Uterine fibroids are non-cancerous growths that develop from the muscle tissue of the uterus. These growths are extremely common, affecting a large percentage of women during their reproductive years. While most fibroids do not “come out” as expected, they can naturally reduce in size. In specific, rare instances, certain types of fibroids can be physically expelled through the vagina.
How Fibroids Naturally Shrink
The size and growth of uterine fibroids are closely linked to the presence of reproductive hormones, particularly estrogen and progesterone. Fibroid tissue contains more receptors for these hormones than the surrounding normal uterine muscle, which explains their growth during the reproductive years. When the stimulation from these hormones decreases, the fibroids typically stop growing and begin to shrink, a process known as atrophy.
The most significant natural reduction in fibroid size occurs after a woman reaches menopause. With the cessation of ovarian function, the sharp drop in circulating estrogen and progesterone levels removes the primary growth stimulus for the fibroids. This hormonal shift often leads to a noticeable decrease in their size, and symptoms typically lessen or disappear completely.
Fibroids may also shrink following pregnancy. After childbirth, the high hormone levels that supported the pregnancy rapidly decline, and the fibroids decrease in size in the postpartum period. This reduction is an internal process, distinct from physical expulsion, where the fibroid tissue becomes smaller within the uterine wall. Natural shrinkage is generally a slow process, proportional to the reduction or cessation of hormone exposure over time.
The Process of Fibroid Expulsion
Fibroid expulsion, sometimes called fibroid sloughing, is a rare event that primarily involves fibroids projecting into the uterine cavity. The types most likely to be expelled are submucosal fibroids, which grow beneath the lining of the uterus, and pedunculated fibroids, which are attached by a stalk.
Expulsion typically begins when the fibroid outgrows its blood supply, causing the tissue to die, a condition known as necrosis or degeneration. Once the fibroid tissue is necrotic, the body recognizes it as foreign material and attempts to push it out of the uterus. The uterus contracts intensely to force the dead tissue through the cervix and into the vagina, similar to the process of labor.
Expulsion is often accompanied by severe, labor-like cramping, heavy vaginal bleeding, and the passing of solid, grayish tissue or large blood clots. The entire fibroid, or significant pieces of it, may be expelled over a period of days or weeks. This event requires immediate medical attention due to the risks of hemorrhage, retained tissue, or infection.
When Medical Intervention Is Necessary
When fibroids are asymptomatic or cause only minor discomfort, the standard approach is often watchful waiting. This involves tracking the growths over time using regular gynecological check-ups and imaging, such as ultrasound, to monitor their size and growth rate.
Intervention becomes necessary when fibroids cause significant symptoms that affect a person’s health or quality of life. Common indications for treatment include heavy menstrual bleeding that leads to anemia, chronic and debilitating pelvic pain, or pressure symptoms affecting the bladder or bowel function. Treatment options vary depending on the fibroid characteristics and the patient’s desire for future fertility.
Non-surgical management may involve hormonal medications to control symptoms or procedures like Uterine Fibroid Embolization (UFE), which blocks the blood supply to the fibroid, causing it to shrink. Surgical options range from a myomectomy, which removes only the fibroids while preserving the uterus, to a hysterectomy, which involves removing the entire uterus. The choice of treatment is individualized, based on the severity of symptoms and specific health goals.