Obstetrics and Gynecology

May 15, 2026

Uterine fibroids, which affect about 80% of women worldwide, are the most common pelvic lesions among premenopausal women. While uterine fibroids are benign and can be asymptomatic, they also are commonly associated with pelvic pain, menorrhagia and infertility. Uterine fibroid management at Mayo Clinic emphasizes individualized care through using comprehensive imaging, engaging in multidisciplinary collaboration and prioritizing minimally invasive options.

"Fibroids have the potential to cause major issues for patients," says Shannon K. Laughlin-Tommaso, M.D., a gynecologic surgeon at Mayo Clinic in Rochester, Minnesota. "We try to treat the fibroids in a way that optimizes the patient's quality of life — including reducing symptoms or planning for future fertility."

Common symptoms of uterine fibroids include:

• Heavy menstrual bleeding or painful periods.
• Longer or more-frequent periods.
• Pelvic pressure or pain.
• Frequent urination or trouble urinating.
• Enlarging or protruding abdominal area.
• Constipation.
• Pain in the pelvic area or lower back, or pain during sex.

Initial evaluation at Mayo Clinic typically includes pelvic ultrasound and magnetic resonance imaging (MRI). "We tend to get either an ultrasound or an MRI to ensure a detailed map of the fibroid size, number and location," says Sarah L. Rassier, M.D., M.P.H., a gynecologic surgeon at Mayo Clinic in Rochester, Minnesota. "For more-complex cases, we have an imaging conference with our radiology colleagues where we discuss the nuances as a group and confirm the best treatment plan," Dr. Rassier says.

"Using MRI in addition to the ultrasound helps us avoid any surprises by knowing exactly where the fibroids are located and how many there are," Dr. Laughlin-Tommaso says. "High-level imaging also helps us differentiate whether the patient has fibroids, malignant tumors or adenomyosis."

Consulting with multidisciplinary colleagues aids decision-making. "During our imaging conferences, we'll discuss things like whether a fibroid looks concerning, whether it has any unusual features and how the blood flow looks," Dr. Rassier says. "Reviewing the things that might be a little harder to determine solely based on imaging enables us to form a consensus opinion regarding the appropriate therapy."

Treatment options at Mayo Clinic

"When considering treatment for uterine fibroids, there are typically three main questions that we ask," Dr. Laughlin-Tommaso says. "What symptoms is the patient experiencing? What are the patient's plans regarding fertility? How close is the patient to menopause? Using the patient's input, we take a very individualized approach as to what treatment options might work best for their needs."

Options for uterine fibroid treatment at Mayo Clinic include:

• Gonadotropin-releasing hormone (GnRH) agonists.
• Gonadotropin-releasing hormone (GnRH) antagonists.
• Progestin-releasing intrauterine device (IUD).
• Tranexamic acid.
• Endometrial ablation.
• MRI-guided focused ultrasound surgery (FUS).
• Uterine artery embolization.
• Radiofrequency ablation — both laparoscopic and transcervical approaches.
• Laparoscopic or robotic myomectomy.
• Hysteroscopic myomectomy.
• Abdominal myomectomy.
• Minimally invasive or abdominal hysterectomy.

For qualified candidates, prioritizing minimally invasive options can help relieve symptoms while also offering lower risks and faster recovery time. For example, transcervical radiofrequency ablation is an incisionless, uterine preserving option performed through the cervix under ultrasound guidance.

"We're using an intrauterine ultrasound probe combined with radiofrequency, which isn't yet available at a lot of institutions," Dr. Rassier says. "With ultrasound guidance, the device is placed directly through the vagina and is done without any abdominal incisions, which allows for a less extensive procedure. We target the fibroid using coagulative necrosis to destroy the tissue. The patient typically can go home the same day as the procedure, and the recovery time is typically only a few days."

In qualified candidates, using the ablative technology can achieve significant fibroid volume reduction, in addition to a significant improvement in the patient's bleeding profile. "It can be incredibly effective, and we typically see about 50% to 70% shrinkage of fibroids," Dr. Laughlin-Tommaso says. "The three-year risk of needing an additional surgery is only about 10%."

Fibroid size and location are important factors when considering this minimally invasive procedure. "Transcervical access is best for fibroids that are located within the uterine wall and are within about a 4- to 8-centimeter range," Dr. Laughlin-Tommaso says. Larger fibroids and subserosal fibroids might require laparoscopic radiofrequency ablation, myomectomy or hysterectomy, which can carry higher intra abdominal risk and require a longer recovery period.

"Because each patient's goals and fibroid anatomy differ, we really believe in presenting and walking through the full range of options available at Mayo Clinic," Dr. Rassier says. "Combining detailed patient consultation with a comprehensive preoperative workup ensures that therapy is tailored and personalized."

For more information

Refer a patient to Mayo Clinic.