Managing uterine fibroids in women's health

Read about how to take an evidence-based approach to the diagnosis and management of uterine fibroids in women's health to optimise patient outcomes.

Author
HealthCert Education

3 minute read March 25, 2025

Uterine fibroids, or leiomyomas, are benign tumours of the uterus composed of smooth muscle and fibrous connective tissue. They are common, with up to 50 per cent of women over the age of 30 having uterine fibroids, and are more common in older women, women of black ethnicity and those with an increased body mass. While most cases are asymptomatic, fibroids can significantly impact women’s quality of life and reproductive health.

In clinical practice, fibroids should be suspected in women presenting with menstrual abnormalities, including heavy or prolonged menstrual bleeding, pelvic symptoms such as pain, pressure, or dysmenorrhoea, reproductive concerns such as infertility or recurrent pregnancy loss, or urinary or gastrointestinal disturbances.

Furthermore, fibroids should be suspected in women with abnormal findings on bimanual examination, such as an enlarged, firm or fixed uterus.

Imaging should be performed in all women with signs or symptoms of fibroids, and the first-line diagnostic investigation is a transabdominal or transvaginal pelvic ultrasound.

In cases characterised by abnormal bleeding, an endometrial biopsy should be considered to exclude alternative diagnoses such as adenomyosis, endometrial hyperplasia, or malignancy.

In complex cases or where there is diagnostic uncertainty, further imaging modalities such as magnetic resonance imaging (MRI) or computed tomography (CT) should be considered.

Management of fibroids depends on symptom severity, patient preferences, and reproductive aspirations. Asymptomatic fibroids often require no active management beyond routine surveillance.

First-line pharmacologic treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) for managing menorrhagia, dysmenorrhoea, and pelvic pain, and tranexamic acid to reduce menstrual blood loss and promote necrosis in larger fibroids.

For women desiring fertility or for those in whom first-line medical therapy is ineffective, referral to secondary care for consideration of hormonal or surgical interventions is appropriate.

Hormonal therapies such as gonadotrophin-releasing hormone (GnRH) agonists (such as leuprorelin) and antiprogestogens (such as mifepristone), are first-line medical therapies which can facilitate a temporary reduction in fibroid size. However, these therapies may induce vasomotor symptoms and are associated with bone loss with prolonged use. GnRH antagonists in combination with oestradiol and norethisterone, or a levonorgestrel-releasing intrauterine device (LNG-IUD) may prove beneficial for the management of heavy menstrual bleeding associated with uterine fibroids. Hormonal therapies are reversible, and fertility is restored following cessation.

Myomectomy is the preferred fertility-preserving surgical option and can be performed hysteroscopically, laparoscopically, or via open surgery depending on fibroid size and location.

Where fertility is not desired, uterine artery embolisation is a minimally invasive option, with hysterectomy reserved for women with refractory symptoms.

For women living with fibroids, pelvic examination should be performed annually to monitor uterine size and assess for any new pelvic masses. Additional investigation, including imaging, is warranted in cases of rapid growth, or the emergence of new symptoms, particularly abnormal vaginal bleeding, pain, urinary or gastrointestinal symptoms.

Uterine fibroids are a common condition that can significantly affect women's health. A tailored, evidence-based, patient-centred approach to diagnosis and management is essential for optimising outcomes and ensuring symptom control while preserving fertility when desired.

Dr Samantha Miller, MBChB

Learn more about this topic in the HealthCert online Professional Diploma program in Women's Health

Engaging with this blog can help meet your annual
Education Activities CPD requirement!

How to claim your CPD hours
If you consume educational webinars, podcasts, articles, or research on this blog, you can Quick Log CPD hours with the RACGP via the usual self-submission process. You will be asked to reflect on what you have learned, and you will require supporting evidence such as a screenshot. Download the RACGP’s guide to self-recording your CPD here.