Fibroids Assessment and Management in London

Uterine fibroids are one of the most common conditions affecting women during their reproductive years. If you are experiencing heavy periods, pelvic pain, or other unexplained symptoms, a specialist assessment can provide clarity, an accurate diagnosis, and a clear management plan. At AristoGP, our private gynaecologist offers consultant-led fibroid assessment with same-day pelvic ultrasound at our Central London EC1 clinic.

What Are Uterine Fibroids?

Uterine fibroids — medically known as leiomyomas or myomas — are benign (non-cancerous) growths that develop in or around the uterus. They are composed of muscle and fibrous tissue and can vary enormously in size, from a few millimetres to several centimetres in diameter. Some women develop a single fibroid; others may have multiple fibroids of varying sizes.

Fibroids are remarkably common. Studies suggest that up to 70% of women will develop at least one fibroid by the age of 50, though many women with fibroids experience no symptoms and are unaware they have them. For those who do experience symptoms, the impact on quality of life can be significant — ranging from disruptive periods to difficulty conceiving.

The exact cause of fibroids is not fully understood, but hormonal factors — particularly oestrogen and progesterone — are known to influence their growth. Fibroids tend to grow during the reproductive years when oestrogen levels are higher and often shrink naturally after the menopause.

Types of Uterine Fibroids: Intramural, Submucosal & Subserosal

Fibroids are classified according to their location within or around the uterus. Understanding the type and location of fibroids is important for assessing the likely impact on symptoms and fertility, and for planning management.

Intramural fibroids — The most common type. These grow within the muscular wall of the uterus (the myometrium). Larger intramural fibroids can distort the shape of the uterine cavity and contribute to heavy bleeding.
Subserosal fibroids — These grow on the outer surface of the uterus and can sometimes become very large. They are less likely to affect menstrual flow but may cause pressure symptoms such as pelvic discomfort or urinary frequency.
Submucosal fibroids — These grow just beneath the inner lining of the uterus (the endometrium) and bulge into the uterine cavity. Even small submucosal fibroids can cause heavy or prolonged menstrual bleeding and may affect fertility or implantation.
Pedunculated fibroids — These are attached to the uterus by a stalk rather than being embedded within the wall. They may be subserosal (on the outside) or submucosal (inside the cavity) and can occasionally twist on their stalk, causing acute pain.

Symptoms of Uterine Fibroids

It is important to note that many fibroids are entirely asymptomatic and are discovered incidentally during an ultrasound performed for another reason. When fibroids do cause symptoms, these will depend on the size, number, and location of the fibroids. Common symptoms include:

Heavy menstrual bleeding (menorrhagia) — Flooding, passing large clots, or needing to change sanitary protection very frequently. Heavy periods are particularly associated with submucosal and intramural fibroids.
Prolonged periods — Periods lasting longer than seven days.
Pelvic pressure or pain — A sensation of fullness, heaviness, or discomfort in the lower abdomen or pelvis.
Frequent urination — Larger fibroids can press against the bladder, reducing its capacity and causing a need to urinate more often.
Constipation or bloating — Fibroids pressing on the bowel may cause digestive symptoms.
Lower backache — Particularly with posterior fibroids pressing on structures at the back.
Enlarged abdomen — A noticeably distended or firm abdomen, particularly with large or multiple fibroids.
Pain during intercourse (dyspareunia) — Depending on the location of the fibroid.
Difficulty conceiving or recurrent pregnancy loss — Particularly where fibroids distort the uterine cavity or affect implantation.

If you are experiencing any of these symptoms, it is worth seeking a specialist assessment rather than assuming they will resolve on their own. Symptoms such as heavy periods and pelvic pain are never something you simply have to endure — effective assessment and management are available.

How Are Fibroids Diagnosed?

Pelvic ultrasound is the primary and most accessible imaging tool for diagnosing uterine fibroids. It allows the gynaecologist to identify the presence, size, number, and location of fibroids, and to assess whether they are distorting the uterine cavity. Ultrasound is safe, non-invasive, and highly effective for fibroid assessment.

At AristoGP, pelvic ultrasound is performed by the consultant gynaecologist herself during the same appointment. This consultant-led approach means that findings are interpreted in the context of your symptoms and clinical history in real time — not reported separately by a radiologist who has not spoken with you.

Our clinic uses specialist high-resolution ultrasound equipment with both 2D and 3D imaging capability. Three-dimensional ultrasound is particularly valuable for accurately mapping the position of fibroids relative to the uterine cavity and for planning management. Both transabdominal (over the abdomen) and transvaginal (internal) scans may be performed — the transvaginal approach typically provides clearer detail, particularly for smaller fibroids. The choice of scan will always be discussed with you beforehand.

In some cases, additional investigations may be recommended — for example, blood tests to assess for anaemia resulting from heavy bleeding, or more detailed imaging such as MRI if surgical planning is being considered.

Fibroid Assessment at AristoGP

Our consultant-led gynaecology service provides a comprehensive fibroid assessment in a single appointment. You will see Dr Anastasia Mermigka (GMC 7640566), Consultant Gynaecologist, who will:

Take a detailed medical and menstrual history, including the nature and duration of your symptoms
Discuss any previous investigations, including ultrasound scans, blood tests, or GP referrals
Perform a pelvic examination on our dedicated gynaecology examination plinth in a fully equipped clinical room
Carry out same-day pelvic ultrasound using high-resolution equipment, with immediate discussion of findings
Provide a clear explanation of what has been found — including the type, size, and location of any fibroids
Discuss all available management options and formulate a personalised plan tailored to your symptoms and circumstances

Having a dedicated gynaecology examination plinth and specialist ultrasound equipment on site — rather than a portable machine borrowed from another department — means we can carry out a thorough and accurate assessment without compromise. You leave your appointment with answers, not a further waiting list.

