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Health condition · Clinically reviewed

Uterine fibroids, from Mirena and Ryeqo to embolisation, ablation and surgery.

Most women will get fibroids. Most will not need surgery. A stepped, uterus-preserving plan usually beats a rush to hysterectomy.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG88, RCOG and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including Ryeqo, Yselty, uterine artery embolisation and Sonata ablation.

Key facts

Fibroids at a glance.

The essentials, in plain English: what fibroids are, who gets them and how they are treated in the UK today.

  • What they are

    Benign smooth-muscle tumours of the uterus (leiomyomas) driven by oestrogen and progesterone. Not cancerous.

  • How common

    Between 25 and 70 per cent of women develop fibroids in their lifetime, most commonly between 30 and 50.

  • Who is affected

    Higher incidence and often more severe symptoms in Black African-Caribbean women, and where there is a family history.

  • Types by location

    FIGO 0 to 8: submucosal, intramural, subserosal, pedunculated and cervical. Location shapes symptoms and treatment.

  • Typical symptoms

    Heavy periods and anaemia, pelvic pressure, urinary frequency, dysmenorrhoea and, for some, subfertility.

  • Modern options

    From the Mirena coil and Ryeqo tablets to uterine artery embolisation, Sonata ablation, myomectomy and hysterectomy.

Why this guide matters

A stepped plan, not a rush to hysterectomy.

Fibroids are common, hormone-driven and often manageable without major surgery. The three points below shape everything else on this page.

  • Symptoms drive treatment, not size

    A 10 cm subserosal fibroid with no symptoms may not need treatment. A 3 cm submucosal fibroid causing anaemia usually does.

  • Uterus-preserving options come first

    Mirena, Ryeqo, uterine artery embolisation, Sonata ablation and myomectomy usually come before hysterectomy is considered.

  • Fertility plans change the plan

    If you want to conceive, submucosal fibroids in the cavity, and any large fibroid, deserve a fertility-aware plan early.

How the diagnosis is made

From heavy periods to a clear plan.

The steps a UK GP or gynaecologist will normally follow, per NICE NG88, so you know what to expect and why.

  1. 01

    Assessing

    History and symptom pattern

    Bleeding pattern, pain, pressure symptoms, fertility plans and impact on daily life. A PBAC (pictorial blood loss chart) helps quantify heavy periods.

  2. 02

    Assessing

    Pelvic examination

    A bulky, irregular uterus is often palpable on abdominal or bimanual examination when fibroids are moderate or large.

  3. 03

    Assessing

    Bloods

    Full blood count and ferritin for iron deficiency, coagulation if bleeding is very heavy, and thyroid function where indicated.

  4. 04

    Confirming

    Transvaginal ultrasound

    First-line imaging per NICE NG88. Maps number, size and location of fibroids and screens for other pelvic pathology.

  5. 05

    Confirming

    MRI pelvis where needed

    For large uteri, multiple fibroids, surgical planning or when embolisation or ablation is being considered. Superior soft-tissue detail.

  6. 06

    Confirming

    Hysteroscopy for submucosal disease

    Direct view of the uterine cavity to confirm FIGO 0 to 2 fibroids and plan hysteroscopic resection. See our diagnostic hysteroscopy guide.

  7. 07

    Ruling out

    Endometrial sampling if indicated

    Biopsy for postmenopausal bleeding, atypical bleeding over 45, or persistent unexplained bleeding to exclude endometrial pathology.

Typical timeline: a first appointment to a settled plan in weeks, not months.

Symptoms

What fibroids actually feel like.

Bleeding, bulk, pain and pressure. Some symptoms map to fibroid location, and one or two are red flags for urgent review.

  • Heavy menstrual bleeding

    The most common symptom. Long, flooding periods and clots that can cause iron-deficiency anaemia and profound fatigue.

  • Pelvic pressure and bulk

    A dragging or bloated feeling, a visible lower-abdominal swelling and clothes that no longer fit around the waist.

