Uterine Fibroids: Causes, Treatments, & Impact on Fertility

If you’ve just been told you have uterine fibroids, the first question on your mind is probably: can I still get pregnant? It’s a completely normal thing to worry about.

Here’s the quick answer: most fibroids don’t interfere with fertility or pregnancy at all. In rare cases, they can make it harder to conceive or raise the risk of certain pregnancy complications, and it all comes down to their size and location.

Here’s what you need to know, from the different fibroid types to your treatment options.

What Are Uterine Fibroids?

Uterine fibroids (also called myomas or leiomyomas) are non-cancerous tumors that grow in, on, or around the uterus. They are very common, affecting 20-80% of women by age 50, according to the National Institutes of Health.

Although fibroids are technically classified as tumors, they don’t invade nearby tissue or spread through the body the way cancer does. They can show up alone or in clusters, and the size varies wildly, ranging anywhere from a seed to a grapefruit, sometimes bigger.

Fibroids are closely linked to two hormones: estrogen and progesterone. Both drive the growth of the uterine lining during your menstrual cycle, and fibroids tend to grow right along with them. That explains why fibroids often shrink after menopause, once those hormone levels drop.

Types of Uterine Fibroids and Why It Matters

Not all fibroids are the same, and their location often determines their impact on fertility and pregnancy.

Who Is Most Likely to Develop Uterine Fibroids?

Almost anyone with a uterus can have fibroids, but a few factors increase the odds:

Other risk factors linked to higher fibroid risk include low vitamin D, a diet heavy on red meat and light on fruits, vegetables, and dairy, drinking more alcohol, and starting your period at a young age.

Symptoms of Uterine Fibroids

Many women have fibroids without ever knowing it. This is because they cause no symptoms and are sometimes only discovered during a routine pelvic exam or an ultrasound for something unrelated. When symptoms do show up, the most common ones include:

•         Heavy menstrual bleeding (menorrhagia) or bleeding between periods
•         Anemia caused by ongoing heavy blood loss
•         Pelvic pain or discomfort, both during and between periods
•         Bowel or bladder symptoms, like constipation or frequent urination, depending on where the fibroid is pressing

If you’re showing any of these symptoms, your doctor may order an ultrasound to confirm the diagnosis and determine the size, number, and location of any fibroids.

How Do Uterine Fibroids Affect Fertility?

Here’s the good news first: most women with fibroids conceive and deliver healthy babies without any trouble. Research suggests fibroids are the sole identifiable cause of infertility in only about 1-3% of women evaluated for fertility problems. That said, fibroids do turn up in roughly 5-10% of women seeking fertility treatment.

For the women whose fibroids do play a role, it almost always comes down to location, size, or both. According to the American Society for Reproductive Medicine (ASRM) and supporting research, fibroids can affect fertility in the following ways:

Can You Get Pregnant With Fibroids?

Yes, in most cases. Plenty of women with fibroids, including some fairly large ones, go on to conceive naturally and carry healthy pregnancies to term.

Fibroids getting in the way of pregnancy is the exception, not the rule. And when it does happen, it’s almost always down to the location and size factors covered above, not just having fibroids in general.

How Do Fibroids Affect Pregnancy Once You’ve Conceived?

Fibroids do not usually impact your ability to get pregnant, but they can affect you differently once a pregnancy is underway.

Fibroid Growth and Degeneration During Pregnancy

Rising estrogen and progesterone in early pregnancy can make fibroids grow, sometimes noticeably, with most of that growth happening in the first trimester before things settle down.

Note: Not every fibroid grows, though; some stay the same, and some actually shrink. Roughly a third of fibroids grow larger during pregnancy, while most stay stable or shrink slightly.

Sometimes, a fibroid outgrows its own blood supply. When that happens, the tissue starts to break down in a process called red degeneration, causing sudden, sharp pain, a mild fever, and tenderness in the area. It sounds worse than it usually is.

Most cases are easily managed with rest, fluids, and acetaminophen (Tylenol) rather than surgery, and the pain typically goes away within days to a couple of weeks. Red degeneration doesn’t harm the baby.

Pregnancy Complications Linked to Fibroids

Most pregnancies with fibroids go just fine, but having them, especially larger ones or ones sitting close to the placenta, does raise the odds of a few things:

The bigger and more numerous the fibroids, the more these risks tend to increase, which is why your provider may want to scan you more often during pregnancy if you have known fibroids to track growth and catch any issues early.

What Happens to Fibroids After Delivery?

Many fibroids shrink on their own after birth, once estrogen and progesterone levels drop back down. Surgery during pregnancy is rare and reserved for severe cases, since the safest window to treat a fibroid surgically is almost always before conception or after delivery, not when you’re pregnant.

Treating Uterine Fibroids to Improve Fertility and Pregnancy Outcomes

Treatment isn’t always necessary. Most fibroids are small, cause no symptoms, and are fine to leave alone. But if yours is causing heavy bleeding, pain, or fertility trouble, here are the treatment options you can consider:

If fertility matters to you, myomectomy is the first treatment option you want to look at since it deals with the fibroid while still making pregnancy possible. Some women with fibroids can also benefit from IVF, which can bypass many fibroid-related barriers to conception.

At RSMC, we walk every patient through these options based on their specific fibroid type, size, and fertility goals, since the right treatment depends on the individual situation.

When Should You See a Doctor About Fibroids?

If you’re experiencing heavy or prolonged bleeding, pelvic pain, or you’ve been trying to conceive without luck, you may want to visit a doctor for an evaluation. A fertility specialist can help determine whether fibroids are actually contributing to the issue or whether something else is going on. Fibroids do not usually cause fertility struggles, and ruling things in or out early saves time.

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Julianna Nikolic

Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.