"Most of the time, uterine fibroids don't affect pregnancy, per se," says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. "But they can pose challenges—it all depends on their location."

To help you better understand your overall fertility outlook after a fibroids diagnosis, we asked experts to answer the most common questions prospective and expectant mothers have about the relationship between uterine fibroids and pregnancy; here's what they had to say.

RELATED: What Are Uterine Fibroids—And What Can You Do If You Have Pain and Bleeding?

Uterine-Fibroids-and-Pregnancy-AdobeStock_232793683 , only 5-10% of infertile women have fibroids. In other words, it's not a primary cause of infertility, and having fibroids doesn't necessarily mean you'll have trouble getting pregnant.

But it is important to note that fibroids can interfere with both conception and implantation, per a 2016 study in Current Obstetrics and Gynecology Reports, which outlines a variety of ways uterine fibroids can prevent a pregnancy from happening. This includes anatomical abnormalities that block the passage of sperm, changes to normal uterine contractions, anti-inflammatory responses, and changes to the uterine lining.

The good news, though, is that the link between fibroids and miscarriage is no longer as widely accepted as it used to be. A 2017 study in the American Journal of Epidemiology found no evidence of an increase in miscarriage associated with fibroids. Researchers flagged the evidence behind the prior fibroid-miscarriage connection as "potentially biased," finding that once other factors were considered (such as the age and race of participants and their ultrasound-confirmed fibroid status), the miscarriage rate was the same between women who had fibroids and those who didn't, reports the National Institutes of Health.

RELATED: What Causes Uterine Fibroids? 5 Risk Factors to Know, According to Experts

Should I treat uterine fibroids before I get pregnant?

Ideally, yes. If you are diagnosed with fibroids outside of pregnancy and your doctor determines that the size or location of your fibroids could interfere with your chances of conceiving or carrying a baby to full term, it would be best to treat them via surgery before you become pregnant, says Dr. Lisa Hansard, board-certified reproductive endocrinologist at Texas Fertility Center. However, you should work closely with your doctor on the timing of that treatment.

"You should try to plan the surgery in a timeline that's close to when you want to conceive," Dr. Hansard explains. "We can't change what it is about a woman that makes her prone to making fibroids, and they have a 33% recurrence rate, so as soon as the uterus heals, you should try to become pregnant."

Otherwise, Dr. Hansard adds, you could have more fibroids or fibroid regrowth after waiting too long post-surgery to try and conceive.

But again, working with your doctor is important here; while Dr. Ruiz echoes the same recommendation about not waiting too long, he also adds that fibroid surgery can affect how a baby is delivered if the uterus hasn't fully healed: "If woman has had fibroid surgery and gets pregnant afterwards, we recommend she wait three to six months to get pregnant—but depending on how big the fibroid was and how deeply we had to cut into the uterus, she may need a C-section to deliver."

Dr. Ruiz says the risks of vaginal birth after fibroid surgery are similar to the risks of vaginal birth after prior C-section, or VBAC; while it's sometimes possible and doesn't always cause complications, some doctors prefer not to place added pressure on a uterus that has been previously operated on.

RELATED: 10 Uterine Fibroid Treatments to Consider, Including Fertility-Sparing Options

How do uterine fibroids affect pregnancy?

In many cases, says Dr. Ruiz, fibroids won't affect a pregnancy at all, but sometimes the size of fibroids can interfere with your prenatal care.

"If they're really big, it can be hard to measure the size of the baby and assess fetal growth, so we may have to do regular ultrasounds to make sure the baby is growing normally," he explains.

Additionally, the Society for Maternal-Fetal Medicine reports that fibroids can increase your risk for placental problems, including placental abruption and placenta previa. The other issue of concern during pregnancy is growth of existing fibroids; the increases in hormone production during pregnancy can lead to changes in the size of fibroids, per UT Southwestern Medical Center, whether that's an increase or a decrease in size.

An increase is more common, says Dr. Lisa Hansard, board-certified reproductive endocrinologist at Texas Fertility Center, and if that happens, it can raise problems during your baby's delivery.

"If a uterine fibroid grows, it will be extremely vascular," she explains, "so if you need a C-section at delivery, it's become dramatically more risky because of [the increased likelihood of] blood loss."

Can I treat uterine fibroids during pregnancy?

Unfortunately, UT Southwestern Medical Center says there's not much you can do during pregnancy to treat fibroids; most surgical procedures on the uterus won't be performed to protect the baby except in rare cases.

Your doctor will probably recommend you manage any pain symptoms during pregnancy conservatively, per a 2010 study in Reviews in Obstetrics & Gynecology, which may include increasing the amount of rest you get and taking pregnancy-safe pain relievers.

RELATED: Rebel Wilson Opens Up About How Her Weight Loss Is Linked to Her Fertility Journey

Dr. Ruiz also adds that the location of fibroids can change the outcome of your baby's birth, because fibroids in the lower segment of the uterus can cause the baby to present in a breech position, increasing your chances of needing a C-section. While some breech babies can be delivered vaginally, the American College of Obstetrics and Gynecology says most breech babies are born via scheduled C-section to reduce complications.

What should I do about my fibroids after pregnancy?

That depends on what happens to them after pregnancy, since the hormonal changes associated with childbirth and breastfeeding may help to shrink fibroids, per a 2019 study in Scientific Reports. Among a group of 157 postpartum women, a significant size reduction in fibroids was observed in all of them compared to pre-pregnancy ultrasounds, and in some cases, fibroids seemed to have disappeared completely; breastfeeding was also associated with shrinking or stopped growth in participants.

But if your fibroids are still an issue after delivery, UT Southwestern Medical Center suggests that the typical fibroid treatments used for non-pregnant women remain largely safe. They do, however, recommend waiting at least six months postpartum to undergo any surgical procedures so that the uterus has time to heal and shrink back down to its normal size.

To get more stories about health and wellness delivered to your inbox, sign up for the Healthy Living newsletter

In fact, pain is one of the key symptoms of fibroids, says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California, though he notes that the pain caused by uterine fibroids can manifest in many different ways: from dull pressure to sharp pain to period-style cramping, making it tricky to recognize or distinguish from other conditions that cause similar kinds of pain.

To help you identify uterine fibroid-related pain, here are all the ways you might experience it—and what you can do to feel better.

RELATED: What Are Uterine Fibroids—And What Can You Do If You Have Pain and Bleeding?

Types of uterine fibroid pain

As Dr. Ruiz notes, there are several different ways you might experience the pain associated with uterine fibroids. These are the most common.

Pelvic pain

Johns Hopkins Medicine includes pelvic pain as one of the primary symptoms women with uterine fibroids may experience.

You may also feel dull pressure in the pelvic region, or notice radiating pain in other parts of your body, says Dr. Rose Chang-Jackson, an ob-gyn at Austin Regional Clinic in Austin, Texas: "Many times, fibroids are associated with pelvic pressure symptoms, and sometimes a fibroid is so large, it impinges on other organs and you may feel pain symptoms elsewhere."

Lower back pain

Some fibroids may cause pain in both your lower back and down your legs, says the Mayo Clinic. This is due to the effects on other organs Dr. Chang-Jackson referred to; when fibroids grow large enough, they can compress nerves along the spine that cause back and leg pain.

