What are Uterine Fibroids?
The uterus is made up of muscular tissue, and sometimes, abnormal growths can develop within or around this muscle. These growths are called uterine fibroids, also known medically as leiomyomas or myomas. They are the most common non-cancerous growths seen in women of reproductive age.
Fibroids are almost benign, which means that they are not cancerous. They can appear as a single growth or in groups, and their size can vary enormously, from as small as a tiny seed to as large as a watermelon. They can develop in different locations, within the muscular wall of the uterus, inside the main cavity, or on its outer surface.
What are the Types of Uterine Fibroids?
Uterine fibroids are categorised based on where they are located in or around the uterus and their attachment to it.
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Intramural Fibroids It is the most common type of uterine fibroids that grow directly within the muscular wall of the uterus and can cause the organ to appear larger than normal as they expand. Because they are embedded in the wall itself, larger intramural fibroids can sometimes alter the shape of the uterus, which may have implications for fertility and pregnancy.
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Submucosal Fibroids Submucosal fibroids are found just beneath the inner lining of the uterine cavity. Although they are less common than other types, they tend to cause the most pronounced symptoms. Because of their position against the uterine lining, they can significantly disrupt normal uterine function and are most closely associated with fertility-related concerns.
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Subserosal Fibroids These types of fibroids grow on the outer surface of the uterus and can grow out into the pelvic cavity. They do not immediately affect the uterine cavity and generally enlarge to large sizes before causing significant problems. Their outward growth is more likely to press against nearby organs than to directly affect menstrual bleeding.
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Pedunculated Fibroids Pedunculated fibroids do not grow directly from the uterine wall. Instead, they are attached to the uterus by a thin stalk, giving them a mushroom-like appearance. They can grow either on the outer surface of the uterus or inside the uterine cavity, depending on where the stalk originates. Their stalk-like attachment makes them somewhat more prone to complications if the stalk twists. This is the least common type of fibroids.
How Common are Uterine Fibroids in India?
Uterine fibroids are highly prevalent in India. A globally published study found that India recorded the largest increase in fibroid occurrences worldwide over the last 2-3 decades. The reasons could be a combination of genetic susceptibility, environmental exposure to pollution, and endocrine-disrupting chemicals. Several India-specific factors are also believed to contribute, including hormonal imbalances, family history, nutritional deficiencies in traditional diets, rising obesity rates, and widespread vitamin D deficiency. It is also worth noting that part of this increasing trend may reflect improved diagnostic facilities and greater awareness.
A gynaecology OPD-based study found a fibroid prevalence rate of approximately 18%, with the highest concentration of cases among women aged 31 to 50. Heavy bleeding during periods was the most commonly reported symptom, affecting 45% of patients, followed by lower abdominal pain and painful periods.
Intramural fibroids, which develop within the muscular wall of the uterus, were the most frequently diagnosed type, accounting for 55% of cases. On a broader economic scale, India's uterine fibroid treatment market is estimated to reach USD 0.09 billion in 2026, reflecting the growing demand for diagnosis and care in the country.
What are the Symptoms of Uterine Fibroids?
Some women experience no symptoms despite having uterine fibroids, while others find them significantly disruptive to daily life. Here are some common symptoms:
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Symptoms of Intramural Fibroids
- A feeling of pressure, fullness, or discomfort in the pelvic area
- Lower back pain
- Frequent urination, particularly if the fibroid is pressing on the bladder
- Heavy or unusually long periods
- Trouble getting pregnant, if the fibroid grows large and starts affecting fertility.
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Symptoms of Submucosal Fibroids
- Irregular periods or periods with heavier bleeding than usual, including blood clots.
- Constant pelvic pain or a dull ache in the lower abdomen
- A sensation of bloating or abdominal fullness
- Anaemia (loss of healthy blood)
- Fertility issues.
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Symptoms of Subserosal Fibroids
- Constipation caused by the pressure in the rectum.
- Frequent urination.
- Pain and discomfort in the pelvis
- Unusual feeling of fullness
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Symptoms of Pedunculated Fibroids
- A sensation of pressure on the pelvis
- Discomfort in the pelvis
- If the stalk of the fibroid turns, you may feel extreme pain
- Feeling full, pelvic pain, frequent urination, etc.
What Causes Uterine Fibroids?
The exact reason behind uterine fibroids is not fully understood. However, as per research, one of the following things, or their combination, can cause them.
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Hormonal Influence: Oestrogen and progesterone, the two main female reproductive hormones, are believed to play an important role in the growth of uterine fibroids. Fibroids often grow during the reproductive years when hormone levels are higher and may shrink after menopause when these hormone levels decline.
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Genetic Factors: Genetic changes in uterine muscle cells and a family history of fibroids can increase the likelihood of developing uterine fibroids, suggesting a hereditary component to the condition.
