Dr Manou Kaur Answers Common Questions About Fibroid Surgery

What are fibroids? 

Fibroids (also called uterine myomas or leiomyomas) are non-cancerous growths that develop in or around the womb. They are made of muscle and fibrous tissue and can vary greatly in size, from as small as a seed to as large as a melon. 

Fibroids are extremely common. Depending on how they are looked for, an estimated 70 per cent of women develop fibroids during their lifetime, most often between the ages of 30 and 50. They are the most common non-cancerous tumour affecting the female reproductive system. Fibroids are more common, and often develop earlier and grow larger, in women of Black and Asian heritage, and other recognised risk factors include a family history of fibroids, having a higher body weight, high blood pressure and never having been pregnant. 

Fibroids are usually classified by where they grow: 

• Intramural fibroids, which grow within the muscular wall of the womb (the most common type) 

• Submucosal fibroids, which grow into the cavity of the womb and are more likely to cause heavy bleeding and fertility difficulties 

• Subserosal fibroids, which grow on the outer surface of the womb and can become very large 

• Pedunculated fibroids, which grow on a stalk either inside or outside the womb 

What symptoms can fibroids cause? 

Many women with fibroids have no symptoms at all, and their fibroids are found incidentally during a scan or examination. When symptoms do occur, they vary from person to person but commonly include: 

• Heavy or prolonged menstrual bleeding, sometimes with clots 

• Iron-deficiency anaemia and fatigue as a result of heavy bleeding 

• Pelvic pain, pressure or a feeling of fullness in the lower abdomen 

• A noticeably swollen or enlarged abdomen 

• Frequent or urgent need to pass urine, or difficulty emptying the bladder 

• Constipation or bowel pressure 

• Lower back pain 

• Pain during sex 

• In some cases, difficulty becoming pregnant or complications in pregnancy 

Because symptoms such as heavy bleeding and pelvic pain overlap with other gynaecological conditions, an accurate diagnosis is an important first step towards effective treatment. 

The impact of fibroids on daily life and wellbeing 

Fibroids are often spoken about in terms of scans and measurements, but for many women the greatest burden is the effect on daily life and emotional wellbeing. This is a theme Dr Kaur returns to often, because it is so frequently overlooked. 

Living with heavy, unpredictable bleeding can mean planning life around the menstrual cycle, worrying about leaks and accidents at work or in public, cancelling social plans, and carrying constant fatigue from anaemia. Persistent pain and pressure, a swollen abdomen and changes to the body can affect a woman’s confidence, self-image and sense of femininity. Pain during sex and anxiety about bleeding can place a strain on intimacy and relationships, and the uncertainty of a diagnosis or worries about fertility can weigh heavily. It is very common for women in this situation to experience low mood, anxiety, frustration or a sense of not being heard, and these feelings are entirely understandable. The psychological impact of fibroids is real and deserves to be taken as seriously as the physical symptoms. 

In the interview, Dr Kaur also highlights how much difference support can make. Understanding from a partner, family and friends, and reasonable flexibility and understanding in the workplace, can help women cope while they are being investigated and treated. Feeling believed and supported, rather than dismissed, is an important part of recovery. Part of good specialist care is recognising this wider impact, giving women the time and space to talk about how fibroids are truly affecting their lives, and involving the people around them where that is helpful. 

When is treatment recommended for fibroids? 

Not every fibroid needs to be treated, and surgery is not the right answer for everyone. As Dr Kaur emphasises, the aim is to treat the woman and her symptoms, not simply the scan report. Many small or symptom-free fibroids can safely be monitored over time. 

Depending on a woman’s symptoms, age, fertility plans and previous treatments, management may include watchful waiting, medication, hormonal treatments or a minimally invasive procedure. Treatment or surgery may be considered when: 

• Symptoms such as heavy bleeding or pain continue despite medical treatment. 

• Fibroids are causing anaemia that affects quality of life. 

• Fibroids are large, growing, or pressing on the bladder or bowel. 

• Fibroids are thought to be affecting fertility or contributing to pregnancy complications. 

• There is uncertainty about a diagnosis that needs to be clarified. 

The decision is always individual and should be made after discussing the potential benefits, limitations and risks with an experienced specialist. 

What treatment options are available? 