Abdominal pressure

According to the Cleveland Clinic, a feeling of fullness or pressure in the abdomen is a common symptom of fibroids.

Pain during intercourse

Fibroids can cause pain while having sex; according to UCSF Health, this may be intermittent enough to only occur when having sex in certain positions. Dr. Ruiz says they can also cause pain before and during your period—this may feel like the typical uterine cramping associated with menstruation, but it may last longer or be more persistent if you have fibroids

Rectal and bladder pressure

Depending on their location, fibroids can also cause uncomfortable pressure on your bladder and your rectum, reports the Office on Women's Health.

RELATED: This Woman Had Endometriosis Since She Was a Teen, But Doctors Insisted Her Symptoms Were All in Her Head

What if my uterine fibroid pain becomes severe?

While typical uterine fibroid pain can be quite uncomfortable, severe or debilitating pain that is unrelenting could be a sign that something else is happening with your fibroids, per Dr. Ruiz.

"If you have what's called a degenerating fibroid, when the live fibroid tissue begins to die off from the inside-out, it will feel like the worst pain you've ever had," he explains. "It's a severe, stabbing pain that will probably leave you doubled-over."

Dr. Chang-Jackson explains that fibroids degenerate when they outgrow their own blood supply, essentially starving themselves and dying off. Sometimes these types of fibroids resolve on their own after several days, while others require surgery, explains Brigham and Women's Hospital. If you experience a sudden increase in pain or vaginal bleeding, the Mayo Clinic advises you to see your doctor ASAP.

RELATED:What's Really Causing Your Pelvic Pain?

Other common uterine fibroid symptoms

According to the Cleveland Clinic, other symptoms of uterine fibroids include:

• Heavy or irregular menstrual bleeding
• Breakthrough bleeding between periods
• An increased need to urinate or difficulty voiding
• Constipation
• Vaginal discharge
• A clearly distended or enlarged abdomen
• Difficulty conceiving, or infertility

RELATED: What Causes Uterine Fibroids? 5 Risk Factors to Know, According to Experts

How is uterine fibroid pain treated?

Treatment options vary widely for uterine fibroids, says Dr. Chang-Jackson, based on their size and location, whether or not they're causing symptoms, and whether or not they are affecting your fertility.

There are surgical procedures to drain or remove fibroids, but unfortunately they often regrow, says the Mayo Clinic, which adds that the only way to eliminate the risk of fibroids for good is to have a hysterectomy.

RELATED: How Having a Hysterectomy at 17 Changed My Life

How can I managed my uterine fibroid pain?

If you're simply focused on managing your pain symptoms, there are a few strategies you can try:

• OTC pain relievers, like Tylenol and Motrin, can work on the spot to reduce pain caused by fibroids, per NYU Langone Health.
• Some forms of hormonal birth control, such as the combination estrogen-progesterone pill or the progesterone-only IUD, can treat symptoms of fibroids like heavy bleeding, pain, and menstrual cramping, says Dr. Chang-Jackson. However, other forms of birth control have not been proven effective, she warns.
• Gonadotropin-releasing hormone (GnRH) agonists like Lupron can promote shrinking of fibroids, reports the Office on Women's Health, but this is often recommended for women who experience heavy bleeding; it may or may not be as useful for women who experience pain and pressure related to their fibroids.
• Home remedies that tend to work for traditional menstrual cramps, which includes heating pads, vitamin supplements, and mild exercise may help you with uterine fibroid pain, but these strategies have not been proven as effective treatments, so you should check with your doctor before implementing them.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

Rousey concluded the post by reminding everyone that breastfeeding is something to celebrate, not hide. "It's really nothing to be ashamed of, it's something to brag about," she wrote, finishing her post off with the hashtags #normalizebreastfeeding and #proudmama.

This isn't the first time Rousey has gotten real about motherhood. Just ten days after welcoming her daughter, she shared an unedited image of her postpartum body along with a message that she is in no hurry to get back into shape, despite the fact that her mother started training six days after her sister was born and won the US Open Judo a mere six weeks later.

Rousey opened up about her pregnancy in a July 24 Instagram post. "I wish I could say that pregnancy feels amazing, that I've never felt more powerful as a woman. But it feels more like my organs are being crushed by the miracle of life. I've never felt more exhausted, unmotivated or aware of gravity. Some days I have to lay on my side for hours just to comfortably breathe. There's no break, it's a grind, I'm just trying to get through one day at a time," she admitted.

RELATED: 5 Times Ronda Rousey Got Real About Her Body

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

It was September 2020, and I wailed as I stared at her body on the ultrasound monitor. My husband, Thomas, watched by video from the parking lot because he was not allowed inside the hospital due to the pandemic. "I was just stuck there," he recalls. "I felt helpless."

I Developed Asherman Syndrome After a Miscarriage—It Threatened My Fertility, and It Might’ve Been Preventable to remove fetal tissue after a miscarriage—as well as to remove retained placenta after a birth. During a D&C, the contents of the uterus are emptied with a suction device, or a combination of suction and scraping with a sharp, spoon-shaped tool called a curette.

Having a D&C after a miscarriage feels like a consequential event. It is the medical equivalent of a burial. Many people who have one allow the hospital to discard the remains, but we needed a path to healing, so we asked my doctor to preserve them so we could cremate her and plant her ashes along with a tree.

Everyone at the hospital treated the surgery as routine. Even the generic consent forms, with only vague warnings of the risks of a D&C, implied that what I was about to go through was ordinary.

While I waited for the surgery, the nurses encouraged me to try to get pregnant again, and they told stories about the "rainbow babies" they had following their own miscarriages. My doctor added that the ease with which I conceived Mara boded well for my fertility.

Two weeks later, after a quick pelvic exam to make sure I was fully recovered from the surgery, another ob-gyn in the practice said I could start trying for a baby after my period came back—a time frame that nearly every article online claims can take between two to six weeks.

But my period never returned.

My missed periods offered clues

Each month, I felt signs my period was coming. I was bloated, and I had cramps that were more intense than I had ever felt before. But I never saw anything more than a few drops of blood. I didn't need a tampon, or even a pantiliner. It was as if my period was trapped inside my body.

I took to Google for answers. Over and over, there was only one explanation for my missing period: a disorder called Asherman syndrome.

Asherman syndrome is characterized by scarring, or "adhesions," inside the uterus or on the cervix, and it's often caused by trauma during surgery. Many cases of Asherman syndrome arise after a D&C, I learned. Common symptoms include scant or missing periods, known as amenorrhea, and cyclical menstrual cramping that can at times feel more intense due to trapped menstrual blood. Many people who develop Asherman's cannot conceive, and those who do often miscarry.

Diagnosis and treatment of Asherman syndrome often require multiple surgeries with a procedure called a hysteroscopy, in which a thin lighted tube helps visualize the uterus. Meanwhile, the doctor snips away the adhesions with a small instrument, such as microscissors.

The odds of getting pregnant for people with Asherman syndrome depend on the severity of the scarring. Even after treatment, many people face higher pregnancy complication risks, and some have trouble rebuilding a healthy endometrial lining, which is vital to becoming and staying pregnant.

