly and return to normal life within days.