If you have been told you have uterine fibroids, you may have also been told to simply “watch them.”

But a measurement on an ultrasound does not tell the whole story.

A 2-centimeter fibroid in one location may cause heavy bleeding or affect the uterine cavity. A much larger fibroid somewhere else may cause pressure, fullness, or no symptoms at all.

At Women’s Health Group Chicago, Dr. Michael Awad takes a different approach to fibroid care.

The question is not simply:

“How big is the fibroid?”

The better questions are:

Where is it? What is it doing? And what matters most to you right now?

For one woman, the main goal may be stopping heavy bleeding.

For another, it may be relieving pelvic pressure or pain.

For someone trying to become pregnant, the priority may be protecting or optimizing fertility.

And for another woman who has completed childbearing, the goal may be finding the most effective long-term treatment.

Fibroid treatment should match the patient—not just the ultrasound report.

What Are Uterine Fibroids?

Uterine fibroids, also called leiomyomas or myomas, are benign growths made from smooth muscle and connective tissue in the uterus. They are very common and may occur as a single fibroid or as several fibroids at the same time.

Fibroids may be:

• Very small or quite large
• Single or multiple
• Located inside the uterine cavity
• Within the muscular wall of the uterus
• Growing toward the outside of the uterus

Many women have fibroids without symptoms and never need treatment.

For women who do have symptoms, understanding where the fibroids are located is often one of the most important parts of deciding what to do next.

With Fibroids, It Is Often “Location, Location, Location”

Fibroids are commonly described based on where they grow.

Submucosal Fibroids

These grow toward or into the inside cavity of the uterus.

Even relatively small fibroids in this location can be important because they can change the shape of the uterine cavity.

They may be associated with:

• Heavy menstrual bleeding
• Bleeding between periods
• Fertility concerns
• Difficulty with embryo implantation in selected patients

For women trying to become pregnant, fibroids that distort the uterine cavity deserve special attention. ASRM has found evidence that hysteroscopic removal of submucosal fibroids can improve clinical pregnancy rates in appropriately selected patients.

Intramural Fibroids

These grow within the muscular wall of the uterus.

Depending on their size and exact position, they may contribute to:

• Heavy bleeding
• Pelvic pain
• Pressure
• Enlargement of the uterus

Their effect on fertility is less straightforward when they do not distort the uterine cavity. Current evidence does not support automatically removing every intramural fibroid simply to improve fertility.

Subserosal Fibroids

These grow toward the outside surface of the uterus.

They may cause fewer bleeding problems but can create symptoms from their size and pressure on nearby organs.

Symptoms may include:

• Pelvic pressure
• Abdominal fullness
• Frequent urination
• Back discomfort
• Pressure on the bowel or bladder

Does Fibroid Size Matter?

Yes—but size alone should not determine treatment.

A larger fibroid may be more likely to cause pressure, fullness, or changes in the overall size of the uterus.

But location, number, symptoms, and your reproductive goals can be just as important.

Imaging used to plan fibroid treatment evaluates the size, number, and location of the fibroids rather than relying on a single measurement.

That is why we do not treat an ultrasound number.

We treat what the fibroid is actually doing to the patient.

Fibroid Symptoms Are Different for Every Woman

Fibroids do not produce one standard set of symptoms.

Two women can have fibroids of similar size and have completely different experiences.

Common symptoms include heavy or prolonged periods, pelvic pain or pressure, frequent urination, back discomfort, and pain during intercourse.

Heavy Periods

Heavy menstrual bleeding is one of the most common reasons women with fibroids seek treatment.

You may notice:

• Soaking through pads or tampons quickly
• Passing large blood clots
• Needing to change protection during the night
• Periods lasting longer than they used to
• Planning activities around your period
• Missing work, exercise, travel, or social events because of bleeding

Over time, heavy bleeding can also contribute to iron-deficiency anemia.

Symptoms may include:

• Fatigue
• Weakness
• Shortness of breath
• Dizziness
• Reduced exercise tolerance

Stopping the bleeding is important, but so is identifying and treating the effect that blood loss has had on the rest of your body.

Pelvic Pressure and Fullness

For some women, bleeding is not the main problem.

Instead, fibroids create a constant feeling of:

• Pelvic pressure
• Abdominal fullness
• Bloating
• Heaviness
• A larger or more prominent lower abdomen

Some women describe feeling as though they are always carrying pressure in their pelvis.

In this situation, the treatment goal is different from someone whose main concern is bleeding.