Most online resources, including the National Organization for Rare Disorders, state that Asherman's is "rare." Still, I wondered why no one had warned me about the potential complication from my D&C.

Finding a doctor who listened to me

In December 2020, after three months passed without a period, I contacted the doctor who performed my D&C. Her office did not see my problem as urgent, and I could not secure an appointment for several weeks. When she finally saw me and I told her I feared I had Asherman syndrome, she seemed unconcerned. She downplayed my symptoms, saying she doubted I had Asherman syndrome because a vaginal ultrasound to examine my uterine lining showed I was technically menstruating and therefore still ovulating. She even suggested that stress could be the culprit.

I suspected she was wrong. Perhaps she knew it, too, because she referred me to a fertility doctor who ran tests to rule out other possible diagnoses. After ultrasound technicians discovered they couldn't pass a catheter through my cervix during one test, I followed my suspicions.

I searched for Asherman specialists and found James Robinson, MD, a gynecologic surgeon at MedStar Health in my home city of Washington, DC. He diagnosed me in just one telemedicine session and scheduled me for my first of three hysteroscopies, based on my symptoms: I had no period since my D&C, I had cramping every month, and I was not able to conceive. For the first time, I felt like someone was listening to me.

Asherman’s was not so rare after all

"Your story I hear every single week," Dr. Robinson told me in an interview a few months later, noting that most of his patients arrive like I had: frustrated that no one warned them of scarring risks from uterine surgery.

I joined an online support group for women with Asherman syndrome, where I saw my own story reflected in their experiences. Like me, their doctors didn't believe they had Asherman syndrome, and they had to hunt for specialists who would take them seriously. I started to suspect that Asherman syndrome was not so rare.

"After almost a year of pain and amenorrhea, my ob-gyn still insisted I could not have Asherman syndrome," Marisa Ruiz of California, whom I met online, tells me now. "By the time I finally saw an Asherman specialist and was diagnosed, my uterus was 70% scarred shut."

Charles March, MD, formerly with HRC Fertility in Pasadena, California, who had treated more than 3,000 patients with Asherman syndrome before retiring last year, has long sought to make the case that Asherman syndrome is not rare. He points to multiple studies, which have shown that the incidence of developing adhesions can be in the range of 13% to 46%.

One systematic review concluded that one in five women who had a miscarriage developed intrauterine adhesions and found that the D&C procedure was a risk factor for developing scarring. The risk for adhesions is even greater for those who've had multiple D&Cs, as well as for those who have retained placenta or experienced a later-term pregnancy loss.

"Doctors don't know, and they aren't taught in medical school or a residency very much about the condition," Dr. March tells Health, adding, "I think the whole culture has to change."

Asherman's also may be becoming more common because scarring risks increase with age, according to Australia-based gynecologist and Asherman specialist Thierry Vancaillie, MD. "The incidence of Asherman's has increased, and that is mainly due to the fact that in the modern world, pregnancy is delayed and most women are of an older age," he tells Health.

In a study he led that was published in 2020, Dr. Vancaillie urged doctors to consider Asherman's as a possible diagnosis "in any woman with a history of miscarriage or postpartum curettage who then fails to conceive again."

What I wish I had known before my procedure

Through my own research and talking to experts and other women with Asherman's, I discovered a few things I wish I had known before I consented to a D&C.

For starters, the D&C is considered a "blind" procedure, meaning it is performed by feel, without any tools to help doctors see what they are doing. This persists even though modern devices such as ultrasound and hysteroscope are available to help doctors visualize the uterus both during and after surgery, to make sure they are removing all of the pregnancy tissue while avoiding any damage to the uterine lining.

A "blind" D&C increases the risk that pregnancy tissue can be missed, according to Dr. Vancaillie, and having retained fetal products or placenta is "the number one risk factor for developing scar tissue." Checking that the uterine cavity is empty should be done, he says, adding that uterine imaging should be a "minimum" standard.

The type of instrument used in a D&C also matters. A D&C performed with a vacuum-like machine that creates suction, for instance, is less traumatic to the uterine lining than a sharp curette, according to multiple experts, including the International Federation of Gynecology and Obstetrics. "There are very few indications for a sharp curettage," says Dr. Robinson.

The best option after a miscarriage is to try using medication to empty the uterus because it is the least risky, Dr. Robinson says. If that is not possible, he recommends the hysteroscopic removal of pregnancy tissue because it allows for "direct visualization" and lets the doctor empty the uterus with precision, without scraping or suctioning the entire lining. If operative hysteroscopy is not possible, then Dr. Robinson suggests the next-best option would be a suction curettage.

Discovering what happened during my D&C

I was dumbfounded to learn that a D&C could even be performed blindly. It seemed like common sense that performing any surgery by feel is a bad idea. I wondered whether this happened to me, so I requested my medical file and saw for the first time a description of my surgery.

There, I read how my baby's remains had been removed, both with suction and by being scraped out of me with a sharp curette, until I was empty inside. There was no mention of a hysteroscopy, let alone basic ultrasound.

I became curious about what kind of guidance ob-gyns were getting about best practice standards for a D&C, so I contacted the American College of Obstetricians and Gynecologists (ACOG). ACOG is the largest medical organization in the US for ob-gyns, with more than 60,000 members. The group is responsible for issuing practice guidelines that, while not mandatory, are influential in establishing standards of care.

ACOG sent me a copy of its guidelines on the management of early pregnancy loss. To my surprise, I discovered they are, at times, out of step with what some of the world's leading Asherman syndrome experts are recommending.

ACOG's guidelines do promote suction curettage over sharp curettage. But rather than urging doctors to largely avoid sharp curettage due to scarring risks, they state that suction is "superior" to sharp curettage alone and that sharp curettage "does not provide any additional benefit" when used in combination with suction in a first trimester loss.

The guidelines are also silent on the risks of a blind D&C. They do not address ultrasound-guided surgery, let alone superior alternatives such as operative hysteroscopy, despite evidence it could reduce scarring risks because it allows a doctor to visualize the uterus while being more precise in removing retained pregnancy tissue.

ACOG also claims that developing adhesions from a D&C is "rare," even though research suggests otherwise.

In response to my concerns with ACOG's guidelines, Christopher Zahn, MD, head of the ACOG practice committee, provided a statement to Health. In his statement, he acknowledged that the impact of Asherman syndrome on patients is "significant," but said evidence "does not support the routine use of ultrasound to guide the evacuation of the uterus," noting that it could "delay" care. An ACOG spokesperson added that while experts may have their own recommendations about the use of ultrasound during a D&C, ACOG is an evidence-based clinical organization that must "make its recommendations based on the available peer-reviewed published scientific literature, reflecting the entire body of evidence."

Putting my grief into action

After reviewing ACOG's guidelines, I felt so concerned about what I considered—based on my own experience and the medical research from Asherman experts—to be their shortcomings that I banded together with some women I met online and wrote a petition urging ACOG to update its standard of care for a D&C. 

In it, we asked ACOG to "make the ultrasound-guided D&C the standard of care, in cases where a hysteroscopic resection or miscarriage management with medication is not available or appropriate," and stop referring to Asherman syndrome as "rare."

