The sources behind what we say
about fibroids across midlife.

By age 50, cumulative incidence of uterine fibroids reaches ~70% in white women and ~80% in Black women; Black women present at younger ages, with more and larger fibroids and more severe symptoms.

The single most-cited prevalence figure. Bring this when 'you might have a few fibroids' is being treated as incidental at age 45.

Black women in the US have hysterectomy rates for fibroids roughly 2–3× those of white women, and are more likely to receive open (abdominal) hysterectomy rather than minimally-invasive procedures — reflecting later diagnosis, larger disease burden, and inequitable access to uterus-sparing options.

The evidence base for pushing hard for the full menu of options — Mirena, tranexamic acid, GnRH antagonists, UAE, myomectomy — before hysterectomy is treated as the default.

Fibroid research has systematically under-recruited Black women, so the evidence base under-represents the population most affected. Reviews call this one of the largest equity gaps in benign gynaecology.

Useful when a doctor says 'the trials show…' — the honest answer is 'in mostly white cohorts.' Name the gap in the appointment.

The levonorgestrel intrauterine system (Mirena) substantially reduces menstrual blood loss and improves quality of life in women with fibroids where the uterine cavity is not distorted, and is a NICE-recommended first-line pharmacological option for heavy menstrual bleeding.

The referenceable answer to 'my doctor said Mirena isn't for fibroids' — for uncomplicated fibroids without cavity distortion, it is a first-line option.

Tranexamic acid taken only during heavy bleeding days reduces menstrual blood loss by roughly 40–50% and is safe for the majority of women (avoid with a personal history of thromboembolism).

Non-hormonal, cheap, effective, under-prescribed. A useful bridge while a bigger decision is worked out.

Relugolix combined therapy (relugolix + estradiol + norethisterone acetate; Ryeqo) reduces heavy menstrual bleeding from fibroids by ~70% vs placebo with add-back hormones preserving bone density, and is approved by the FDA (2021) and MHRA/NICE (2021–22) for moderate-to-severe fibroid symptoms.

The newer medical option many family doctors haven't caught up on. Ask by name if bleeding is heavy and surgery is being framed as the only option.

Elagolix + add-back is FDA-approved (2020) for management of heavy menstrual bleeding due to uterine fibroids for up to 24 months, with sustained reductions in bleeding and improvements in anemia.

Second GnRH-antagonist option, more common in US practice. Time-limited to protect bone health.

Uterine artery embolization gives similar symptom control and quality-of-life gains to hysterectomy at 5 and 10 years, with shorter hospital stay and faster return to normal activity, at the cost of a higher rate of further intervention over time.

The evidence base for UAE being offered as a genuine alternative to hysterectomy, not a second-tier fallback.

Where feasible, minimally-invasive routes for hysterectomy (vaginal or laparoscopic) result in fewer complications, less pain and faster recovery than abdominal hysterectomy, and should be preferred where clinically appropriate.

Bring this if abdominal hysterectomy is being offered by default. Ask whether minimally-invasive is on the table.

Preserving the ovaries at hysterectomy in women under 65 who do not have a specific indication for oophorectomy is associated with lower all-cause mortality, lower cardiovascular disease and lower osteoporosis than removing them.

Fibroids are a uterine disease, not an ovarian one — ovary removal is a separate decision and generally should not be automatic.

In most women, fibroids regress over the years after the final menstrual period as ovarian estrogen production falls, though the timing and completeness of regression vary.

Useful context for 'will these get better on their own after menopause?' — usually yes, but not always, and not immediately.

Menopausal hormone therapy is not contraindicated in women with fibroids, but systemic estrogen can maintain or occasionally increase fibroid size; treatment plans should acknowledge fibroids explicitly, prefer transdermal estrogen where suitable, and monitor symptoms.

The referenceable answer to 'you can't have HRT because of your fibroids' — that framing is out of date; the plan changes, HRT is not automatically ruled out.

Iron-deficiency anemia is a common and under-recognised consequence of heavy menstrual bleeding from fibroids; ferritin is a more sensitive marker of iron deficiency than hemoglobin and should be measured explicitly.

Ferritin under 30 warrants treatment even with a 'normal' hemoglobin. Ask for ferritin by name.

Alternate-day oral iron dosing improves iron absorption and reduces gut side effects compared with daily dosing in iron-deficient women.

Useful if daily oral iron is being tolerated badly or absorbing poorly. Alternate days often works better.