  • Urinary frequency and urgency

    Pressure on the bladder from anterior fibroids can cause daytime frequency, nocturia and, occasionally, incomplete emptying.

  • Bowel symptoms

    Posterior fibroids press on the rectum, causing constipation, incomplete emptying or low backache.

  • Dysmenorrhoea and pelvic pain

    Cyclical period pain, chronic pelvic ache and, occasionally, sharp pain from a degenerating or torted pedunculated fibroid.

  • Subfertility

    Submucosal fibroids distorting the cavity reduce implantation. Large intramural fibroids can also affect fertility outcomes.

  • Pregnancy problems

    Higher rates of miscarriage, preterm birth, malpresentation, obstructed labour and postpartum haemorrhage in some cases.

  • Red flag - acute pain

    Sudden severe pain suggests red degeneration in pregnancy or torsion of a pedunculated fibroid. Seek urgent gynaecology review.

Treatment

How fibroids are treated in the UK.

Watchful waiting, medical options like the Mirena and Ryeqo, uterine artery embolisation, Sonata ablation, myomectomy and hysterectomy. Sequenced to symptoms and goals.

  • Watchful waiting

    For asymptomatic fibroids found incidentally. Yearly review, iron checks and education on the symptoms that should prompt a return visit.

  • LNG-IUS (Mirena)

    First-line NICE option for heavy periods with fibroids of 3 cm or less and an undistorted cavity. Reduces bleeding dramatically over three to six months.

  • Tranexamic and mefenamic acid

    Non-hormonal tablets taken only during the period. Cut bleeding volume and pain without altering the cycle. Useful for those trying to conceive.

  • Combined pill or progestogens

    Regulates cycles and lightens bleeding. Progestogen-only options are useful where oestrogen is contraindicated.

  • GnRH analogues

    Leuprolide or goserelin injections shrink fibroids for up to six months, typically pre-operatively. Add-back HRT protects bone and eases menopausal symptoms.

  • GnRH antagonists (Ryeqo, Yselty)

    Oral relugolix or linzagolix combined with add-back HRT. NICE-approved for fibroids. A newer, gentler alternative to injections.

  • Uterine artery embolisation

    Interventional radiology procedure that starves fibroids of blood supply. Preserves the uterus and is supported by REST and EMMY trial evidence.

  • Sonata radiofrequency ablation

    Transcervical, ultrasound-guided ablation of intramural and submucosal fibroids. Day-case, uterus-sparing and no incisions.

  • Hysteroscopic myomectomy

    Removes submucosal (FIGO 0 to 2) fibroids through the cervix. Excellent for heavy bleeding and fertility, with rapid recovery.

  • Laparoscopic myomectomy

    Keyhole removal of intramural and subserosal fibroids. Preserves the uterus and fertility. Robotic assistance is increasingly used.

  • Open myomectomy

    For very large or multiple fibroids where keyhole is not feasible. Preserves the uterus but requires a longer recovery.

  • Hysterectomy

    The only definitive cure. Considered when family is complete, symptoms are severe or other treatments have failed. Usually laparoscopic or robotic.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynaecologist knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Heavy menstrual bleeding: assessment and management (NG88).

  • NICE TA832. Relugolix-estradiol-norethisterone (Ryeqo) for treating moderate to severe symptoms of uterine fibroids.

  • NICE TA919. Linzagolix (Yselty) for treating moderate to severe symptoms of uterine fibroids.

  • Royal College of Obstetricians and Gynaecologists (RCOG). Uterine artery embolisation in the management of fibroids.

  • REST and EMMY trials. Uterine artery embolisation versus surgical treatment for fibroids.

  • FIGO PALM-COEIN classification of causes of abnormal uterine bleeding.

Red flags

When fibroids need urgent attention.

Most fibroids are manageable in a planned clinic setting. These are the situations that are not, and where a specialist opinion is needed quickly.