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Cell Origins: Research suggests that fibroids might arise from a single stem cell in the uterine muscle tissue. In time, this cell starts to divide repeatedly to form a firm, distinct mass in the wall of the uterus.
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Growth Factors: Certain substances that help the body maintain and repair tissue, such as insulin-like growth factor, are thought to influence how fibroids grow and develop.
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Extracellular Matrix: Fibroids contain higher levels of a substance called the extracellular matrix, which is the material that holds cells together. This gives fibroids their firm, fibrous texture and may also stimulate further cell changes that encourage growth.
Risk Factors of Uterine Fibroids
As the cause of uterine fibroids cannot be identified, here are some risk factors. Addressing those within your control may help support overall reproductive health.
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Family History: If your mother or sister had uterine fibroids, you may be more likely to develop them as well.
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Higher BMI: Excess body weight and a higher body mass index (BMI) have been linked to an increased risk of fibroid growth.
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Early Start of Menstruation: Getting your first period at a younger age (before 10) may increase the chances of developing fibroids later in life.
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Not Having Children: Women who have never been pregnant may have a higher risk of fibroids compared to those who have had a baby.
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Late Menopause: A longer reproductive lifespan may expose the uterus to hormones for a greater period, which may contribute to fibroid development.
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Dietary Factors: Consuming excessive red meat and low levels of fruits, vegetables, and dairy products have been associated with a greater risk of fibroids.
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Low Vitamin D Levels: Insufficient vitamin D means there is a higher likelihood of developing fibroids.
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Alcohol Consumption: Regular alcohol intake, including beer, may increase the risk of having fibroids in some women.
What are the Complications of Uterine Fibroids?
Most women do not have to face serious complications due to the presence of fibroids. However, in some cases, the following complications may arise:
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Heavy Bleeding and Anaemia: Excessive menstrual bleeding over time can reduce the number of healthy red blood cells in the body. This may lead to anaemia, which can cause tiredness, weakness, dizziness, and fatigue.
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Chronic Pain: Some fibroids can cause ongoing pain, pressure, or discomfort in the lower abdomen and pelvic region, making daily activities difficult.
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Swelling of the Abdomen: Large fibroids may increase the size of the abdomen, causing bloating or a feeling of heaviness. In some cases, the swelling can become quite noticeable.
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Twisting of a Fibroid: Fibroids attached to the uterus by a stalk-like structure can sometimes twist. This may cut off their blood supply and result in sudden pain, nausea, or fever.
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Degeneration of Fibroids: When a fibroid grows rapidly or begins to break down due to reduced blood supply, it can cause major pain and discomfort.
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Difficulty Getting Pregnant: Although uncommon, certain fibroids may interfere with conception or affect fertility in some women.
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Need for Blood Transfusion: Severe blood loss due to prolonged heavy bleeding may occasionally become serious enough to require a blood transfusion.
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Pregnancy Complications: Large or strategically located fibroids may increase the risk of miscarriage, preterm birth, abnormal fetal position, placental problems, and caesarean delivery.
When Should I See My Healthcare Provider?
It is a sensible idea to consult a doctor if you notice unusual changes in your menstrual cycle, such as very heavy bleeding, increased pain, irregular periods, or bleeding between periods. You should also seek medical advice if you experience ongoing pelvic pain, discomfort during sex, a feeling of pressure or fullness in the lower abdomen, difficulty emptying your bladder, or persistent tiredness and weakness that could be linked to anaemia caused by excessive blood loss. Since many of these symptoms can occur in other gynaecological conditions as well, a proper medical evaluation is important.
Some women with fibroids may not have any symptoms at all. Regular gynaecological check-ups and pelvic scans can sometimes help detect fibroids before they start causing problems.
How are Uterine Fibroids Diagnosed?
Uterine fibroids are diagnosed through physical exams, ultrasounds, blood tests, and other specialised methods. Here is an overview of the diagnosis process.
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Pelvic Examination During a pelvic exam, the doctor may detect changes in the size or shape of your uterus that could suggest the existence of fibroids. This is often the first step in diagnosis.
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Ultrasound Exam Ultrasound is the most common test for fibroids. It utilises sound waves to generate images of your uterus and can help determine how many fibroids there are, how large they are, and where they are located. The scan can be performed over the abdomen or through the vagina to get a better view.
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Other Scans The following scans may be recommended for a proper diagnosis:
- Saline Infusion Sonography (SIS): This helps provide a more precise view of the uterine cavity and can make certain fibroids easier to detect.
- MRI Scan: It is mainly useful for assessing large fibroids and understanding their exact position before treatment planning.
- Hysteroscopy: In this test, the doctor can look inside the uterus using a specialised scope or camera. This process can help verify the diagnosis and provide a closer view of the fibroids.
