A 20-year-old woman visited our clinic, complaining of heavy menstrual bleeding and severe lower abdominal pain, particularly during the first two days of her periods. Though she initially thought these symptoms were just part of a normal menstrual cycle, the bleeding had become intense enough to disrupt her daily life and academic schedule. An ultrasound examination revealed a large uterine fibroid, an overgrown tissue mass, measuring approximately 6 to 8 centimetres.
While fibroids are more commonly diagnosed in women in their 30s and 40s, they can also occur in younger women. Poor diet, lack of physical activity, obesity and lack of Vitamin D (both can lead to overproduction of estrogen) and increased stress can lead to hormonal imbalance, potentially fuelling fibroid growth. And when they do, they often require timely medical attention.
In this case, the size and symptoms associated with the fibroid indicated the need for surgical treatment. We did a myomectomy — the surgical removal of the fibroid while preserving the uterus. This allowed the patient to return to her daily routine with reduced pain and normalised menstrual cycles. The case underscores how fibroids, although benign, can significantly impact quality of life even in early adulthood, and how their management must be tailored to age, size, and future reproductive plans.
How to manage fibroids in your 20s
Women in their 20s discover fibroids either incidentally or when they begin causing symptoms such as painful periods, heavy bleeding or pelvic pressure. Management at this age is especially conservative if the fibroids are small (under 3 centimetres) and not causing significant issues. In such cases, hormonal medications and pain relief can be sufficient to control symptoms. However, if the fibroid is larger than 3 centimetres and is causing distress — as seen in the case above — surgical intervention becomes necessary.
This procedure can be done via open, laparoscopic, or robotic techniques, depending on the fibroid’s size and location. It’s important to note that recurrence is possible, so ongoing monitoring is advised. At this age, preserving fertility is a top priority, and every effort is made to ensure that treatment does not compromise future reproductive potential.
What about preserving fertility in your 30s
For women in their 30s, fibroids within the uterine cavity can affect the ability to conceive or carry a pregnancy to term. They can increase the risk of miscarriage, pre-term labour or complications during delivery. Fibroids that distort the uterine cavity or are associated with difficulty conceiving are often surgically removed to improve fertility outcomes. Myomectomy remains the standard approach. In cases where conception is not an immediate concern and symptoms are mild, medical management may still be appropriate.
The cautious approach after 45
In women aged 45 and above, particularly those nearing menopause, the treatment approach tends to be more definitive. As estrogen levels naturally decline during menopause, fibroids often shrink on their own.
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However, for women with large fibroids or significant symptoms like heavy bleeding and pelvic pain, hysterectomy — the complete removal of the uterus — is often considered, especially when childbearing is complete. That’s because although fibroids are mostly benign, there is a very small risk of malignant transformation, particularly in women over 60.
For smaller fibroids or milder symptoms, medication can help manage bleeding and discomfort. Hormonal intrauterine devices (IUDs) help in reducing bleeding and controlling fibroid growth. Additionally, newer, less invasive techniques reduce blood supply to the fibroid, thereby shrinking it over time.
No two cases of fibroids are the same. Management depends not just on the size and location of the fibroid, but also on the woman’s age, symptoms, and reproductive goals.
(Dr Suri is senior consultant, Obstetrics and Gynecology, Indraprastha Apollo Hospitals, Delhi)
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