  • Severe anaemia

    Breathlessness, chest pain, dizziness or a haemoglobin under 80 g/L need urgent assessment and, sometimes, transfusion.

  • Postmenopausal bleeding

    Any bleeding after the menopause needs a two-week-wait referral and endometrial assessment to exclude cancer.

  • Acute severe pain

    Sudden severe pelvic pain can mean red degeneration in pregnancy or torsion of a pedunculated fibroid. Attend A&E or contact gynaecology urgently.

  • Rapidly growing uterus

    Rapid growth, particularly after the menopause, is uncommon and needs specialist review to exclude the rare (under 0.1 per cent) risk of leiomyosarcoma.

  • Urinary retention

    Inability to pass urine, or new obstructive symptoms from a very large fibroid, is a urological emergency.

  • Pregnancy with large fibroids

    Specialist maternal-medicine input is warranted for very large or submucosal fibroids because of preterm and haemorrhage risk.

  • Persistent unexplained bleeding

    Bleeding that does not fit a fibroid pattern deserves a fresh look at the endometrium, cervix and coagulation.

  • Fertility concerns

    Submucosal fibroids distorting the cavity should be reviewed early if you are trying to conceive. Delay costs eggs and time.

  • Signs of infection after procedure

    Fever, offensive discharge or worsening pain after embolisation, ablation or myomectomy needs same-day review.

Living with it

A common condition, with a clear ladder.

Four things that make the biggest difference day to day: treating anaemia, tracking bleeding, planning around fertility and knowing when to escalate.

A quiet reminder

You are not asking for too much.

Heavy periods, anaemia and pelvic pressure are not something to endure. Modern, uterus-preserving options work well and are worth asking about.

  1. 01 Iron

    Treat the anaemia first

    Oral iron, ferritin monitoring and, where needed, intravenous iron infusions. Energy returns before the fibroids do.

  2. 02 Track

    Keep a period diary

    A PBAC score and pain diary make treatment decisions clearer and objective, and help specialists tailor your plan.

  3. 03 Fertility

    Plan around your goals

    Fertility plans change everything. Say them out loud so treatment preserves the option to conceive when it matters.

  4. 04 Escalate

    Do not settle for exhaustion

    If iron and the Mirena are not enough, ask about embolisation, ablation or myomectomy. Modern options have transformed outcomes.

Frequently asked

Everything we get asked about fibroids.

Quick answers on medical options, embolisation, myomectomy, fertility and cancer risk.

  • What are uterine fibroids?

    Fibroids (leiomyomas) are benign smooth-muscle tumours of the uterus. They are extremely common, hormone-dependent and range from a few millimetres to more than 20 cm. They are not cancerous.

  • Do all fibroids need treating?

    No. Fibroids found incidentally on scans, without symptoms and without fertility concerns, are usually monitored rather than treated. Treatment is guided by symptoms, size, location and future pregnancy plans.

  • Are Ryeqo and Yselty the same as GnRH injections?

    They work on the same hormonal pathway but are taken as a daily tablet with built-in add-back HRT. Both are NICE-approved oral treatments for moderate to severe fibroid symptoms and are usually gentler than older injectable GnRH analogues.

  • Will uterine artery embolisation affect my fertility?

    Embolisation preserves the uterus and many women go on to conceive after the procedure. However, myomectomy is still generally preferred for those actively trying to conceive. Discuss the balance with a specialist who does both.

  • Can fibroids come back after myomectomy?

    Yes. Around a quarter of women develop new or recurrent fibroids over the following five to ten years. Only hysterectomy is definitively curative, which is why it remains an option once family is complete.

  • Are fibroids ever cancerous?

    True fibroids are benign. Malignant transformation to leiomyosarcoma is rare, occurring in fewer than 1 in 1,000 cases. Rapid growth, particularly after the menopause, is the main warning sign and warrants specialist review.

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