Reviewed for medical accuracy by Dr Evelyne Jonniaux, Medical Advisor
Last updated 17 September 2026
A fibroid found on a scan, does it need treating?
Usually not. In Baird’s systematic ultrasound screening study (American Journal of Obstetrics and Gynecology, 2003), 51% of premenopausal women with no prior diagnosis had visible fibroids. The American College of Obstetricians and Gynecologists estimates that only around 25% of fibroids become troublesome enough to warrant intervention (Practice Bulletin 228, 2021). A fibroid found by chance is therefore not a disease to treat, it is an observation to follow. These figures describe populations, not one woman. Bleeding heavy enough to drop your haemoglobin, sudden pain, or urinary compression deserve advice without waiting. Noria Health arranges a full gynaecological work-up within 24 to 48 hours near Brussels.
How many women are affected
| What is measured | The figure | Source |
|---|---|---|
| Cumulative incidence by age 50, black women | over 80% | Baird, Am J Obstet Gynecol, 2003 |
| Cumulative incidence by age 50, white women | close to 70% | Baird, 2003 |
| Gap between the two incidence curves | odds ratio 2.9 (95% CI 2.5 to 3.4) | Baird, 2003 |
| Premenopausal women with no prior diagnosis in whom ultrasound finds fibroids | 51% | Baird, 2003 |
| Women who already had a diagnosis | 35% | Baird, 2003 |
| Fibroids clinically significant enough to require intervention | about 25% | ACOG Practice Bulletin 228, 2021 |
These six lines read together. Fibroids are among the commonest things a uterus produces over a lifetime, and most of the ones that exist are silent. The gap between 51% and 25% is what matters: one woman in two carries them without knowing, and only a quarter of fibroids will ever justify a procedure.
What happens to a fibroid left alone
Peddada’s study (Proceedings of the National Academy of Sciences, 2008) followed 262 fibroids in 72 premenopausal women, with up to four MRI scans over twelve months. The results are counterintuitive.
| What is measured | The result | Source |
|---|---|---|
| Median growth over 6 months | 9%, with a range from -89% to +138% | Peddada, PNAS, 2008 |
| Fibroids that shrank spontaneously by more than 20% | 7%, with no treatment and before menopause | Peddada, 2008 |
| Growth variance within one woman | twice the variance between women | Peddada, 2008 |
| Factors predicting growth rate | not size, not location, not BMI, not parity | Peddada, 2008 |
Two fibroids in the same woman, in the same hormonal environment, do not grow at the same speed. And nothing measurable in a consultation tells you which one will. That is why spaced surveillance is a defensible course of action, not a refusal to act.
Embolisation or surgery, what three randomised trials measured
The question people ask most is also the one best studied. Three European randomised trials and a Cochrane review cover it.
| What is measured | The result | Source |
|---|---|---|
| Hysterectomy within 10 years of embolisation | 35% by intention to treat, so about two thirds avoid it | EMMY, Am J Obstet Gynecol, 2016, 177 patients |
| Satisfaction at 10 years | 78% after embolisation, 87% after hysterectomy | EMMY, 2016 |
| Generic quality of life at 10 years | stable, with no significant difference between the two | EMMY, 2016 |
| Reintervention at 5 years | 32% after embolisation, 4% after surgery | REST, BJOG, 2011, 157 women |
| Reintervention at 2 years, meta-analysis | odds ratio 3.72 (95% CI 2.28 to 6.04) | Cochrane, 2014, 7 trials, 793 women |
| The authors’ own absolute translation | if 7% after surgery, then 15% to 32% after embolisation | Cochrane, 2014 |
| UFS-QOL quality of life at 2 years, myomectomy against embolisation | 8.0 points favouring myomectomy (p = 0.01) | FEMME, N Engl J Med, 2020, 254 women |
| The same difference at 4 years | 5.0 points, p = 0.13, not significant | FEMME, 4-year follow-up, 2023 |
These trials tell a coherent story that is rarely summarised honestly. Embolisation and surgery deliver comparable quality of life in the long run. What embolisation trades is a far lighter initial procedure against a reintervention risk roughly four to six times higher. And the advantage of myomectomy over embolisation, statistically significant at two years, is no longer significant at four.
