Uterine Fibroids (Rasoli): Symptoms, Causes and Treatment

If an ultrasound report ever mentions a "fibroid" or the doctor says the word "rasoli", know first that you are in very common company: by age 45, well over half of women have at least one, and most never need treatment. A fibroid is a non-cancerous growth of the muscle of the uterus. Some stay the size of a pea and never announce themselves; some grow large enough to cause heavy periods, pressure and fertility trouble. This guide covers how to know which kind you have and what can be done about it in Pakistan.

What fibroids are

Fibroids (the medical name is uterine leiomyoma) grow from the muscle wall of the uterus. They are hormone-responsive, so they tend to appear during the reproductive years, grow during pregnancy, and shrink after menopause. They are not cancer, and they do not turn into cancer except in genuinely rare cases. Where a fibroid sits matters as much as its size: one bulging into the cavity of the uterus can cause flooding periods at 2 cm, while one on the outer wall can reach 8 cm quietly.

Symptoms that point to fibroids

Heavy or long periods are the classic sign: soaking through a pad or cloth in an hour or two, passing large clots, or bleeding beyond seven days. Over months this quietly drains iron, and many women discover their fibroids only after a blood test finds anaemia; if you are always tired and pale, read our guide to iron deficiency in women alongside this one. Other signs include pelvic pressure or a feeling of fullness, a belly that looks slightly swollen low down, needing to urinate often (a fibroid pressing the bladder), constipation, pain during intimacy, and backache. Painful periods on their own are more often something else; our period pain guide and the endometriosis guide cover those paths.

Diagnosis in Pakistan

A pelvic ultrasound is usually all it takes, and costs roughly Rs 1,500 to 4,000 at private labs and hospitals. The report will state each fibroid''s size and position (the words to look for are submucosal, meaning inside the cavity and most likely to cause bleeding and fertility problems; intramural, in the wall; and subserosal, on the outside). A full blood count to check for anaemia usually accompanies it. Fibroids found by chance during a scan for something else and causing no symptoms generally need nothing but an occasional follow-up scan.

Treatment: matched to your symptoms and your plans

No symptoms: no treatment. Watchful waiting is a legitimate medical plan, not neglect. Fibroids shrink after menopause, so a woman in her late 40s with mild symptoms may simply outlast them.

Tablets for the bleeding. Tranexamic acid taken during the period can cut blood loss substantially; NSAIDs like mefenamic acid help both flow and pain. Hormonal options (the pill, or a hormonal IUD if the cavity shape allows) reduce bleeding month after month. None of these shrink the fibroid; they control the symptom, which for many women is enough. Iron repletion runs alongside whichever option you choose, because treating the bleeding without refilling the iron leaves you exhausted anyway.

Procedures. When symptoms stay severe, the main options in Pakistan are myomectomy (surgical removal of the fibroids, keeping the uterus, the standard choice when you still want children), hysterectomy (removing the uterus, a definitive fix when childbearing is complete), and in selected centres uterine artery embolisation, which starves fibroids of blood supply through a pinhole in the wrist or groin. Which one fits depends on your age, fibroid map and family plans; a gynaecologist at any major hospital can walk you through the trade-offs.

Fibroids and getting pregnant

Most women with fibroids conceive without difficulty. The exception is submucosal fibroids distorting the cavity, which can interfere with implantation and are usually removed before fertility treatment. If you are trying to conceive with known fibroids, mention them early to your doctor; our trying-to-conceive guide covers the wider picture, and the infertility and IVF guide explains the pathway if help is needed.

When to see a doctor

Book a gynaecology visit if your periods are heavy enough to disrupt work or soak through protection hourly, if your belly feels persistently full or swollen low down, or if periods have become both heavy and irregular (our guide to period changes lists the other causes worth ruling out). Sudden severe pelvic pain with a known fibroid needs same-day care, as a fibroid can occasionally outgrow its blood supply or twist.

This article is for education and does not replace medical advice. Reviewed for accuracy by our medical review board.