NHS GP & Women’s Health Specialist

Dr Sylvia Kama-Kieghe, FRCGP — NHS GP & Women’s Health Doctor

You’ve been told you have fibroids. Now you’re trying to figure out what happens next — and whether the NHS will actually do anything about them.

Here’s what every treatment option looks like, in plain English.

Watch First: Fibroid Shrinking Methods — Which One Works Best?

What are Fibroids?

Fibroids are non-cancerous growths that develop in or around the uterus (womb). They’re extremely common — up to 70% of women will develop fibroids at some point in their lives, and Black women are two to three times more likely to be affected and to experience more severe symptoms.

They don’t always cause problems. But when they do — heavy periods, pelvic pain, pressure on the bladder or bowel, difficulty getting pregnant — you deserve proper treatment. Not just “come back in six months.”

The NHS Treatment Pathway: What to Expect

Your GP will typically refer you to a gynaecologist if your symptoms are significantly affecting your quality of life. An ultrasound scan confirms the diagnosis. From there, the treatment options fall into three categories.

1. Watchful Waiting

If your fibroids are small and your symptoms are mild, your doctor may suggest monitoring rather than treating immediately. This is reasonable — fibroids often stop growing or shrink naturally after menopause.

When it works: Small fibroids, minimal symptoms, approaching menopause.

When to push back: If your period is so heavy it’s affecting your daily life, you’re in pain, or you’re struggling to conceive — watchful waiting isn’t good enough. Say so, clearly.

2. Medication Options

Medication is usually the first treatment offered. Here’s what’s available on the NHS:

For heavy bleeding:

• Tranexamic acid — reduces blood loss during your period. Taken when bleeding starts.
• Mefenamic acid (an NSAID) — reduces bleeding and helps with period pain. Also taken during your period.
• The Mirena coil (hormonal IUS) — a small device placed in the womb that releases a low dose of progesterone. Very effective for heavy periods caused by fibroids, though it works best for smaller fibroids.
• The combined contraceptive pill — can help manage heavy bleeding, though it doesn’t shrink fibroids.

For shrinking fibroids before surgery:

• GnRH agonists (e.g., Prostap, Zoladex) — injections that temporarily switch off oestrogen production, which shrinks fibroids. Usually used for 3–6 months before surgery to reduce the size and make the operation safer. Not a long-term solution as they cause menopausal symptoms.
• Linzagolix (Yselty)/Relugolix (Ryeqo) — are newer oral tablets that works similarly to GnRH agonists. Available on the NHS as of 2023 for moderate-to-severe symptoms.

3. Procedures and Surgery

If medication doesn’t control your symptoms, or if your fibroids are large, these are the options:

Uterine Artery Embolisation (UAE) A minimally invasive procedure performed by a radiologist, not a surgeon. Tiny particles are injected into the blood vessels feeding the fibroids, cutting off their blood supply so they shrink. You keep your uterus. Recovery is typically 1–2 weeks. Available on the NHS, but not all hospitals offer it — you may need a referral to a specialist centre.

MRI Guided Ultrasound This non-invasive procedure uses high doses of focused ultrasound to destroy fibroid tissue without damaging the surrounding tissues. It is usually performed within an MRI chamber to allow the specialist see within the body to conduct the procedure.

Endometrial Ablation Removes the lining of the womb. Very effective for heavy bleeding, but only suitable for small fibroids near the lining. Not appropriate if you want to get pregnant.

Myomectomy Surgical removal of the fibroids while keeping the uterus intact. The right choice if you want to preserve your fertility. Can be done via keyhole surgery (laparoscopy) or open surgery depending on fibroid size and location.

Hysterectomy (removal of the womb) — the only permanent ‘cure’ for fibroids. A major operation with a longer recovery (6–8 weeks). This is not the only option. Do not accept it as your only option without a full conversation about the alternatives above.

Red Flags — Go Back to Your GP

See your GP urgently if you experience:

• Very heavy bleeding (soaking a pad or tampon every hour for several hours)
• Sudden, severe pelvic pain
• Rapid increase in abdomen size
• Symptoms of anaemia — extreme fatigue, dizziness, shortness of breath

Also Watch: What You Don’t Know About Diet and Fibroids

The Bottom Line

The NHS does have effective treatments for fibroids — but you need to know what to ask for. Watchful waiting is appropriate in some cases. But heavy bleeding that disrupts your life, pain that stops you working, and pressure symptoms that affect your bladder are not things you should be told to just live with.

Know your options. Go in informed. Advocate for yourself.

Similar Topics

• 7 Reasons Your GP May Refuse to Prescribe Mounjaro
• 6 Tips for Shrinking Fibroids Naturally to Improve Symptoms
• Fibroids and Menopause – Do they SHRINK with age?
• How Long Does It Take for Fibroids to Shrink Naturally? (Effective Strategies for Relief)