The British REST trial measured an economic consequence worth stating: the cost advantage of embolisation at twelve months is cancelled out by five years through reinterventions. The two treatments become cost-neutral.
The drugs, and the episode that recalibrated caution
Three GnRH antagonists combined with hormonal add-back have shown high and consistent response rates on heavy bleeding.
| Treatment | Responders against placebo | Source |
|---|---|---|
| Relugolix combination therapy | 73% and 71%, against 19% and 15% | LIBERTY 1 and 2, N Engl J Med, 2021, 770 women |
| Elagolix with add-back | 68.5% and 76.5%, against 8.7% and 10% | Elaris UF-1 and UF-2, N Engl J Med, 2020, 790 women |
| Linzagolix 200 mg with add-back | 93.9%, against 29.4% | PRIMROSE 2, The Lancet, 2022 |
| Linzagolix 100 mg without add-back | 56.4% and 56.7% | PRIMROSE 1 and 2, 2022 |
One caveat, stated by the trials themselves: relugolix reduced bleeding without reducing fibroid volume. These treatments control a symptom, they do not remove the lesion, and hormonal add-back is needed to protect bone, except with low-dose linzagolix.
The ulipristal acetate story shows how little regulatory tolerance a benign condition gets. Five liver transplants worldwide were enough to trigger a European procedure: precautionary suspension in March 2020, a pharmacovigilance committee recommendation to revoke the authorisation in September 2020, and a final European Commission decision on 11 January 2021 restricting rather than revoking it. The drug can now only be used in premenopausal women for whom surgery, including embolisation, is unsuitable or has failed. It must not be used to bridge the wait before an operation.
Occult sarcoma, and an estimate revised thirtyfold
This is the hardest subject in the file, and the one where the literature moved most. In 2017 the Food and Drug Administration reassessed how often a sarcoma is found by chance during surgery for a presumed benign fibroid.
| What is estimated | The result | Source |
|---|---|---|
| Occult uterine sarcoma, fixed-effects model | 0.328%, about 1 in 305 | FDA reassessment, 2017 |
| Range adopted by the FDA | 1 in 225 to 1 in 580 | FDA, 2017 |
| Leiomyosarcoma specifically | 0.175%, about 1 in 570 | FDA, 2017 |
| Range for leiomyosarcoma | 1 in 495 to 1 in 1,100 | FDA, 2017 |
| What the clinical community estimated before 2014 | as rare as 1 in 10,000 | FDA, 2017 |
An estimate revised by a factor of about thirty, purely from a systematic reading of data that already existed. That is what led the FDA to restrict laparoscopic power morcellation to selected women, only with a tissue containment system, and to contraindicate it beyond age 50.
This figure is not a reason to refuse surgery for a symptomatic fibroid. It is a reason to insist that the operative technique be discussed explicitly, and that the question of morcellation be raised before the operation rather than after.
What the studies do not allow anyone to claim
Three limits deserve saying, because they concern claims heard constantly.
Fibroid regression at menopause is not quantified. The idea is repeated everywhere and we found no prospective study giving a proportion of women affected or a mean volume reduction. The only solid regression figure, 7%, comes from Peddada and concerns premenopausal women. We therefore treat this claim as a gap in the evidence, not an established fact.
The ACOG’s 25% does not mean 75% will never become symptomatic. It is a cross-sectional proportion of fibroids warranting intervention, not longitudinal follow-up of a cohort of newly appeared fibroids. The distinction changes what the sentence means.
There is no dedicated meta-analysis of recurrence after myomectomy. The figure of 19% at five years comes from a claims cohort of 35,631 women, and it measures reintervention, not recurrence on imaging. Three of its authors are employed by the manufacturer of one of the drugs above, and we say so.
What delay adds
In England, 585,308 gynaecology pathways were waiting in July 2026, and only 60.0% were treated within 18 weeks against a 92% standard. In Ireland, on 27 August 2026, 40,870 adults were waiting for a first gynaecology outpatient appointment, 8,801 of them for more than six months. That Irish list grew by 13.7% in seven months.