Fibroid care spans a wide range of options, and part of good specialist care is matching the right approach to the right woman. Options include: 

• Active monitoring for fibroids that are small or not causing significant symptoms. 

• Medical treatment, such as tranexamic acid or anti-inflammatory medication to reduce bleeding, hormonal contraception, the hormonal coil (intrauterine system), and hormone-modifying medicines that can temporarily shrink fibroids or control bleeding. 

• Myomectomy, an operation to remove the fibroids while preserving the womb. This can be performed by hysteroscopy (through the neck of the womb, with no incisions), by keyhole or robotic-assisted surgery, or by open surgery, depending on the size, number and position of the fibroids. Myomectomy is often the preferred option for women who wish to preserve their fertility. 

• Transcervical radiofrequency ablation (the Sonata treatment), an incisionless, uterus-preserving procedure performed through the neck of the womb. Using real-time ultrasound guidance from within the womb, precisely targeted energy is delivered to shrink the fibroids from the inside. Because it avoids any abdominal incisions, it is usually carried out as a day case and allows a rapid recovery. It is generally considered for women who are not planning a future pregnancy, as evidence on pregnancy after the procedure is still limited. 

• Uterine artery embolisation, a non-surgical, radiologically guided procedure that blocks the blood supply to the fibroids so that they shrink. 

• Endometrial ablation, which treats the lining of the womb to reduce heavy bleeding in selected cases. It is aimed at heavy bleeding arising from the womb lining rather than at the fibroids themselves, so it is not a treatment for fibroids as such and is of limited value where fibroids are the main problem. It is also important to know that pregnancy is not safe after endometrial ablation, so any woman who has this procedure will need reliable contraception until she reaches the menopause. 

• Hysterectomy, removal of the womb, which is the only definitive cure for fibroids and may be appropriate for women with severe symptoms who have completed their family. 

Why specialist surgery matters 

Fibroid surgery can range from relatively straightforward procedures to highly complex operations, particularly when fibroids are large, numerous or in difficult positions. 

For women with complex fibroids, care that is carefully planned by an experienced specialist can help ensure that treatment is matched to the size, number and location of the fibroids, and to each woman’s wider goals such as preserving fertility or avoiding a hysterectomy. As the named lead for fibroids at Chelsea and Westminster Hospital NHS Foundation Trust, Dr Kaur has a particular interest in developing and improving fibroid services in multidisciplinary ways and in advancing the standard of care that women with fibroids receive. 

Dr Kaur specialises in minimally invasive hysteroscopic, robotic-assisted and, where needed, open surgery for complex gynaecological conditions, including fibroids. An internationally recognised robotic surgeon and a proctor who trains other surgeons in robotic-assisted techniques, she uses these approaches, where appropriate, to help reduce blood loss, shorten hospital stays and support a faster recovery. Her approach focuses on preserving healthy tissue and the womb wherever possible, while tailoring treatment to each woman’s individual goals and symptoms. 

A word about adenomyosis 

Fibroids can occur alongside a related condition called adenomyosis, and the two can cause overlapping symptoms. In adenomyosis, tissue similar to the lining of the womb grows into the muscular wall of the uterus, causing the womb to become enlarged and painful. It commonly causes heavy, prolonged and painful periods, pelvic pain, pain during sex and a bloated or full sensation in the lower abdomen. 

Because fibroids and adenomyosis can look (sometimes) and feel similar, and frequently coexist, a careful assessment, often including a detailed ultrasound and sometimes an MRI scan, is important to understand exactly what is causing a woman’s symptoms. Getting this diagnosis right allows treatment to be planned accurately, whether that involves medical management, a hormonal coil, a uterus-preserving procedure or, in some cases, surgery. 

What can patients expect before treatment? 

Before recommending surgery, patients will usually undergo a detailed assessment, which may include: 

• A discussion of symptoms and medical history. 

• Pelvic examination where appropriate. 

• A high-resolution ultrasound scan to map the fibroids, and an MRI scan in selected or complex cases. 

• Blood tests, for example to check for anaemia. 

• Review of previous treatments. 

• Discussion of fertility wishes and future pregnancy plans. 

Understanding a woman’s priorities is an important part of deciding whether surgery, another procedure or medical treatment is the most appropriate option. 

Recovery after fibroid surgery 

Recovery varies depending on the type of operation performed and the size and number of fibroids treated. 