The petition, which I sent to ACOG this past June, garnered 128 signatures from patients with Asherman syndrome from around the globe. An ACOG spokesperson said later that same month its practice committee would review it.

It also sparked the interest of a group of women in Australia and New Zealand I met online who, like me, suffered from Asherman syndrome. Using the petition as inspiration, they sent a similar request in September to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, asking for the organization to help improve how Asherman syndrome is diagnosed, treated, and managed.

While Asherman syndrome is not always avoidable, there are things I think doctors can do to minimize risks. They should use less risky surgical tools, anticipate possible scarring, and follow up after surgery to detect it. Above all, doctors should not brush people off when they report possible symptoms—like my doctor did to me.

Dr. March told me the myth that Asherman's is rare continues not only because of a lack of education about the condition among doctors, but also because patients who develop it often fail to report the negative outcome to their ob-gyns.

Inspired by his words, the next day, I wrote a letter to the doctor who performed my D&C to let her know about my diagnosis from Dr. Robinson. "The intrauterine and cervical adhesions I developed from the D&C have been traumatic for me to endure and it has cost me seven-plus months of delays in my journey to become a mother, when time is not on my side," I wrote in that letter.

I also provided her with a link to an article that Dr. Robinson wrote to help educate doctors more about Asherman syndrome, and I urged her read it.

In her response, she said she would read Dr. Robinson's article, and she wished me luck on my "journey to a happy and healthy pregnancy," but she did not acknowledge the trauma I endured. That was the last time we communicated.

The grief that grips you after a miscarriage is a powerful force. In my case, I allowed it to take over, and I consented to the D&C without asking basic questions about the procedure or my own doctor's experience performing it. As hard as it may seem in that moment of pain, I now urge women in my online support groups to make sure they do their research first before agreeing to the surgery.

"All patients should be inquiring of their surgeons: 'Do you do this frequently?'" Dr. Robinson says. "If you start asking questions about the risk of adhesions and you start being blown off… you should probably seek a second opinion."

My journey continues

It took me more than six months to get treated for Asherman syndrome, robbing me of time I could have spent trying to conceive as my 40th birthday approaches.

On the seven-month anniversary of my D&C, I returned to the hospital again. This time, I was there to undo the damage. I drifted off to sleep, terrified of what Dr. Robinson might discover, yet hopeful he could remove the scarring that had prolonged the pain of losing Mara.

When I awoke, I felt like I had just downed 10 margaritas, but my mind could only think of one thing: "How bad is it?" I asked my husband.

He told me the news: The scarring was minimal. The majority of the scarring was in my cervix, and my lining was not damaged. Dr. Robinson felt confident in my prognosis. Compared to many people with Asherman syndrome, I was lucky. I covered my face, and I cried.

My journey to becoming a mother is not over, and it won't be easy. But now that I am armed with more knowledge, and my scarring has been cleared, at least it feels a little bit less bitter.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

That instinct makes sense, but in the case of uterine fibroids, the "why" isn't a simple answer: there isn't a clear cause for why uterine fibroids form, at least not in the same way that decades of smoking can cause lung cancer, for example. Per the Cleveland Clinic, there is no known cause of uterine fibroids; it's still something of a mystery how and why the body develops them when it does.

But there are factors that can increase your chances of developing uterine fibroids. Here's what to know about the most common ones that can raise your risk.

What are uterine fibroids—and how common are they?

According to the Mayo Clinic, uterine fibroids are non-cancerous tumors, or growths, that form in the walls of the uterus; they vary in size, and can grow in a number of ways, including both into the uterine cavity and outside the uterus.

The Office on Women's Health estimates that anywhere from 20-80% of women have one or more uterine fibroids before the age of 50, making them a fairly common health condition affecting many women of childbearing age.

RELATED: What Are Uterine Fibroids—And What Can You Do If You Have Pain and Bleeding?

What causes uterine fibroids?

Again, doctors don't know for certain what causes uterine fibroids to grow. However, they do know that they're seen frequently in women who have certain factors in common.

Here are the most likely reasons why a woman develops uterine fibroids:

Genetics

If you have a family history of uterine fibroids, it's more likely that you'll have them, too; for example, if your mother had or has them, this increases the chance that you will also, says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

This may be because of the genetic component involved with the condition: researchers have noticed similar types of genetic abnormalities in some women with uterine fibroids. A 2012 American Journal of Human Genetics study finds related genetic aberrations among women with a predisposition for uterine fibroids, while a 2018 study in Nature Communications suggests that women who are prone to fibroids may also be prone to other types of hormonally-related tumors because of certain genetic abnormalities.

Hormones

Estrogen and progesterone both play important roles in the reproductive health of women, reports the US Centers for Disease Control and Prevention. These hormones regulate the monthly cycle of menstruation and ovulation, influencing pregnancy and fertility.

However, both female sex hormones appear to promote uterine fibroid growth, per the Mayo Clinic. A 2011 review in the Journal of Reproductive Infertility describes estrogen and progesterone as "promoters of fibroid growth." The study goes on to suggest that when the levels of those two hormones are elevated, an increase in fibroid growth can often be observed.

There are several reasons why estrogen and progesterone levels may be higher at certain times in a woman's life, that same study reports, including:

• Being in your reproductive years versus going through menopause
• Taking hormone replacement therapy drugs
• Frequently having "anovulatory cycles," meaning cycles where your uterus doesn't produce an egg to be fertilized

Age

Not that you can do much about it, but how old you are can impact your likelihood of having fibroids.

"Age matters a lot," Rose Chang-Jackson, MD, an ob-gyn at Austin Regional Clinic in Austin, Texas, tells Health. "The older you get, the longer your reproductive lifespan and the higher your chance of developing them," she says, referring to the cumulative effect of female sex hormones on fibroid growth.

RELATED: How Having a Hysterectomy at 17 Changed My Life

Race

African American women have a two- to three-times higher risk of fibroids compared to white women, states Dr. Chang-Jackson states, and although it's largely unclear why, that disparity is something that has been shown repeatedly to be true.

A 2014 review of studies published in the American Journal of Obstetrics and Gynecology, for example, asserts that the risk for African American women is three times higher, even after adjusting for other coexisting factors; it also reports that this group of women tends to be more symptomatic, have larger growths, and are more likely to require surgery for fibroids.

The review also points to a study linking low vitamin D levels to an increased risk for fibroids in Black women, though there could be other causes for race-based disparities.

Fertility

Lastly, the number of children you've had can impact your chances of developing uterine fibroids, Dr. Chang-Jackson says: "If you've had more children, you're at less risk, but whether that's directly caused by having kids or not is the question."

Having never had a biological child, also called being a "nulliparous woman" in the medical world, is linked to an increase in uterine fibroids; a 2016 review in the International Journal of Fertility and Sterility asserts that pregnancy and lactation is associated with a reduced risk of developing fibroids because of an overall lower exposure to menstrual cycles, and that fibroids are more common in nulliparous women.

RELATED: What's Really Causing Your Pelvic Pain?

