What Are Uterine Fibroids?
Uterine fibroids (leiomyomas) are non-cancerous growths of the uterine muscle. They affect approximately 20–40% of women of reproductive age, and up to 70–80% of women by age 50. In Singapore, fibroids are one of the most common reasons women see a gynaecologist.
Fibroids are hormone-sensitive — they grow under the influence of oestrogen and progesterone and typically shrink after menopause. Most women with fibroids have no symptoms; others experience debilitating heavy bleeding, pain, or pressure effects.
Types of Fibroids by Location
Just under the uterine lining. Causes the heaviest bleeding and has greatest impact on fertility. Treatable hysteroscopically.
Within the uterine muscle wall. Most common type. Causes heavy bleeding and bulk symptoms if large.
On the outer surface of the uterus. Causes pelvic pressure, urinary frequency, constipation. Less effect on periods or fertility.
Attached to the uterus by a stalk. Can twist (torsion) causing acute severe pain. Laparoscopic removal is straightforward.
Symptoms
- Heavy menstrual bleeding (menorrhagia) — soaking through pads/tampons, passing clots
- Prolonged periods (more than 7 days) or intermenstrual bleeding
- Pelvic pressure or fullness — "feeling bloated" or the uterus feeling heavy
- Frequent urination or difficulty emptying the bladder (urinary retention)
- Constipation or rectal pressure
- Lower back pain or leg pain
- Difficulty conceiving (infertility) or recurrent miscarriage
- Iron deficiency anaemia secondary to heavy bleeding
Treatment Options
Non-Surgical / Medical Management
Appropriate for women with mild symptoms, approaching menopause, or who wish to avoid surgery:
- Hormonal IUD (Mirena): Reduces heavy menstrual bleeding significantly; does not shrink fibroids but controls symptoms well. Not suitable for submucosal fibroids distorting the cavity.
- Tranexamic acid: Non-hormonal tablet taken during menstruation to reduce bleeding volume by 30–50%
- Combined oral contraceptives / Progestogens: Can regulate cycles and reduce bleeding; do not shrink fibroids
- GnRH agonists (e.g., Lupron/Zoladex): Induce temporary menopause, shrink fibroids by up to 35–65%. Used pre-operatively to reduce fibroid size or for short-term symptom control. Not a long-term solution due to bone density effects.
- Ulipristal acetate (Esmya): Selective progesterone receptor modulator; may not be available in Singapore currently
Minimally Invasive Procedures
| Procedure | Suitable For | Uterus Preserved? | Private Cost (SGD) |
|---|---|---|---|
| Hysteroscopic Myomectomy | Submucosal fibroids ≤5cm | Yes | $5,000–$12,000 |
| Laparoscopic Myomectomy | Intramural/subserosal ≤10cm, ≤3–4 fibroids | Yes | $10,000–$20,000 |
| Uterine Fibroid Embolisation (UFE) | Multiple/large fibroids, no desire for pregnancy | Yes | $10,000–$20,000 |
| MRI-guided Focused Ultrasound (MRgFUS) | Select patients; limited availability in SG | Yes | $8,000–$15,000 |
Surgical Treatment
| Procedure | Suitable For | Uterus Preserved? | Private Cost (SGD) |
|---|---|---|---|
| Open Myomectomy (laparotomy) | Large/multiple fibroids, complex cases | Yes | $12,000–$25,000 |
| Laparoscopic Hysterectomy | Completed family, definitive treatment | No | $12,000–$22,000 |
| Vaginal Hysterectomy | Smaller uterus, selected cases | No | $10,000–$18,000 |
| Total Abdominal Hysterectomy (TAH) | Large fibroids, complex anatomy | No | $12,000–$28,000 |
*All costs include surgeon, anaesthesia, hospital stay. Claimable via Medisave + MediShield Life.
Frequently Asked Questions
See our researched shortlist: subspecialty focus, credentials and clinic websites, checked against public records.
View the shortlist →Extremely rarely. Uterine fibroids (leiomyomas) are almost always benign. Malignant transformation to leiomyosarcoma occurs in approximately 1 in 1,000 cases or fewer. The presence of rapid growth, particularly after menopause, or certain MRI features may warrant closer evaluation. Most fibroids do not require removal for cancer risk prevention.
If you wish to preserve fertility, myomectomy (surgical removal of fibroids while preserving the uterus) is the appropriate choice. Hysteroscopic myomectomy is best for submucosal fibroids; laparoscopic or open myomectomy for intramural/subserosal types. Uterine Fibroid Embolisation (UFE) is generally not recommended if future pregnancy is desired. After myomectomy, most gynaecologists advise waiting 3–6 months before trying to conceive.
Fibroid recurrence after myomectomy is possible — rates vary from 20–40% at 10 years. New fibroids can develop, as the underlying predisposition remains. However, re-operation is needed in a much smaller percentage. Fibroids that recur are often smaller and less symptomatic. Hysterectomy is the only definitive cure, eliminating all risk of recurrence.
Yes. Both myomectomy and hysterectomy are Medisave-claimable surgical procedures in Singapore. MediShield Life and Integrated Shield Plan (IP) insurance also cover these procedures subject to deductible and co-payment. Patients with good IP coverage at private hospitals often pay $2,000–$5,000 out-of-pocket for procedures that cost $15,000–$25,000 in total.