Frequent Urination

Fibroids that push against the bladder may cause:

• Frequent urination
• Urgency
• Waking during the night to urinate
• Pressure when the bladder fills

This is a good example of why location matters.

A fibroid positioned near the bladder may create urinary symptoms because of where it is, not simply because of its measurement.

Pelvic Pain and Pain During Sex

Fibroids can be associated with pelvic discomfort and pain, although fibroids are not the only possible cause of these symptoms.

If pain is the main complaint, we also consider other possible causes, such as:

• Endometriosis
• Adenomyosis
• Ovarian conditions
• Pelvic floor problems
• Gastrointestinal or urinary conditions

Finding fibroids on an ultrasound does not automatically prove that they are responsible for every symptom.

The imaging has to match the patient’s story.

Fibroids and Fertility: The Location Matters More Than Simply Having a Fibroid

Many women with fibroids become pregnant normally.

Having fibroids does not automatically mean you will have infertility.

The strongest concern involves fibroids that distort the uterine cavity, especially submucosal fibroids. ASRM reports evidence that hysteroscopic myomectomy for submucosal fibroids can improve clinical pregnancy rates.

The evidence is much less clear for fibroids that do not affect the uterine cavity.

For a patient who wants to become pregnant, we therefore look carefully at:

• Fibroid location
• Whether the uterine cavity is distorted
• Fibroid size and number
• Age
• Ovarian reserve when relevant
• Previous pregnancies
• Prior pregnancy loss
• Other causes of infertility
• Future fertility plans

The goal is not to remove every fibroid.

The goal is to determine whether a particular fibroid is likely to interfere with the patient’s reproductive plan and whether treatment is likely to help.

How We Diagnose Fibroids at Women’s Health Group Chicago

Good fibroid treatment starts with good imaging.

It is not enough to know that a fibroid exists.

We want to understand:

• How many fibroids are present?
• Exactly where are they?
• How large are they?
• Do they change the shape of the uterine cavity?
• Are they pushing outward from the uterus?
• Could they explain the patient’s symptoms?
• Is something else contributing to the problem?

Ultrasound is an established first-line imaging tool for identifying and evaluating uterine fibroids. More advanced imaging, including MRI, may be useful in selected situations.

High-Quality In-Office Ultrasound

At Women’s Health Group Chicago, much of the fibroid evaluation can be performed right in our office.

Our ultrasound program is designed to provide detailed imaging of the uterus, ovaries, and pelvis without automatically sending patients to a separate imaging facility.

Our ultrasound technologist, Gabi, plays an important role in that process.

She combines strong technical skills with the qualities that matter during a pelvic ultrasound: being gentle, patient, kind, and attentive to the patient’s comfort.

A technically excellent study matters.

So does the experience of the patient having it performed.

Imaging Reviewed in the Context of Your Symptoms

At our practice, imaging is not treated as a report that simply appears in the chart.

Dr. Mike reviews the images in the context of the patient’s symptoms and medical history, and our imaging is also interpreted by an expert board-certified radiologist.

That gives us multiple perspectives on the same study.

The radiologist provides expert imaging interpretation.

Dr. Mike then considers those findings alongside:

• Your bleeding
• Your pain
• Your examination
• Your age
• Your previous imaging
• Your fertility goals
• Your stage of life
• What is actually bothering you

That distinction matters.

An ultrasound may tell us that a fibroid measures 4 centimeters.

The clinical question is:

Does that 4-centimeter fibroid explain what this particular patient is experiencing?

The Goal of Fibroid Treatment Is Different for Every Patient

There is no single definition of successful fibroid treatment.

For one patient, success may mean:

“I want my periods under control.”

For another:

“I want to stop feeling this pressure.”

For another:

“I want to become pregnant.”

And another patient may say:

“I am finished having children and I want this problem solved as definitively as possible.”

Those are different goals.

They should lead to different conversations.

Medical Treatment for Fibroids

Fibroid treatment does not always mean surgery.

For many patients, medical treatment is a reasonable first option, especially when bleeding or pain is the main concern.

ACOG recognizes several medication options for managing symptoms associated with fibroids and heavy menstrual bleeding.

Tranexamic Acid

Tranexamic acid is a nonhormonal prescription medication used during the menstrual period to reduce heavy bleeding.

It does not remove the fibroid.

Its purpose is to reduce menstrual blood loss.