Other possible risk factors for uterine fibroids

Obesity. There's a possible association between obesity and uterine fibroids, but it's not necessarily straightforward, say the authors of a recent review and meta-analysis in the Journal of Epidemiology & Community Health. In fact, Dr. Ruiz says he doesn't know if obesity truly contributes to fibroids, but that obesity does mean "it's harder to diagnose [fibroids] because your pelvic exams aren't as clear." In other words, fibroids may go undetected for longer because of the challenges associated with pelvic exams on obese women, so the correlation may not be quite as simple as obesity causing fibroids.

Diet. Women with uterine fibroids may wonder if their diet contributed to growth or, conversely, if eating or avoiding certain foods could stop or slow the growth of existing fibroids. Similar to obesity, a poor diet has the potential to contribute to fibroid growth; a 2021 review of studies in the International Journal of Environmental Research and Public Health points to possible links between uterine fibroids and diets low in fruits and vegetables, diets high in dairy, and diets low in vitamin D, among others.

Early menstruation. Piggybacking off the influence of childbearing on the growth of fibroids, an early onset of menses has also been linked to an increased risk of fibroids; by simply having more periods in your lifetime, the Cleveland Clinic suggests, you might be more likely to develop fibroids, presumably because of the additional exposure to female sex hormones like estrogen and progesterone.

RELATED: This Woman Had Endometriosis Since She Was a Teen, But Doctors Insisted Her Symptoms Were All in Her Head

Can you reduce your risk of uterine fibroids?

Since genetics, hormones, age, race, and fertility are all factors out of your control, there isn't much you can do to prevent uterine fibroids if you're at a higher risk of developing them, says Dr. Chang-Jackson, though you may be able to slow their growth by living a healthy lifestyle.

"There's some question of whether or not people who have higher activity levels can decrease the growth of their uterine fibroids," she notes. "Some studies have shown that avoiding excess alcohol consumption, especially beer, for some reason, can help, as can eating less red meat and more greens and citrus fruits," she explains.

At the end of the day, however, Dr. Chang-Jackson warns that if you're "destined" to have fibroids, all your efforts may not have much of an effect; you can't change your genes or choose the number of your reproductive years, after all. Still, a healthy lifestyle is beneficial for a number of reasons, per the CDC, so it certainly can't hurt your chances to exercise, not smoke, sleep well, and eat a balanced diet.

To get more inspiring stories delivered to your inbox, sign up for the Healthy Living newsletter

While any talk of genetics often implies that something is passed down from previous generations, that's not always the case with genetic components of diseases—some genetic variants are hereditary, meaning they're passed down through family members, but other genetic changes occur during a person's lifetime, without a link back to the person's ancestry.

All that's to say: Whether or not a disease is genetic is not always a question with a clear-cut answer—and research around genetic components to many diseases (like polycystic ovary syndrome, for example) is incomplete.

But what if you do have polycystic ovary syndrome (PCOS), and you're concerned about possibly passing it down to your children; or if your mother has PCOS, and you're wondering whether it's possible you could have it too? Here, experts weigh in on what they know about any genetic component to PCOS, and how that contributes to your risk of getting the condition.

RELATED: PCOS and Hair Loss: Why It Happens and What to Do About It, According to Experts

What is PCOS again?

Polycystic ovary syndrome—sometimes known a polycystic ovarian syndrome—is a common issue among women or those assigned female at birth, caused by an imbalance of reproductive hormones. That hormonal imbalance—which is usually higher-than-normal levels of androgens—affects the ovaries, causing them to develop multiple small cysts.

According to the Centers for Disease Control and Prevention (CDC), PCOS is one of the most common causes of female infertility. It affects as many as 6%–12% of people of reproductive age.

The most common symptoms of PCOS, according to the Office on Women's Health (OWH), include:

• Irregular menstrual cycles
• Hirsutism (excessive hair growth, typically on the face, neck, or chest)
• Acne
• Thinning hair
• Weight gain
• Darkening of skin
• Skin tags

RELATED: What Actually Causes PCOS—and What to Do About It

Is PCOS genetic?

The short answer: Maybe. It's hard to say for sure whether PCOS is genetic or not, but it's definitely a possibility—and it could date back to the fetus' intrauterine environment, Meggie Smith, MD, an ob-gyn who specializes in reproductive endocrinology and infertility in Nashville, Tennessee, tells Health.

"While no one knows exactly what causes PCOS yet, we do think it is an interplay between both genetics and one's environment," says Dr. Smith. Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University, agrees: "No one would say PCOS is primarily genetic, but it is fair to say that there does seem to be a genetic component that may be associated with PCOS, but it has not been specifically described and is multifactorial."

According to the Genetics Home Reference, a multifactorial disorder (sometimes called a complex disorder) is influenced by many different factors—that can include multiple genes, along with a combination of lifestyle and environmental factors (think: exercise, diet, or even exposure to pollution).

And while PCOS doesn't have a clear hereditary pattern, per the Genetics Home Reference, there does seem to be some sort of family association—an estimated 20%–40% of those with PCOS have an affected family member, usually a mother or sister.

As far as the specific genes variants most likely to contribute to PCOS, those appear to be genes that involved in the production of androgens—specifically ones that lead to "high levels of androgens, like testosterone, in the ovary that make it difficult for the brain and ovary to communicate for normal ovulatory function," says Dr. Smith. The Genetics Home Reference also says genetic variants that interfere with follicle-stimulating hormone, energy production, inflammation, and insulin production and regulation, may also contribute to PCOS.

RELATED: 3 Things to Do If You're Trying to Get Pregnant With PCOS

Are there any known risk factors for PCOS?

While your family history may not debunk your PCOS fate, there are other risk factors you can watch out for.

According to Dr. Streicher, being overweight can be a big risk factor for developing PCOS—but those at a higher weight aren't destined to develop the condition. Per the CDC, many women who are at an average weight have PCOS, and many women who are considered overweight do not. In women with PCOS who are also overweight, when that weight is lost, "they find that the PCOS resolves, because it's likely not so much that the ovaries are abnormal but the response of the ovaries to the abnormal hormonal levels," says Dr. Streicher.

PCOS has also been linked to a handful of other health issues, per the (OWH)—though it's unclear if PCOS causes these issues, if these issues cause PCOS, or if there's another underlying cause that leads to both PCOS and some of these issues.

Diabetes is one of those conditions linked to PCOS. According to the OWH, more than half of those with PCOS will go on to develop diabetes or prediabetes before the age of 40. This is linked to insulin resistance in people with PCOS—specifically those who are overweight, have unhealthy eating habits, don't get enough exercise, or have a family history of diabetes.

PCOS has also been linked to high blood pressure, high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol, sleep apnea, depression and anxiety, and in some cases endometrial cancer.

Issues with ovulation may also be a sort of risk factor for PCOS. Though it's typically thought that abnormal menstrual cycles, Dr. Streicher says that it may also be a risk factor for PCOS: "If someone is not ovulating…it's hard to say if it's the chicken or the egg, meaning are they not ovulating because they have PCOS or did they get PCOS because they're not ovulating?"