Many women return home on the same day following a hysteroscopic myomectomy, or after a short hospital stay of one day after a robotic-assisted myomectomy, whereas open surgery generally requires a longer recovery. Recovery continues over the following weeks, with advice tailored to the individual procedure and each woman’s circumstances. 

The surgeon will explain what to expect, when a woman can return to work, exercise and driving, and what follow-up care she will need. 

Expert patient education 

The aim of interviews like this is to make specialist information more accessible and to help women feel confident asking questions about their care. Improving how women with fibroids are informed, supported and treated is something Dr Kaur is deeply committed to, both in her clinical practice and through her wider work in education and service development. 

Understanding the role of treatment and surgery, along with the benefits and limitations of each option, allows women to make informed decisions alongside their healthcare team. 

If you have symptoms that may be caused by fibroids, seeking assessment from a specialist can help you understand the options available. 

Frequently Asked Questions 

What does fibroid surgery involve? 

The most common uterus-preserving operation is a myomectomy, in which the fibroids are removed while the womb is left in place. This may be performed through the neck of the womb by hysteroscopy, by keyhole or robotic-assisted surgery, or by open surgery, depending on the size, number and position of the fibroids. Other uterus-preserving options include transcervical radiofrequency ablation (the Sonata treatment) and uterine artery embolisation to shrink the fibroids, and, in some cases, hysterectomy. 

Is surgery a cure for fibroids? 

Removing fibroids with a myomectomy can significantly improve symptoms and preserve the womb, but new fibroids can sometimes develop over time. Hysterectomy, removal of the womb, is the only definitive cure, but is not necessary as a repeat myomectomy can be carried out again if required. Treatment plans are tailored to each individual and may combine medical and surgical approaches. 

How do I know if I need surgery? 

Not everyone with fibroids requires surgery. The decision depends on your symptoms, examination findings, imaging results, previous treatments and personal goals, including whether you are planning a pregnancy. Many women are managed successfully with monitoring or medication. 

Is robotic surgery available for fibroids? 

For a large proportion of patients, robotic-assisted myomectomy is appropriate. Robotic technology can provide enhanced precision and dexterity during complex minimally invasive surgery, which may help reduce blood loss and support quicker recovery. Whether it is suitable depends on the individual case and should be discussed with your surgeon. 

Can fibroids affect fertility? 

The simple answer is yes, they can. It depends on their size and position: fibroids that distort the cavity of the womb in particular may affect fertility or increase the risk of complications in pregnancy. However, many women with fibroids conceive without difficulty. If you are trying to become pregnant and have fibroids, specialist assessment can help determine the most appropriate management. 

What is the difference between fibroids and adenomyosis? 

Fibroids are distinct growths of muscle and fibrous tissue in or around the womb, whereas adenomyosis is a condition in which womb-lining tissue grows into the muscular wall of the uterus, often scattered throughout the muscle. Both can cause heavy, painful periods and pelvic pain, and they can occur together. A careful ultrasound and/or an MRI helps distinguish between them and guide treatment. 

When should I see a fibroid specialist? 

You should consider specialist assessment if you experience heavy or prolonged periods, abnormal bleeding in between periods, iron-deficiency anaemia, persistent pelvic pain or pressure, abdominal swelling, bladder or bowel symptoms, or difficulty conceiving, or if previous treatments have not improved your symptoms. 

Where can I learn more? 

You can watch Dr Manou Kaur’s interview for further information about fibroids and common patient questions: 

https://www.youtube.com/watch?v=C_jwCqjaR9U 

If you would like personalised advice, you can also arrange a consultation with Dr Manou Kaur to discuss your symptoms, diagnosis and treatment options. 

For further trusted, independent information about fibroids, you may also wish to read the patient resources produced by national and professional bodies: 

• Royal College of Obstetricians and Gynaecologists (RCOG) — patient information: https://www.rcog.org.uk/for-the-public/ 

• British Society for Gynaecological Endoscopy (BSGE): https://www.bsge.org.uk/ 

• NHS — Fibroids: https://www.nhs.uk/conditions/fibroids/ 

• American College of Obstetricians and Gynecologists (ACOG) — Uterine Fibroids: https://www.acog.org/womens-health/faqs/uterine-fibroids