Dr George Xynopoulos
Consultant Physician & Founder, Victoria Medical London
GMC Registered · MBBS · MSc Internal Medicine
In my clinic, uterine fibroids are one of the most common reasons women seek a private gynaecology consultation — and one of the most frequently misunderstood. Many women have been told their heavy periods are "just normal" for years before a pelvic ultrasound reveals fibroids that explain everything. The statistics are striking: fibroids can be detected in up to 80% of women by the age of 50, yet only 20–50% experience symptoms significant enough to seek treatment.[1]
The good news is that fibroids are almost always benign. They are non-cancerous growths of muscle and connective tissue that develop within or around the wall of the uterus. With the right diagnosis and a tailored management plan, the vast majority of women can achieve excellent symptom control — whether through medication, minimally invasive procedures, or surgery. This article explains what fibroids are, how they are classified, what symptoms they cause, how we diagnose them, and the full spectrum of treatment options available to you privately in London.
If you are experiencing heavy periods, pelvic pressure, or unexplained anaemia, I would encourage you to read on — and then consider booking a private gynaecology consultation so we can investigate properly with a same-day pelvic ultrasound.
What Are Uterine Fibroids?
Uterine fibroids — also known as leiomyomas or myomas — are benign tumours arising from the smooth muscle cells (myocytes) of the uterine wall. They are the most common benign tumours in women of reproductive age and the leading indication for hysterectomy, accounting for approximately 39% of all hysterectomies performed annually.[1] Despite their prevalence, the precise cause of fibroid development remains an active area of research. Current evidence points to a combination of genetic predisposition, hormonal sensitivity (particularly to oestrogen and progesterone), and local growth factors within the uterine environment.[4]
Fibroids grow as discrete nodules that can range from a few millimetres to, in rare cases, several centimetres in diameter. A single woman may have one fibroid or many simultaneously — a condition called uterine leiomyomatosis. They are oestrogen-dependent, which explains why they typically develop during the reproductive years, often enlarge during pregnancy, and tend to shrink after the menopause when oestrogen levels fall.[2]
One important distinction to make early: fibroids are not the same as ovarian cysts, though both are common benign gynaecological findings. If you have been told you have a pelvic mass, a pelvic ultrasound is the definitive way to distinguish between the two. You can read more about ovarian cysts in our dedicated guide.
Types and Locations of Fibroids
The location of a fibroid within or around the uterus is the single most important factor in determining what symptoms it causes and which treatment is most appropriate. The internationally recognised FIGO classification system categorises fibroids into eight types (0–7) based on their relationship to the uterine cavity and outer surface.[2] For clinical purposes, the three principal categories are:
| Type | Location | Primary Symptoms | Fertility Impact |
|---|---|---|---|
| Submucosal (FIGO 0–2) | Project into the uterine cavity | Heavy bleeding, prolonged periods, anaemia | High — most likely to impair implantation |
| Intramural (FIGO 3–4) | Entirely within the uterine wall | Heavy bleeding, pelvic pressure, bulk symptoms | Moderate — depends on size and proximity to cavity |
| Subserosal (FIGO 5–7) | Project outward from uterine surface | Pelvic pressure, urinary frequency, back pain | Low — unless very large |
| Pedunculated | Attached by a stalk (submucosal or subserosal) | Variable; torsion possible if pedunculated subserosal | Variable by location |
Table 1: FIGO fibroid classification by location, primary symptoms, and fertility impact. Adapted from Donnez & Dolmans (2016).[2]
Symptoms of Uterine Fibroids
Many fibroids are discovered incidentally — found on an ultrasound performed for another reason — in women who have no symptoms at all. However, when fibroids do cause symptoms, they can significantly affect quality of life. The most common presenting symptom is heavy menstrual bleeding (menorrhagia), which affects the majority of symptomatic women and can lead to iron-deficiency anaemia, fatigue, and reduced ability to work and exercise.[1] If you have been experiencing heavy periods, you may also find our article on irregular periods and when to see a gynaecologist helpful.
Beyond bleeding, larger fibroids — particularly intramural and subserosal types — can cause a range of "bulk symptoms" related to the physical pressure they exert on surrounding structures. These include urinary frequency and urgency (from pressure on the bladder), constipation and bloating (from pressure on the bowel), low back pain, and a sensation of pelvic heaviness or fullness. Some women notice visible abdominal distension when fibroids are very large.
Submucosal fibroids that distort the uterine cavity can impair fertility by interfering with implantation or causing recurrent miscarriage. If you are trying to conceive and have been diagnosed with fibroids, a specialist assessment is essential to determine whether the fibroid location is likely to be contributing to your difficulties.
Symptoms That Warrant Prompt Assessment
Whilst fibroids are almost always benign, certain symptoms should prompt urgent gynaecological review: rapidly increasing uterine size, post-menopausal bleeding, unexplained weight loss, or severe acute pelvic pain. These symptoms require investigation to exclude uterine sarcoma (a rare malignancy) and other serious pathology. If you experience any of these, please call us on 020 3146 9508 or contact us for a same-day appointment.
