Only if symptomatic! Treatment is decided based on the presenting symptoms, the size and location of the fibroids and the wishes of the patient. Fibroids originate from the muscle layer of the uterus but they may expand outwards towards the outer layer of the uterus (subserosal) or may largely grow inwards towards the cavity of the uterus (submucosal). Some of these submucosal fibroids may be pedunculated, attached to the muscle layer by a stalk when they are termed fibroid polyps. Very large size fibroids generally involve the whole body of the uterus, distorting the shape of the uterus (intramural).

Submucous fibroids usually present with menorrhagia, irregular bleeding, or intermenstrual spotting. These may interfere with conception. Intramural fibroids present with 'bulk' symptoms including urinary frequency, urgency, stress incontinence,urinary retention, bowel symptoms of bloating, constipation, or pelvic pressure and back ache. Heavy and prolonged bleeding is also frequently seen. Small subserosal fibroids may be completely asymptomatic but when large may present with pressure effects. There is considerable overlap between the types of fibroids and their presentation.