As of right now, the link between PCOS and genetics is still being studied, per the OWH—these studies will hopefully yield more results to find a potentially stronger genetic or environmental link, which can then lead to newer, better ways to treat PCOS that go beyond the current regimen of just managing symptoms.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

"We think about 50% of women have them, but about 50% of those women aren't symptomatic," says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. "That's what makes fibroids so fascinating—you can do an exam on a patient and it may feel like the uterus is large, but the patient is asymptomatic."

Now, if you have uterine fibroids, you might not think they're "fascinating," but Dr. Ruiz's point still stands: there is a tremendous amount of variation in the experiences of women with fibroids. And because the growths aren't cancerous, per the Mayo Clinic, there's plenty of variation in how they're treated, too.

Here's what you need to know about the treatment of uterine fibroids, including medication and surgical options.

RELATED: What Causes Uterine Fibroids? 5 Risk Factors to Know, According to Experts

If I have uterine fibroids, should I treat them?

Before you begin discussing treatment options with your doctor, you'll have to decide whether or not you want to treat them at all. According to Lisa Hansard, MD, board-certified reproductive endocrinologist at Texas Fertility Center, doing nothing about your uterine fibroids is "100%" an option in some cases.

If your uterine fibroids aren't causing symptoms, for example, Dr. Hansard and other experts say you may not want or need to treat them. But according to the Cleveland Clinic, fibroids can cause pain, cramping, abnormal bleeding, and heavier or longer periods, among other symptoms, so treating them can improve your quality of life.

The other point of consideration is your fertility, or your plans to become pregnant in the future.

RELATED: What Are Uterine Fibroids—And What Can You Do If You Have Pain and Bleeding?

Medicines for treating uterine fibroids

There aren't any medications that can "cure" uterine fibroids or make them disappear completely, Rose Chang-Jackson, MD, ob-gyn at Austin Regional Clinic in Austin, Texas, tells Health. But there are medications that can alleviate some of your worst fibroid-related symptoms and, in some cases, slow down the growth of fibroids or even shrink the growths during the course of treatment.

Over-the-counter medicines

The Cleveland Clinic states that common pain relievers, like acetaminophen and NSAIDs such as ibuprofen, can be used to treat pain associated with fibroids.

Iron supplements

These are sometimes recommended if you bleed heavily enough during your period for anemia to be a concern, according to the Cleveland Clinic.

Hormonal birth control

Per Dr. Chang-Jackson, some forms of birth control can reduce symptoms like pain and bleeding.

"Birth control is first-line for symptom management, but only some types work, like the combination pill and progesterone-only IUDs," she advises. "Other types of birth control, like the estrogen-only pill, the implant, and injections, are not proven to help with symptoms."

Gonadotropin-releasing hormone (GnRH) agonists

These medicines reduce estrogen levels, putting you into a menopause-like state, which can cause your fibroids to shrink, reports the Cochrane Database of Systematic Reviews.

However, this isn't a long-term solution; per University of Michigan Health, GnRH agonists are used to make fibroids smaller before a surgical procedure or keep them from causing symptoms until menopause (at which point they will probably stop causing symptoms on their own).

Blood loss therapy

One treatment, tranexamic acid, is an oral drug used to reduce heavy menstrual bleeding due to uterine fibroids. A 2014 review in the World Journal of Clinical Cases describes this non-hormonal option as generally safe.

RELATED: What's Really Causing Your Pelvic Pain?

Surgery for treating uterine fibroids

The type of surgery you undergo for a uterine fibroid takes location, size, and fertility preservation into account; your doctor can advise you on which approach is best based on these three factors.

"Size and location, [such as if the fibroid is growing] into the uterine cavity, matter in terms of the operative approach, including whether or not you get surgery and, if so, which type," advises Dr. Chang-Jackson. "If the woman has a desire for fertility, the surgery is focused on draining or removing fibroids versus performing a hysterectomy."

"The only proven and safe way to treat fibroids is excision," says Dr. Hansard, "so depending on location and size, the surgery might be laparoscopy, hysteroscopy, or laparotomy, which is an open incision."

Myomectomy

Per NYU Langone Health, fertility-safe procedures fall under the surgical category of myomectomy and are designed to remove the fibroids surgically while keeping the uterus intact. the procedures typically involve:

• making multiple small incisions so a surgical scope can allow for minimally-invasive surgery (laparoscopy)
• making one larger incision so fibroids can be manually removed (laparotomy)
• inserting a surgical scope into the uterus via the vagina, so fibroids within the uterine cavity can be removed (hysteroscopy)

Hysterectomy

Surgical removal of the uterus is the only treatment to prevent fibroids from returning, per NYU Langone Health. It's usually reserved for instances in which the person is near or past menopause, has large fibroids, has heavy bleeding, or doesn't want children, says the federal Office of Women's Health (OWH).

RELATED: What Every Woman Needs to Know About Uterine Cancer, Now That It's on the Rise

Other uterine fibroid procedures

If fertility isn't a concern, Dr. Hansard says other options may be on the table. These include:

Uterine embolization, a procedure that involves cutting off the blood supply to the uterus to stop the growth of fibroids.

Radiofrequency ablation, or use of high frequency sound waves to break up the fibroid from outside your body.

Endometrial ablation, in which a probe sends an electrical current to the fibroid to make it stop growing.

What is the expected outcome after fibroid treatment?

The prognosis for fibroids depends on the type of treatment, since medication options don't remove the fibroids—they only slow their growth or reduce symptoms. In many cases, once you discontinue the medication, your symptoms return or the fibroids begin to grow again, reports UCSF Health.

If you've had surgery to remove fibroids, the outlook may be different. According to the Mayo Clinic, many people experience relief from their symptoms after fibroid removal, and some may find it easier to become pregnant if they struggled previously with infertility.

However, it's important to note that any non-hysterectomy surgery isn't foolproof; fibroids can grow back and new fibroids can begin growing, says University of Michigan Health. How often this happens—aka the "recurrence rate"—varies from study to study and by type of procedure. A small 2018 study found a higher rate of recurrence at eight years post-surgery in those having laparoscopic myomectomy (76.2%) versus open myomectomy (63.4%). Among patients having uterine fibroid embolization, studies show a 13% rate of a repeat procedure after year and 32% at five years, according to Cleveland Clinic.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

Halsey-Posts-Empowering-Body-Positive-Message-on-IG-GettyImages-1048413948

"My body has felt like a stranger's for a long time. I uphold myself to honesty to the point of over sharing sometimes but this feels important," Halsey continued, explaining some of the revealing photos they opted to share with fans.

"The first picture on this slide is days after my baby was already born. A lot of people don't know that you still look pregnant for a while after," they explained. "It is still changing and I am letting it," Halsey continued, admitting that they have "no interest in working out" right now. "I'm too tired and too busy playing with my darling son."

Halsey-Courtesy-@iamhalsey-Instagram-Oct-11-2021

"I do not want to feed the illusion that you're meant to feel and look 'great' immediately postpartum. That is not my narrative currently," Halsey stated, getting to the heart of the message.

"If you've been following me because you're also a parent and you dig what I'm doing, please know I'm in your corner. I will never have my 'pre baby body back' no matter how it changes physically because I have now had a baby! And that has altered me forever; emotionally, spiritually, and physically. That change is permanent. And I don't want to go back!"