This may be useful for a woman whose main goal is bleeding control and who does not necessarily want hormonal treatment.

Hormonal Treatment

Hormonal medications can be used to control heavy or irregular bleeding in selected patients.

Depending on your health and goals, options may include:

• Birth control pills
• Progestin treatment
• A hormonal IUD
• Other hormone-based therapies

These treatments may improve bleeding even though they do not physically remove the fibroid.

Medications That Suppress Fibroid Growth or Shrink Fibroids

Certain medications that affect the GnRH hormonal pathway can temporarily reduce fibroid-related bleeding and, with some therapies, fibroid or uterine size.

They are generally used for specific situations rather than as a permanent cure because symptoms or fibroid growth may return after treatment is stopped.

For the right patient, these medications can be useful as part of a larger treatment plan.

Treating Anemia Matters Too

If heavy periods have caused iron deficiency or anemia, controlling the fibroid-related bleeding is only part of the treatment.

We may also need to restore iron levels and correct anemia.

Again, the goal is to treat the whole patient, not simply the fibroid.

Procedural and Surgical Treatment for Fibroids

Medication is not always enough.

Sometimes the location of the fibroid, the severity of the symptoms, fertility goals, or the patient’s preference makes a procedure or surgery the better choice.

There are several options.

Hysteroscopic Myomectomy

If a fibroid grows into the uterine cavity, it may be possible to remove it through the vagina and cervix using hysteroscopy.

There is no abdominal incision.

Hysteroscopic myomectomy is widely used for submucosal fibroids causing abnormal uterine bleeding and can also be considered for selected patients with infertility or recurrent pregnancy loss.

This is where our separate discussion of in-office hysteroscopy becomes relevant.

Not every fibroid can be treated hysteroscopically.

But when a fibroid is located in the uterine cavity, hysteroscopy may allow us to directly see and treat the problem.

Myomectomy

A myomectomy removes one or more fibroids while leaving the uterus in place.

Depending on the fibroids, surgery may be performed through:

• Hysteroscopy
• Laparoscopy or robotic surgery
• A traditional abdominal incision

Myomectomy is commonly considered when preserving the uterus is important, including for selected women who want future pregnancy. New fibroids can still develop later after existing fibroids are removed.

Uterine Fibroid Embolization

Uterine fibroid embolization, or UFE, is performed by an interventional radiologist.

A small catheter is used to reduce blood flow to the fibroids so that they shrink over time. It can improve bleeding and pressure symptoms in appropriate patients.

Fertility after UFE is less well established than fertility after uterus-preserving myomectomy, so reproductive goals are an important part of deciding whether this option is appropriate.

Other Minimally Invasive Fibroid Treatments

Other treatments, including focused ultrasound and fibroid ablation techniques, may be appropriate for selected patients.

Imaging is particularly important because candidacy depends on factors including fibroid size, number, and location.

No single procedure is best for every fibroid.

Hysterectomy

A hysterectomy removes the uterus and is the definitive surgical treatment for uterine fibroids.

It may be a reasonable choice for a patient who:

• Has completed childbearing
• Has severe symptoms
• Has multiple or difficult-to-treat fibroids
• Has not improved with other treatment
• Wants the most definitive treatment

But finding fibroids does not mean that hysterectomy is automatically necessary.

There are often medical, minimally invasive, and uterus-preserving options to consider first.

You Do Not Have to Choose Between “Do Nothing” and Surgery

One of the biggest misconceptions about fibroid care is that there are only two choices:

Watch them.

or

Have surgery.

Modern fibroid care is much broader than that.

Depending on the patient, options may include:

• Observation
• Treatment of anemia
• Nonhormonal medication
• Hormonal medication
• Hormonal IUD
• Fibroid-suppressing medication
• Hysteroscopic removal
• Myomectomy
• Uterine fibroid embolization
• Other minimally invasive procedures
• Hysterectomy

The right plan depends on the patient.

Fibroid Treatment Should Match Your Stage of Life

If Your Main Goal Is Fertility

We focus heavily on whether the fibroid affects the uterine cavity and whether treating it is likely to improve reproductive outcomes.

A fibroid simply being present does not automatically mean it should be removed.

If Your Main Goal Is Controlling Bleeding

Medical treatments may be enough.

If a fibroid projects into the uterine cavity, hysteroscopic treatment may also be an option.

If Your Main Goal Is Reducing Pain

We first make sure the fibroid is actually the likely source of the pain.

Then medical or surgical treatment may be considered based on the cause and severity.