How Are Fibroids Diagnosed?
Ultrasonography is the recommended first-line imaging modality for the diagnosis of uterine fibroids — a recommendation supported by both the American Academy of Family Physicians and the Royal College of Obstetricians and Gynaecologists.[1] A pelvic ultrasound can confirm the presence of fibroids, determine their number, size, and location within the FIGO classification, and assess their relationship to the uterine cavity and endometrium — all information that is critical for planning treatment.
At Victoria Medical, we offer both transabdominal and transvaginal pelvic ultrasound. Transvaginal ultrasound provides superior resolution for detecting small submucosal fibroids and assessing the endometrial cavity, while transabdominal ultrasound is better suited for mapping larger or more numerous fibroids across the whole uterus. In many cases, both approaches are used in the same appointment to provide a complete picture.
For women with suspected submucosal fibroids or those planning fertility treatment, saline infusion sonohysterography (SIS) — where a small amount of saline is instilled into the uterine cavity during ultrasound — can delineate the extent of cavity distortion with greater precision. MRI is reserved for complex cases, pre-surgical planning, or when the ultrasound findings are inconclusive.
Blood tests also form an important part of the assessment. A full blood count will identify anaemia from chronic blood loss, and hormone panels (including FSH, LH, oestradiol, and thyroid function) help exclude other causes of heavy or irregular bleeding. You can read more about our private blood testing services.
Treatment and Management Options
The management of uterine fibroids is not one-size-fits-all. The right approach depends on the size and location of the fibroids, the severity of symptoms, the patient's age, desire to preserve fertility, and proximity to the menopause. In my experience, a significant proportion of women with fibroids do not require active treatment — particularly those approaching the menopause, where expectant management (watchful waiting with regular monitoring) is entirely appropriate, as fibroids typically regress after oestrogen levels decline.[1]
Medical Management
For women with symptomatic fibroids who wish to avoid surgery, several medical options can provide effective symptom relief. Hormonal contraceptives (the combined pill, progestogen-only pill, or the levonorgestrel intrauterine system) reduce heavy menstrual bleeding and are often the first-line medical approach. Tranexamic acid reduces blood loss during menstruation by inhibiting fibrinolysis, and NSAIDs provide pain relief whilst also reducing blood flow.[3]
For women who need more substantial symptom reduction — particularly pre-operatively or when approaching the menopause — gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) or goserelin (Zoladex) are highly effective, reducing fibroid volume by 35–65% by creating a temporary hypo-oestrogenic state.[3] However, symptoms return when treatment is stopped, and long-term use is limited by bone density loss and menopausal side effects. Newer GnRH antagonists (such as relugolix) offer similar efficacy with a more favourable side-effect profile.
Minimally Invasive Procedures
For women who wish to preserve their uterus but require more definitive treatment than medication alone, several minimally invasive options are available. Uterine artery embolisation (UAE) is an interventional radiology technique in which small particles are injected into the uterine arteries to block blood supply to the fibroids, causing them to shrink. It is highly effective for bulk symptoms and heavy bleeding, with a good evidence base from randomised controlled trials.[5]
MRI-guided focused ultrasound surgery (FUS) is a completely non-invasive technique that uses focused high-intensity ultrasound waves to heat and destroy fibroid tissue, guided in real time by MRI. It requires no incision and has a short recovery time, though it is not suitable for all fibroid types or locations. Radiofrequency ablation, performed laparoscopically or transcervically, offers similar advantages with growing evidence supporting its effectiveness.[5]
Surgical Treatment
Myomectomy — surgical removal of fibroids whilst preserving the uterus — is the preferred surgical option for women who wish to maintain their fertility or who prefer to keep their uterus. It can be performed hysteroscopically (for submucosal fibroids), laparoscopically, robotically, or via open surgery, depending on the size, number, and location of fibroids. It is important to note that fibroids can recur after myomectomy: an estimated 15–33% of fibroids recur, and approximately 10% of women will ultimately require hysterectomy within 5–10 years.[1]
Hysterectomy — removal of the uterus — is the only definitive cure for fibroids and eliminates any possibility of recurrence. It remains the most commonly performed surgical treatment for fibroids and is appropriate for women who have completed their family, have severe symptoms, or have not responded to other treatments. Modern minimally invasive hysterectomy techniques (laparoscopic or robotic) offer shorter recovery times and less blood loss compared with open surgery.[7]
| Treatment | Best For | Fertility Preserved | Recurrence Risk |
|---|---|---|---|
| Watchful waiting | Asymptomatic / near menopause | Yes | N/A |
| Hormonal medication | Mild–moderate bleeding symptoms | Yes | Symptoms return on stopping |
| GnRH agonists | Pre-operative shrinkage / near menopause | Yes (short-term) | High on stopping |
| Uterine artery embolisation | Bulk symptoms, heavy bleeding, no fertility plans | Possible but reduced | ~20% at 5 years |
| MRI-guided FUS | Suitable fibroid size/location, no surgery preference | Yes | Moderate |
| Myomectomy | Fertility preservation, symptomatic fibroids | Yes | 15–33% |
| Hysterectomy | Definitive cure, family complete | No | None |
Table 2: Summary of fibroid treatment options. Adapted from De La Cruz & Buchanan (2017)[1] and Micić et al. (2024).[5]
NHS vs Private Fibroid Care: What Is the Difference?