Management Options for Fibroids

Treatment depends on the size and location of the fibroids, the severity of your symptoms, your age, and whether you wish to preserve fertility. There is no single approach that suits everyone, and the right plan will be tailored to your individual situation.

Watchful Waiting

For women with small or asymptomatic fibroids, a ‘watch and wait’ approach — involving regular monitoring with repeat ultrasound — is often entirely appropriate. Many fibroids remain stable or grow slowly, and may shrink naturally around the time of the menopause. At AristoGP, we can arrange follow-up pelvic ultrasound appointments as part of an ongoing monitoring plan.

Medical Management

Several medications can help manage fibroid symptoms. Tranexamic acid and non-steroidal anti-inflammatory drugs (NSAIDs) can reduce heavy bleeding and pain without affecting the fibroids themselves. Hormonal treatments — including the combined oral contraceptive pill, progestogen-only treatments, or the levonorgestrel-releasing intrauterine system (Mirena coil) — can help manage bleeding. GnRH agonists may be used to shrink fibroids temporarily in preparation for surgery.

Surgical and Procedural Options

For women with significant or refractory symptoms, surgical options include myomectomy (removal of fibroids while preserving the uterus), hysterectomy (removal of the uterus, appropriate for women who have completed their family), and uterine artery embolisation (UAE, a minimally invasive radiological procedure). AristoGP provides thorough assessment and management planning; where surgical intervention is indicated, we arrange referral to an appropriate surgical colleague with your specific circumstances and preferences in mind.

A Well Woman assessment at AristoGP can also identify other conditions that may be contributing to your symptoms — helping to identify conditions that may be contributing to your symptoms.

When Should You See a Specialist?

You should seek a specialist assessment if you are experiencing any of the following:

Heavy periods that are getting progressively worse or significantly impacting your daily life
Pelvic pain or pressure that is persistent or unexplained
Difficulty conceiving, particularly if no other cause has been identified
A known fibroid that appears to have grown rapidly, or new symptoms developing
Symptoms of anaemia — such as persistent tiredness, breathlessness, or heart palpitations — that may result from heavy blood loss
Any other gynaecological concerns requiring assessment by a specialist

You do not need a GP referral to attend AristoGP. You can book a private gynaecology appointment directly. Our female gynaecologist, Dr Anastasia Mermigka, provides a confidential, respectful consultation in a calm and unhurried clinical environment.

Fibroids Assessment: Pricing

The following packages are available for fibroid assessment at AristoGP:

Service	Price
Gynaecology Consultation Detailed clinical consultation with Dr Mermigka	£180
Gynaecology Consultation + Pelvic Ultrasound Easter Offer — includes same-day ultrasound with 2D/3D imaging	£250
Complete Well Woman Check Comprehensive health assessment including gynaecology consultation, pelvic ultrasound, smear test, and STI screening	£340

For most women concerned about fibroids, the Consultation + Pelvic Ultrasound package (£250) provides the most complete assessment in a single appointment. All fees are transparent with no hidden charges. For pricing queries, please visit our contact page.

Book Your Fibroids Assessment

Frequently Asked Questions — Fibroids

What causes uterine fibroids?

The exact cause of fibroids is not fully understood, but they are known to be influenced by the hormones oestrogen and progesterone, which are produced during the reproductive years. This is why fibroids tend to grow during periods of hormonal activity and often shrink after the menopause. Genetic factors also play a role — fibroids tend to run in families. Fibroids are more common in women of African-Caribbean heritage. They are not caused by anything a woman has or has not done; they are a common and benign condition.

Can fibroids affect fertility?

Fibroids can affect fertility in some cases, particularly when they distort the shape of the uterine cavity or interfere with implantation. Submucosal fibroids — those that grow into the uterine cavity — are most likely to affect fertility and may be associated with recurrent miscarriage. Intramural fibroids that significantly distort the cavity may also have an impact. If you are having difficulty conceiving and fibroids have been identified, a specialist assessment is important to determine whether the fibroids are contributing and to discuss appropriate management.

Do fibroids need to be removed?

Not necessarily. Many fibroids — particularly those that are small, not causing symptoms, or not affecting the uterine cavity — can be safely monitored without intervention. Treatment is generally recommended when fibroids are causing significant symptoms (such as heavy periods, pelvic pain, or pressure), when they appear to be growing rapidly, when they are affecting fertility, or when they are causing anaemia. The decision to treat, and the most appropriate treatment, depends on the specific situation and is best made following a thorough consultant assessment.

How are fibroids monitored over time?

Once fibroids have been identified, repeat pelvic ultrasound is the standard method for monitoring their size and any changes over time. The frequency of monitoring depends on the size and behaviour of the fibroids and whether you have symptoms. A stable, asymptomatic fibroid may only need annual or biennial ultrasound review; a recently identified or rapidly growing fibroid may need more frequent follow-up. At AristoGP, we can arrange repeat pelvic ultrasound appointments as part of a structured monitoring plan.

Do I need a GP referral to be seen at AristoGP?

No. AristoGP is a self-referral private clinic — you can book an appointment directly without a GP referral. If you have previous test results, letters, or scan reports, it is helpful to bring these to your consultation, but they are not a prerequisite. Our team can also liaise with your GP following your consultation if you would like us to share a summary of findings and recommendations.

This page has been reviewed and approved by Dr Anastasia Mermigka, Consultant Gynaecologist, GMC 7640566. Dr Mermigka holds subspecialty training in reproductive medicine and provides consultant-led gynaecology services at AristoGP, Central London EC1.