RELATED: Halsey Bares Breast on New Album Cover to 'Celebrate Pregnant and Postpartum Bodies'

This isn't the first time the "Manic" singer, who uses she/they pronouns, has been transparent about the realities of motherhood. Even prior to welcoming their son with partner Alev Aydin, Halsey put normalizing motherhood on their agenda when revealing the artwork for their upcoming album "If I Can't Have Love I Want Power."

Halsey-Courtesy-@iamhalsey-Instagram-Oct-11-2021

"This cover image celebrates pregnant and postpartum bodies as something beautiful, to be admired," Halsey explained about the photo, sitting on a throne with a baby in their lap and a breast exposed. "We have a long way to go with eradicating the social stigma around bodies & breastfeeding. I hope this can be a step in the right direction!"

A month following their birth announcement, Halsey flaunted their tiger stripes in a photo dump on social media, captioning the August 8 series of snaps, "Well….this is what it look like 🧸."

Halsey has also shared a few photos nursing the newborn, including one on August 3 in honor of National Breastfeeding Day.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

In the US, as many as 26 million people of childbearing age have uterine fibroids, says the US National Library of Medicine. More than half of these people experience symptoms.

What exactly are uterine fibroids, though, and what happens when you discover you have one? Here's what you need to know.

RELATED: What's Really Causing Your Pelvic Pain?

What are uterine fibroids?

Uterine fibroids are non-cancerous tumors, or masses, that grow in and around the muscle and connective tissue of the uterus, according to the Cleveland Clinic. They rare develop into cancer, and having uterine fibroids doesn't increase your risk of developing a uterine cancer, says OWH.

"Uterine fibroids develop from smooth muscle tissue in the uterus," says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. "Like any other tissue can, it starts cloning itself and growing on its own."

Dr. Ruiz says uterine fibroids are usually discussed in two contexts: size and location. The larger they are, the more likely they are to cause symptoms, he explains. (Alternatively, having several small fibroids that add up to the size of a larger growth can be problematic too.)

Fibroids can be as tiny as a seed or as massive as a watermelon, ranging from 1 millimeter to 20 centimeters (about 8 inches) or more in diameter, reports the Cleveland Clinic. At that point, it can cause weight gain, abdominal swelling, and pain, and large fibroids may also cause damage to the uterus or surrounding organs, interfere with pregnancy or fertility, and cause heavy bleeding, per UCLA Health.

As for location, OWH reports that fibroids grow in three different ways:

1. From the wall of the uterus into the lining or cavity of the uterus. They're called submucosal fibroids.
2. From the wall of the uterus outward, or outside the uterus, called subserosal fibroids.
3. Only contained within the wall of the uterus, known as intramural fibroids.

Dr. Ruiz says submucosal fibroids usually present the earliest and may cause heavy bleeding, while intramural fibroids don't cause many issues unless they become very large. Subserosal fibroids are the least symptomatic and most common, he adds, but they can get big enough to outgrow their blood supply, which can cause severe pain because the tissue may die and become twisted, or infarcted.

RELATED: Women Are Sharing Photos of Their Bloated Bellies to Reveal a Little-Known Symptom of Endometriosis

What causes uterine fibroids?

There are no known causes of uterine fibroids, but Dr. Ruiz says there are some things that increase your chances of developing them.

"Family history [plays a part]," he says, "so if your mom had large uterine fibroids, you're predisposed to them as well."

In addition to genetics, age and race play a role; Black women have a much higher risk of developing fibroids, says Dr. Rose Chang-Jackson, ob-gyn at Austin Regional Clinic in Austin, Texas, as do older women with longer "reproductive lifespans."

Lastly, uterine fibroids often grow when estrogen levels are high, perhaps due to prolonged exposure to estrogen, per Johns Hopkins Medicine.

What are the symptoms of uterine fibroids?

The two primary symptoms of uterine fibroids are pain and bleeding, says Dr. Ruiz.

"[You may have] pelvic pain or pressure, pain during intercourse, and pain before or during menses," he explains, "and you may have heavier and longer periods or abnormal bleeding at abnormal intervals."

In other words, you might suspect you have uterine fibroids if your periods are unusually long and heavy or if you bleed unpredictably between periods.

But Dr. Ruiz also emphasizes that there's no universal experience of uterine fibroid symptoms, regardless of how large or small your fibroids are. He says that fairly large uterine fibroids can be found in a woman who is asymptomatic, while someone with only one small fibroid can experience clear symptoms.

RELATED: This Woman's 'Gluten Intolerance' Turned Out to Be Uterine Cancer

How are uterine fibroids diagnosed?

Initially, says Dr. Chang-Jackson, most uterine fibroids are diagnosed from a physical exam.

"A patient will come into a well-woman visit for a pelvic exam, and we'll notice she has a large uterus," she explains, adding that a pelvic ultrasound is then typically recommended to confirm the diagnosis. An MRI may also be used, she says, especially if an exact location of the fibroid is needed for surgical planning.

According to the American College of Obstetrics and Gynecology, there are a few other tests which may be used to diagnose fibroids:

• Hysteroscopy, a scope that allows your doctor to see any fibroids within the uterus.
• Hysterosalpingography, an x-ray procedure using special dye to obtain images of the uterus and fallopian tubes.
• Laparoscopy, which involves a small incision, giving your doctor a good view of fibroids growing on the outside wall of the uterus.

RELATED: How Having a Hysterectomy at 17 Changed My Life

How uterine fibroids are treated?

You may not need to treat your uterine fibroid at all; if you are asymptomatic and not planning a pregnancy, Lisa Hansard, MD, board-certified reproductive endocrinologist at Texas Fertility Center, says you may be able to sit back and let your body do the work for you.

"About 35% of women at age 35 have a uterine fibroid, but that doesn't mean you have to do anything about it," Dr. Hansard tells Health. "When women go through menopause, typically the fibroids stop growing or get smaller, so our goal is to get you to menopause without having to intervene—if we can do that, it's likely you won't need any treatment."

That said, if you are experiencing symptoms or have concerns about the location of your fibroid with regard to your fertility, you may need to undergo treatment. While fibroids may not affect a pregnancy at all, per Dr. Ruiz, their size and location can introduce complications to the pregnancy as well as to labor and delivery.

A 2017 study published in PLOS One, for example, assessed obstetric outcomes in women with and without uterine fibroids. Having uterine fibroids was associated with a higher risk of cesarean section as well as postpartum hemorrhage; it was also found that babies were more likely to present in a breech position at the time of delivery.

"The most important thing [in determining treatment] is trying to figure out a woman's overall fertility situation, how big the fibroid is, and where it's located," says Dr. Hansard. "If it's in a position where it can interfere with becoming pregnant or maintaining a pregnancy, then based on the size and location we work out what's the best approach."

In most cases, adds Dr. Hansard, this would involve an open incision surgery to excise the fibroid while preserving fertility. However, if fertility isn't a concern, she says other surgical options may be on the table, including laparoscopy, uterine embolization, or hysterectomy.

