GPAtlas🧭 When to suspect
Suspect uterine fibroids (leiomyomas) in any woman of reproductive age presenting with heavy menstrual bleeding (HMB) – flooding, clots, or prolonged/frequent periods – and/or with bulk symptoms from an enlarging uterus. Fibroids are benign, oestrogen- and progesterone-dependent smooth-muscle growths; they are very common, frequently asymptomatic, and often found incidentally on examination or imaging requested for another reason.
Bulk symptoms include pelvic pressure or fullness, bloating, a palpable mass, urinary frequency/urgency, and bowel symptoms such as constipation. Fibroids are significantly more common, tend to present earlier, and are often larger and more symptomatic in Black/African–Caribbean women. They characteristically shrink after the menopause, so new symptoms or growth in a postmenopausal woman should never be assumed to be a simple fibroid.
The clinical skill in primary care is to match treatment to the dominant symptom and the woman's fertility wishes, and to recognise the small number of presentations that need urgent exclusion of malignancy.
| Fibroid location | Typical clinical picture |
|---|---|
| Submucosal (project into the cavity) | Heavy/prolonged bleeding and subfertility even when small; may prolapse through the cervix. |
| Intramural (within the muscle wall) | Most common; gives a bulky, globular uterus and can increase menstrual loss. |
| Subserosal (outer surface) | Pressure/bulk symptoms (bladder, bowel, abdominal swelling) rather than heavy bleeding. |
| Pedunculated (on a stalk) | May tort, causing acute pain; can be subserosal or submucosal. |
Source: NICE NG88
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