| Aspect | NHS | Victoria Medical (Private) |
|---|---|---|
| Initial consultation | GP referral required; weeks to months wait | Same-day or next-day appointment, no referral |
| Pelvic ultrasound | Separate referral; 4–12 week wait | Same appointment, results discussed immediately |
| Specialist access | Gynaecology outpatient; 6–18 week wait | Direct access to consultant gynaecologist |
| Appointment duration | 10–15 minutes | 45–60 minutes; unhurried, comprehensive |
| Treatment planning | Standardised pathways; limited options | Personalised plan across all treatment modalities |
| Follow-up | Variable; often back to GP | Coordinated follow-up with same consultant |
Your Patient Journey at Victoria Medical
Initial Consultation
You meet with Dr Xynopoulos or one of our consultant gynaecologists for a 45-minute appointment. We take a detailed menstrual and symptom history, review any previous investigations, and discuss your concerns and treatment preferences.
Same-Day Pelvic Ultrasound
A pelvic ultrasound is performed in the same appointment — both transabdominal and transvaginal where indicated. We map fibroid number, size, location, and FIGO type, and assess the endometrium and ovaries simultaneously.
Blood Tests
A full blood count to check for anaemia, hormone panel, and thyroid function tests are taken and processed within 24 hours, giving us a complete clinical picture.
Results and Treatment Planning
We discuss your ultrasound and blood test results in detail, explain the clinical significance of your fibroids, and present all management options — from watchful waiting through to surgical referral — with honest guidance on what we recommend for your specific situation.
Coordinated Follow-Up
Whether you choose medical management, a minimally invasive procedure, or surgical referral, we coordinate your ongoing care and provide a written summary letter for your GP and any specialists involved.
Frequently Asked Questions
Can fibroids become cancerous?
Fibroids are almost always benign. The risk of a fibroid harbouring a uterine sarcoma (a rare malignancy) is estimated at less than 1 in 1,000. Rapidly increasing fibroid size — particularly in post-menopausal women — warrants investigation, but the vast majority of fibroids, even large ones, are entirely benign.
Will fibroids affect my ability to get pregnant?
This depends heavily on the type and location of the fibroid. Submucosal fibroids that distort the uterine cavity have the strongest evidence for impairing fertility and increasing miscarriage risk. Intramural fibroids may have a modest effect depending on size, whilst subserosal fibroids generally have little impact on fertility. A specialist assessment with pelvic ultrasound is essential before drawing conclusions.
Do fibroids always need treatment?
No. Many women with fibroids have no symptoms and require no treatment — particularly those approaching the menopause, as fibroids typically shrink once oestrogen levels decline. Watchful waiting with periodic monitoring is entirely appropriate for asymptomatic fibroids.
How quickly can I be seen and diagnosed privately?
At Victoria Medical, we offer same-day and next-day appointments with no GP referral required. Your pelvic ultrasound is performed in the same appointment, and blood test results are available within 24 hours. You can leave your first appointment with a clear diagnosis and a personalised management plan.
What is the difference between a myomectomy and a hysterectomy?
A myomectomy removes the fibroids whilst preserving the uterus — it is the preferred surgical option for women who wish to maintain their fertility. A hysterectomy removes the entire uterus and is the only definitive cure, with no risk of fibroid recurrence. The right choice depends on your symptoms, fibroid characteristics, fertility wishes, and age.
Can fibroids cause heavy periods and anaemia?
Yes — heavy menstrual bleeding is the most common symptom of uterine fibroids, particularly submucosal fibroids that project into the uterine cavity. Chronic blood loss can lead to iron-deficiency anaemia, causing fatigue, breathlessness, and reduced exercise tolerance. A full blood count as part of your assessment will identify anaemia and guide whether iron supplementation or other interventions are needed alongside fibroid treatment.
References
- [1]De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-107. https://www.aafp.org/afp/2017/0115/p100
- [2]Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665-686. https://doi.org/10.1093/humupd/dmw023
- [3]Sohn GS et al. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201. https://pmc.ncbi.nlm.nih.gov/articles/PMC5854898/
- [4]Giuliani E et al. Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Front Cell Dev Biol. 2020;8:612. https://doi.org/10.3389/fcell.2020.00612
- [5]Micić J et al. Currently available treatment modalities for uterine fibroids. Medicina. 2024;60(6):868. https://doi.org/10.3390/medicina60060868
- [6]Baird DD et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-107. https://doi.org/10.1067/mob.2003.99
- [7]Laughlin-Tommaso SK. Alternatives to hysterectomy: management of uterine fibroids. Obstet Gynecol Clin North Am. 2016;43(3):397-413. https://doi.org/10.1016/j.ogc.2016.04.001