"A hysterectomy is not optimal for everyone, but the most common reason to have one in the US is uterine fibroids," Dr. Hansard says.

Finally, in some cases you may be able to stop or slow the growth of your fibroid, delaying or even eliminating the need for treatment, with certain medications—Dr. Chang-Jackson says that some forms of hormonal birth control, like the combination pill and the progesterone-only IUD, can provide "first-line symptom management for women with pain and bleeding" due to uterine fibroids.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

But even though they might not be on the top of your mind at most times, they can be the home to cysts at any time. Ovarian cysts are common, according to the Office on Women's Health. Often, ovarian cysts don't come with symptoms and are usually harmless—but some people can experience what's known as a ruptured ovarian cyst.

The good news: Most of the time, ruptured cysts cause no symptoms or only mild symptoms, according to Johns Hopkins Medicine—and on its own, a ruptured cyst is rarely a medical emergency. But if it's causing extreme pain or severe bleeding, a ruptured cyst could be life-threatening. Here's what you need to know about ruptured cysts, including the most common symptoms and how doctors typically treat them.

ruptured ovarian cyst , cysts can be abnormal, which means they're unrelated to the function of your menstrual cycle; or functional, which occur at different points of your menstrual cycle (these types of cysts are the most common). The types of both functional and abnormal cysts include:

• Follicular cysts: A follicular cyst is a functional cyst that forms when the follicle doesn't rupture or release its egg when it usually would at the midpoint of your cycle, instead continuing to grow.
• Corpus luteum cysts: "When a follicle releases its egg, it begins producing estrogen and progesterone for conception. This follicle is now called the corpus luteum," as the Mayo Clinic explains this type of functional cyst. "Sometimes, fluid accumulates inside the follicle, causing the corpus luteum to grow into a cyst."
• Dermoid cysts: Also known as teratomas, these abnormal cysts can contain tissue, such as hair, skin, or teeth because they form from embryonic cells.
• Cystadenomas: These abnormal cysts can be filled with a watery or a mucous material and develop on the surface of an ovary.
• Endometriomas: These are filled with endometrial tissue and develop as a result of endometriosis, when your uterine endometrial cells grow outside of your uterus.

Cysts typically occur in premenopausal people, with those with polycystic ovary syndrome being at an increased risk for developing cysts, according to Dr. Shin. And again, for the most part, they often go unnoticed. "Cysts are very common, and the majority of times they're actually harmless and women might not even know that they have them," Dr. Shin says.

RELATED: The Most Common Ovarian Cyst Causes, According to Ob-Gyns

What is a ruptured ovarian cyst?

A cyst ruptures when the ovary tissue bursts, opening up the cyst wall, and exposing the fluid that was in the cyst to your abdominal cavity. Smaller cysts are less likely to rupture, but when cysts get larger, and the ovarian tissue surrounding the cyst becomes thinner and thinner, it has a greater likelihood of rupturing, according to Dr. Shin.

Besides its size, another factor that can determine whether a cyst ruptures is if you've done any vigorous activity that affects the pelvis. Many people who have had a ruptured cyst will report having recently had sex or strenuous exercise. But that doesn't mean you should restrict your lifestyle in anyway to avoid rupturing a cyst, Dr. Shin says.

Now, it's actually common for functional cysts to rupture, according to Dr. As-Sanie. In fact, they're the type of cyst that most often ruptures. "A lot of times when patients are seen and say they had pain from a ruptured cyst and you see a small amount of fluid in the pelvis, that often just is normal physiology of the ovaries in a patient who is in reproductive years and is ovulating and has the potential to get pregnant," she explains.

RELATED: This 23-Year-Old Discovered She Had a 'Football-Shaped' Ovarian Cyst Filled With 2 Liters of Fluid

What are the symptoms of a ruptured ovarian cyst?

Sudden onset pain in your pelvic area is the hallmark symptom of a ruptured ovarian cyst. That pain can happen before, during, or after the rupture, Dr. Shin says. The pain following the rupture may last several days; that's because the fluid from the cyst can be irritating after it's released into your abdominal cavity and before your body absorbs it.

Usually, most ruptures cause only mild to moderate symptoms, without serious complications, that can be easily managed. When it comes to a functional cyst rupture, specifically, the pain usually lasts just a couple hours to a day and then goes away on its own or with the help of pain medication, according to Dr. As-Sanie.

But other times, "it can be quite painful," Dr. Shin says. "And oftentimes women will come to the emergency room reporting really severe, intense, acute, sharp pain, kind of not knowing exactly what hit them."

The spot you feel the pain could be where the cyst is, but not necessarily. And then once it's ruptured, the pain can be felt pretty much anywhere in the pelvis since the fluid from the cyst can collect in different areas of the abdominal cavity, according to Dr. Shin.

Besides pain, you can also sometimes have more vague symptoms leading up to a rupture, like nausea, vomiting, abdominal fullness, and bloating, Dr. Shin says.

But as Dr. As-Sanie points out, acute pelvic pain can be tied to a number of conditions—including anything from a urinary tract infection to a kidney stone—and doesn't automatically mean you have a ruptured ovarian cyst. "It's not like I would say that you have unremitting pain and the first thing you should think of is you might have a ruptured cyst," she says. Rather, if you have acute pain that is interfering with your ability to do usual activities like walk and use the bathroom and is unrelieved with over-the-counter medications, Dr. As-Sanie recommends that you contact your doctor.

If your pain is severe and accompanied with nausea, vomiting, and fever, you should go to the emergency room. If the only symptom you're experiencing is pain that's not too severe, then you can schedule a trip to your primary care physician or ob-gyn.

If you don't have established care with any doctor, then it'd be appropriate to go to an urgent care or an emergency department, Dr. As-Sanie says.

RELATED: This 21-Year-Old's Stomach Was So Bloated She Couldn't Tie Her Shoes—and It Turned Out She Had a 9-Pound Ovarian Cyst

How is a ruptured ovarian cyst diagnosed and treated?

Again, there are many potential causes of pelvic pain. So when you go to your doctor for your acute pelvic pain, they will need to figure out exactly what the cause of that pain is. Based on your symptoms and exam findings, the doctor will determine what laboratory tests you need, as well as whether any imaging test is needed, according to Dr. As-Sanie.

The imaging might help your doctor make a retrospective diagnosis. "In theory, if someone has a cyst that was ruptured, then the cyst isn't actually potentially visible on imaging anymore. So really all you know is that they had pain," Dr. As-Sanie says. The imaging might show that there's some fluid in your abdominal cavity, but that alone might not be enough to make a diagnosis. It would be the imaging—along with knowing that the pain has resolved over time—that can allow for a doctor to assume a cyst had ruptured. "Patients often get that label [that maybe a cyst ruptured], but there's nothing to actually confirm or exclude that a cyst was ruptured," she says.

Usually, other than keeping track of symptoms, taking pain medication, and possibly scheduling a follow-up ultrasound, there is no treatment necessary for something believed to be a ruptured cyst. An exception would be if after the cyst ruptures, the pain doesn't let up and there are signs of irritation from the cyst's fluid in your abdominal cavity or internal bleeding—emergency surgery might be needed at that point, Dr. As-Sanie says.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter