What are Fibroids?

Fibroids, also known as uterine fibroids or leiomyomas, are non-cancerous growths that develop in or around the muscle of the uterus (womb). They are common and affect many women during their reproductive years.

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Fibroids vary widely in size, number and location. Some women have fibroids without any symptoms, while others experience significant effects on their quality of life.

Types of fibroids (by location)

The location of a fibroid within the uterus often determines symptoms and treatment options.

Diagram of the female reproductive system highlighting uterine fibroids, including submucosal, intramural, and subserosal fibroids.

  • Grow into the cavity of the uterus. These commonly cause:

    • Heavy or prolonged menstrual bleeding

    • Fertility or pregnancy problems

    These fibroids are often suitable for hysteroscopic removal.

  • Grow within the muscular wall of the uterus. They may cause:

    • Heavy bleeding

    • Pelvic pain or pressure

    • Uterine enlargement

    Treatment depends on size, symptoms and fertility goals.

  • Grow on the outer surface of the uterus. These fibroids are more likely to cause:

    • Pelvic pressure

    • Bladder or bowel symptoms

Common fibroid symptoms

Not all fibroids cause symptoms. When symptoms do occur, they may include:

  • Heavy or prolonged menstrual bleeding

  • Pelvic pain or pressure

  • Abdominal bloating or fullness

  • Frequent urination or bowel symptoms

  • Pain during intercourse

  • Difficulty conceiving or pregnancy complications

Symptoms can worsen gradually over time.

How are fibroids diagnosed?

Fibroids are usually diagnosed using:

  • Pelvic ultrasound

  • MRI scans in selected cases

Imaging helps determine the size, number and location of fibroids and guides treatment planning.

Fibroid treatment options

Medical Management

Medical management refers to treatments that aim to control fibroid-related symptoms, particularly heavy menstrual bleeding, rather than remove fibroids themselves. These options may be appropriate for some women depending on symptoms, fibroid type, age and fertility goals.

Medical treatments do not eliminate fibroids, and symptoms may return once treatment is stopped. For this reason, medical management is often used as a temporary measure or as part of a broader treatment plan.

Medical treatment options

  • Hormonal therapies may help reduce heavy menstrual bleeding associated with fibroids.

    These include:

    • Progesterone-based treatments, such as oral progesterone or intrauterine systems (Mirena)

    • Combined hormonal contraception in selected women

    Hormonal treatments may improve bleeding but usually do not significantly reduce fibroid size.

  • These medications temporarily suppress ovarian hormone production and can:

    • Reduce fibroid size

    • Improve bleeding symptoms

    They are typically used:

    • For short-term symptom control

    • Before surgery to reduce fibroid size or correct anaemia

    Long-term use is limited due to menopausal-type side effects and bone health considerations.

  • Tranexamic acid may be used to:

    • Reduce heavy menstrual bleeding

    • Improve quality of life during periods

    It does not affect fibroid size and is used only during menstruation.

Surgical Management

Why Minimally Invasive?

Minimally invasive fibroid surgery offers effective treatment for uterine fibroids while minimising recovery time and disruption to daily life. At the Auckland Fibroid Clinic, our specialist gynaecologists provide advanced keyhole surgical options tailored to each woman’s symptoms, fibroid type and reproductive goals.

Minimally invasive refers to surgical techniques that remove fibroids or the uterus using small incisions rather than traditional open surgery. These approaches are associated with:

  • Less postoperative pain

  • Shorter hospital stays (1-2 night admission)

  • Faster recovery and return to work

  • Reduced scarring

Not all fibroids require surgery, and not all women need the same operation. Our role is to help you understand your options and choose the most appropriate treatment.

Who is suitable?

Suitability depends on several factors, including:

  • Size, number and location of fibroids

  • Previous abdominal surgery

  • Symptoms and overall health

  • Fertility plans

We offer detailed imaging review and multidisciplinary discussion to determine the safest and most effective approach for each patient.

  • A myomectomy is the procedure to remove a fibroid while preserving the uterus. This option is often suitable for women who:

    • Wish to maintain fertility

    • Have symptoms such as heavy bleeding or pressure

    • Have fibroids that are suitable for keyhole removal

    Laparoscopic myomectomy is performed through small abdominal incisions using specialised instruments and a camera.

  • A myomectomy is the procedure to remove a fibroid while preserving the uterus. This option is often suitable for women who:

    • Wish to maintain fertility

    • Have symptoms such as heavy bleeding or pressure

    • Have fibroids that are suitable for keyhole removal

    Laparoscopic myomectomy is performed through small abdominal incisions using specialised instruments and a camera.

  • A hysterectomy involves removal of the uterus and provides definitive treatment for fibroids. Minimally invasive hysterectomy may be recommended when:

    • Fibroid symptoms are severe

    • Fertility preservation is not required

    • Other treatments have been ineffective

    Where appropriate, hysterectomy can be performed using keyhole techniques to reduce recovery time compared with open surgery.

Uterine Artery Embolisation

Uterine artery embolisation (UAE) is a well-established, minimally invasive treatment for fibroids. It has been refined over decades of clinical use worldwide and is backed by a substantial body of evidence — offering women effective, lasting symptom relief without the need for surgery.

The procedure is performed by an interventional radiologist through a tiny, needle-sized access point in the wrist — no abdominal incision required (see diagram). This radial approach means most women can sit up and move about again soon after the procedure. Using real-time imaging guidance, a thin catheter is directed to the arteries supplying the fibroids, and their blood supply is blocked, causing the fibroids to shrink and symptoms to ease over time.

Why consider UAE?

  • No abdominal incision and no removal of the uterus

  • Performed via the wrist, allowing quick mobilisation after the procedure

  • Typically done as a day case under conscious sedation, avoiding the risks of a general anaesthetic

  • A well-established option with a long track record of safety and effective symptom control

  • Preserves the uterus for women who wish to avoid hysterectomy

UAE may be appropriate for women who:

  • Have significant fibroid-related symptoms, such as heavy menstrual bleeding or pelvic pressure/bulk-related symptoms

  • Prefer a non-surgical option, or do not wish to undergo surgery, after counselling

  • Are not suitable surgical candidates due to medical comorbidities or increased anaesthetic risk

  • Have multiple fibroids where myomectomy would be complex or extensive, and hysterectomy is not desired

  • Wish to avoid hysterectomy

UAE does not remove the fibroids, but it provides good, durable symptom relief for most women. It can also be considered by women wishing to preserve fertility, though this requires careful individual discussion and counselling.

Lifestyle and Dietary support

Fertility 

For women wishing to conceive, fibroid management requires careful planning. Our service includes fertility specialist input to assess how fibroids may affect pregnancy or IVF outcomes and to determine whether surgical removal may improve fertility while minimising risks.

Fibroids and Fertility

While many women with fibroids can conceive naturally, some fibroids—particularly those that distort the uterine cavity or block the fallopian tubes—can affect fertility or increase the risk of pregnancy complications.

Fibroids may contribute to:

  • Difficulty conceiving naturally

  • Recurrent miscarriage

  • Complications during pregnancy, such as preterm labour or malpresentation

  • Interference with IVF or other assisted reproductive techniques

    • Submucosal fibroids (grow into the uterine cavity) – most strongly associated with infertility and miscarriage

    • Large intramural fibroids (within the uterine wall) – may reduce implantation rates or interfere with uterine blood flow

    • Fibroids that distort the cavity or block the fallopian tubes – can prevent sperm or embryos from reaching the uterus

    Fibroids located on the outer surface of the uterus (subserosal) usually do not affect fertility.

    1. Hysteroscopic removal – ideal for submucosal fibroids; preserves the uterus and fertility

    2. Laparoscopic myomectomy – removes intramural or subserosal fibroids while maintaining fertility

    3. Medical management – usually temporary and does not improve fertility

    4. Uterine artery embolisation – generally not recommended for women planning pregnancy due to potential effects on uterine blood supply

    Your gynaecologist will help you choose the treatment that maximises fertility while relieving symptoms.

Fibroids and Pregnancy

  • Many women with fibroids have healthy pregnancies, but fibroids can sometimes increase the risk of complications depending on their size, number, and location.

    Potential effects include:

    • Miscarriage – particularly with submucosal fibroids (inside the uterine cavity)

    • Preterm labour – fibroids may contribute to early contractions or uterine irritability

    • Fetal growth restriction – large fibroids can reduce space for the developing baby

    • Abnormal fetal position – may make vaginal birth more difficult

    • Placental complications – including placental abruption or malposition

    • Pain during pregnancy – fibroids may grow due to hormonal changes, causing discomfort or pressure

    • Most fibroids do not require treatment during pregnancy

    • Pain can sometimes be managed with paracetamol or gentle lifestyle measures

    • Surgery during pregnancy is rare and reserved for complications such as severe pain or fibroid degeneration

    • Women with fibroids are typically monitored closely with ultrasound to check growth, placental position, and fetal development

    • Removing fibroids before conception can improve outcomes, especially for submucosal or large intramural fibroids

    • Hysteroscopic or laparoscopic myomectomy is preferred for fertility preservation

    • Women who have had UAE may need careful fertility counselling, as pregnancy outcomes can be affected

  • At the Auckland Fibroid Centre, women with fibroids who are planning pregnancy or already pregnant are assessed by:

    • Specialist gynaecologists – experienced in minimally invasive fibroid surgery

    • Fertility specialists – to optimise conception and pregnancy planning

    • Multidisciplinary support – including imaging, dietetics, and specialist nursing

    The goal is to ensure the safest possible pregnancy while managing fibroids effectively.

  • Fibroids can sometimes interfere with fertility and the success of in vitro fertilisation (IVF), particularly when they distort the uterine cavity or reduce implantation chances.

    Women undergoing IVF may be recommended fibroid removal if they have:

    • Submucosal fibroids – grow into the uterine cavity and significantly reduce implantation and pregnancy rates

    • Large intramural fibroids – can slightly reduce IVF success if they distort the cavity or reduce uterine blood flow

    • Fibroids causing symptoms – such as heavy bleeding or pain, which could complicate IVF treatment

    Fibroids located on the outer surface of the uterus (subserosal) usually do not affect IVF outcomes and may not require removal.

    • Hysteroscopic myomectomy – ideal for submucosal fibroids; performed through the vagina and cervix without abdominal incisions

    • Laparoscopic myomectomy – used for intramural or subserosal fibroids; minimally invasive abdominal surgery preserves the uterus

    • Open myomectomy – rarely required, reserved for very large or complex fibroids

    The choice of procedure depends on:

    • Fibroid size, number, and location

    • Fertility goals and previous IVF history

    • Specialist assessment and imaging

    • Increases the chance of implantation and pregnancy for women with cavity-distorting fibroids

    • Reduces the risk of miscarriage associated with submucosal fibroids

    • Preserves fertility while relieving symptoms of heavy bleeding or pain

Multidisciplinary approach

At the Auckland Fibroid Centre, women considering IVF are assessed by:

  • A specialist gynaecologist with experience in minimally invasive fibroid surgery

  • A fertility specialist to coordinate IVF planning

  • A multidisciplinary team, including imaging and nursing support

This ensures that treatment is individualised, evidence-based, and aligned with IVF goals.

Book an initial video consultation and we can help you every step of the way. We accept self-referrals.

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