The Royal College of Obstetricians and Gynaecologists has flagged that gynaecology waiting lists are rising while the overall backlog falls. For a fibroid, that delay is not life-threatening, but it is paid in sustained anaemia and in months spent organising your life around your periods.
In practice, if this concerns you
Three questions decide, in this order. Is the fibroid causing measurable symptoms, in particular anaemia documented by a blood test. If so, which option preserves what you care about, knowing that embolisation avoids surgery in about two thirds of women at ten years but carries four to six times more reinterventions. If surgery is chosen, which technique, and is morcellation planned.
Noria Health arranges a full gynaecological work-up in Brussels within 24 to 48 hours: clinical examination, pelvic ultrasound, a blood count to document anaemia, and MRI where it changes the decision. The report is issued within 24 hours, follow-up is structured at D14, D30 and D90, and surgery is considered only around day 10 if it is needed. What Noria Health does not do: treat a fibroid because it is visible. One woman in two carries them, and most will never know.
Further reading
- Endometriosis: 190 million women, up to 12 years to diagnosis
- Colonoscopy: up to 7 times more lesions found, depending on the doctor
Sources
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women, ultrasound evidence. American Journal of Obstetrics and Gynecology, 2003;188:100-107. https://doi.org/10.1067/mob.2003.99
- American College of Obstetricians and Gynecologists. Management of symptomatic uterine leiomyomas. Practice Bulletin 228. Obstetrics and Gynecology, 2021;137:e100-e115. https://pubmed.ncbi.nlm.nih.gov/34011888/
- Peddada SD, Laughlin SK, Miner K, et al. Growth of uterine leiomyomata among premenopausal black and white women. PNAS, 2008;105:19887-19892. https://doi.org/10.1073/pnas.0808188105
- de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy, 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics and Gynecology, 2016;215:745.e1-745.e12. https://doi.org/10.1016/j.ajog.2016.06.051
- Moss JG, Cooper KG, Khaund A, et al. Randomised comparison of uterine artery embolisation with surgical treatment, REST trial, 5-year results. BJOG, 2011;118:936-944. https://doi.org/10.1111/j.1471-0528.2011.02952.x
- Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews, 2014, CD005073. https://doi.org/10.1002/14651858.CD005073.pub4
- Manyonda I, Belli AM, Lumsden MA, et al. Uterine-artery embolization or myomectomy for uterine fibroids. New England Journal of Medicine, 2020;383:440-451. https://doi.org/10.1056/NEJMoa1914735
- Sirkeci F, Moss J, Belli AM, et al. FEMME, 4-year results. International Journal of Gynaecology and Obstetrics, 2023;160:492-501. https://doi.org/10.1002/ijgo.14626
- Al-Hendy A, Lukes AS, Poindexter AN, et al. Treatment of uterine fibroid symptoms with relugolix combination therapy. New England Journal of Medicine, 2021;384:630-642. https://doi.org/10.1056/NEJMoa2008283
- Schlaff WD, Ackerman RT, Al-Hendy A, et al. Elagolix for heavy menstrual bleeding in women with uterine fibroids. New England Journal of Medicine, 2020;382:328-340. https://doi.org/10.1056/NEJMoa1904351
- Donnez J, Taylor HS, Stewart EA, et al. Linzagolix with and without hormonal add-back therapy, two randomised phase 3 trials. The Lancet, 2022;400:896-907. https://doi.org/10.1016/S0140-6736(22)01475-1
- European Medicines Agency. Ulipristal acetate 5 mg medicinal products, referral procedure. https://www.ema.europa.eu/en/medicines/human/referrals/ulipristal-acetate-5mg-medicinal-products
- Food and Drug Administration. Updated assessment of the use of laparoscopic power morcellators to treat uterine fibroids, December 2017. https://www.fda.gov/media/109018/download
- Davis MR, Soliman AM, Castelli-Haley J, Snabes MC, Surrey ES. Journal of Women’s Health, 2018;27:1204-1214. https://doi.org/10.1089/jwh.2017.6752
- NHS England. Consultant-led referral to treatment waiting times, July 2026. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
- National Treatment Purchase Fund. Outpatient waiting list by specialty, 27 August 2026. https://www.ntpf.ie/waiting-list-data/open-data/
See also: all our articles on gynaecology.
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.