- Hysterosalpingography (HSG): A special dye and X-ray are used for this test to see the uterus and fallopian tubes. It can be recommended where there are concerns about fertility, as it can help identify fibroids that may affect conception.
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Laparoscopy This involves inserting a thin camera through a small cut in the abdomen to examine the uterus and nearby organs more closely.
How are Uterine Fibroids Treated?
The treatment for uterine fibroids is determined by the size, location, and number of fibroids. Factors like the severity of symptoms and whether you plan to have children in the future also affect the treatment plan.
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Monitoring Without Treatment: If fibroids are not causing any symptoms, there may be no need for immediate treatment. Your doctor may simply monitor them with regular check-ups and scans to make sure they are not growing or causing problems.
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Medicines: Over-the-counter medicines may help reduce pelvic pain, cramps, and discomfort associated with fibroids. Birth control pills, iron supplements, hormone-releasing intrauterine devices (IUDs), and other medication is given to manage symptoms.
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Myomectomy: In this surgery, the doctor removes the fibroids while leaving the uterus intact. It is often considered for women who may want to become pregnant in the future. The procedure may be performed through open surgery, keyhole surgery (laparoscopy), or hysteroscopy.
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Hysterectomy: For severe cases or when other treatments are not suitable, the uterus may be surgically removed. This permanently eliminates fibroids but also means pregnancy will no longer be possible. This may be an option for women who do not plan to conceive in the future and have severe symptoms.
Can Uterine Fibroids be Prevented?
At present, there is no proven way to prevent uterine fibroids, as the exact reasons for their development are still not fully understood. However, certain healthy habits may support overall reproductive health and possibly reduce the risk of some contributing factors. These include having a healthy body weight, eating a balanced diet, and staying physically active. Regular gynaecological check-ups and pelvic examinations are also important, as they can help detect fibroids early, even before symptoms appear.
What is the Prognosis of Uterine Fibroids?
The outlook for most women with uterine fibroids is generally positive. Fibroids are non-cancerous growths, and many women either have no symptoms at all or experience symptoms that treatment can effectively manage. Fibroids do not always remain the same size. They may grow larger, stay unchanged, or even become smaller over time. These changes are often influenced by hormone levels in the body. For example, fibroids may increase in size during pregnancy when hormone levels are higher. With appropriate medical care and follow-up, most women with fibroids are able to manage the condition successfully and maintain a good quality of life.
Uterine Fibroids and Pregnancy
Many women with uterine fibroids are able to conceive and have healthy pregnancies. In most cases, fibroids do not cause serious problems for either the mother or the baby. However, pregnancy hormones can sometimes cause fibroids to grow larger, which may lead to pelvic discomfort, pressure, or pain.
Depending on their size and location, fibroids may slightly increase the risk of complications such as miscarriage, preterm birth, breech presentation of the baby, placental problems or the need for a caesarean delivery. Sometimes, very large fibroids can block the passage of the baby or the birth canal. In most cases, treatment is usually not needed in pregnancy unless the symptoms are severe.
Does Health Insurance Cover Uterine Fibroids?
Yes, most health insurance policies in India cover the treatment of uterine fibroids. Plans generally cover expenses related to diagnosis, medicines, hospitalisation, and surgery. Many insurers also cover surgeries like myomectomy (surgical removal of fibroids) and hysterectomy (removal of the uterus), as well as certain minimally invasive treatment options, depending on the policy terms and medical necessity.
However, uterine fibroids are often classified under specific listed illnesses for which a waiting period may apply, even if the condition develops after purchasing the policy or was disclosed and accepted at the time of policy issuance.
Since coverage limits, exclusions, waiting periods, and policy conditions vary from one insurer to another, it is important to carefully read the policy documents and understand the terms before purchasing a health insurance plan.
How Much Health Insurance is Required for Uterine Fibroids?
The treatment cost of uterine fibroids can vary significantly as per the treatment plan and the severity of the condition. For example, myomectomy and other surgical options can be costly. Given the rising cost of healthcare in India and the possibility of hospitalisation and surgery, it is generally advisable to have a health insurance policy of at least ₹10 lakh to ₹20 lakh.
FAQs
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Can I live a normal life with uterine fibroids?
Ans: Yes, most women are able to live normally despite having fibroids in the uterus. Many women with uterine fibroids have no symptoms at all and are unaware they have them. If there are symptoms, they can be managed with medicines and treatments. -
What are the symptoms of uterine fibroids?
Ans: Common symptoms of having fibroids include heavy or prolonged periods, pelvic pain or pressure, lower back pain, frequent urination, bloating, and in some cases, fertility difficulties. Symptoms change depending on the type, size, and location of the fibroids. -
What are the causes of uterine fibroids?
Ans: The exact cause of fibroids is not known, but hormonal influence, genetic factors, cell origins in the uterine muscle tissue, and the presence of certain growth factors and extracellular matrix substances are all believed to play a role.