If Your Main Goal Is Relieving Pressure or Fullness

The size, number, and outward location of fibroids become especially important.

A treatment that reduces or removes the fibroid burden may make more sense than simply treating menstrual bleeding.

If You Have Completed Childbearing

You may have a wider range of treatment choices.

That still does not mean you automatically need a hysterectomy.

Your symptoms and preferences remain central to the decision.

Do All Fibroids Need Treatment?

No.

If you have fibroids but they are not causing significant symptoms, observation may be completely appropriate.

Monitoring does not mean ignoring the problem.

It means watching your symptoms and reassessing when something changes.

Treatment becomes more important when fibroids contribute to:

• Heavy bleeding
• Anemia
• Pelvic pain
• Pressure or fullness
• Frequent urination
• Pain during intercourse
• Fertility concerns
• Symptoms that interfere with daily life

Frequently Asked Questions About Uterine Fibroids

What size fibroid needs treatment?

There is no single size that automatically requires treatment.

Size matters, but treatment also depends on the fibroid’s location, symptoms, number, effect on the uterine cavity, and your fertility goals. Imaging used for fibroid treatment planning evaluates all three major features: size, number, and location.

Can a small fibroid cause major symptoms?

Yes.

A smaller fibroid that grows into the uterine cavity may cause significant bleeding or may be important in a fertility evaluation.

A larger fibroid growing outward may instead cause pressure or fullness.

This is why location can sometimes be just as important as size.

Can fibroids be treated without surgery?

Yes.

Depending on your symptoms, medical options may include tranexamic acid, hormonal medications, hormonal IUDs, and medications that suppress fibroid-related hormonal activity.

These treatments generally control symptoms rather than physically removing a fibroid.

Can fibroids be treated without a hysterectomy?

Yes.

Options can include medication, hysteroscopic treatment, myomectomy, uterine fibroid embolization, and other minimally invasive procedures.

Hysterectomy is one option, not the only option.

Which fibroids are most likely to affect fertility?

Fibroids that distort the uterine cavity, especially submucosal fibroids, have the clearest evidence of affecting fertility treatment decisions.

ASRM reports fair evidence that hysteroscopic removal of submucosal fibroids can improve clinical pregnancy rates. The benefit of removing fibroids that do not distort the cavity is less certain.

Can fibroids cause frequent urination?

Yes.

A fibroid can create pressure on the bladder and contribute to urinary frequency or urgency.

Can fibroids cause pelvic pressure and fullness?

Yes.

Larger fibroids or multiple fibroids can cause pelvic pressure, heaviness, or abdominal fullness.

Can fibroids cause anemia?

Yes.

Fibroid-related heavy menstrual bleeding can result in chronic blood loss and anemia.

When that happens, the treatment plan should address both the bleeding and the anemia.

Are fibroids cancerous?

Fibroids are benign, or noncancerous, uterine tumors.

A rare malignant uterine tumor called a leiomyosarcoma is a different disease and is not simply a typical fibroid that has turned into cancer.

How are uterine fibroids diagnosed?

Pelvic ultrasound is commonly used to identify fibroids and determine their size and location. MRI or other imaging may be needed in selected cases, especially when more detailed treatment planning is required.

Do fibroids come back after myomectomy?

The fibroids that are removed do not grow back, but new fibroids can develop later.

Your age and future plans should therefore be part of the treatment discussion.

Get a Fibroid Plan Built Around You

If you have fibroids, you do not need a treatment plan based only on the largest number written on an ultrasound report.

At Women’s Health Group Chicago, we start by understanding what you want to accomplish.

Is it:

• Less bleeding?
• Less pain?
• Relief from pelvic pressure and fullness?
• Correcting anemia?
• Improving your chances of pregnancy?
• Preserving your uterus?
• Finding a long-term solution after childbearing?

Then we use detailed in-office ultrasound imaging, the skill and care of our ultrasound technologist Gabi, review by Dr. Michael Awad, and interpretation by an expert board-certified radiologist to understand how your fibroids fit into the larger picture.

From there, we discuss the full range of appropriate options—medical and surgical.

Because with fibroids, the answer is rarely just:

“How big is it?”

It is often:

Location. Location. Location.

And most importantly:

What treatment makes sense for you, at this point in your life?

Schedule a consultation with Women’s Health Group Chicago for a comprehensive fibroid evaluation and a treatment plan built around your symptoms, your imaging, and your goals.