Besides the discomfort described above, fibroids pose problems with women of childbearing age. They can bulge over the openings of the tubes, effectively blocking them and leading to infertility. They can compete for space with the developing fetus, which can make miscarriage or abnormal presentations of the baby more likely. They can also act as a foreign body, making the uterus more irritible, putting a patient at risk for premature labor. But I suppose the biggest risk to a woman with fibroids is from abnormal bleeding.
Fibroids are a fairly easy diagnosis to make, using ultrasound and a regular office pelvic exam.
Even so, other causes of abnormal bleeding must be ruled out, like polyps or cancer. Once that is done, the possibility of real danger must be assessed. If a patient is anemic, this is usually an indication to act. And whether a patient chooses myomectomy, fibroid shrinking drugs, or hysterectomy, she should consider that the worst scenario would be an emergency hysterectomy if she were to land in an emergency room in shock from vaginal hemorrhage, a case I get from time to time. True, for the most part this type of melodrama is rare.