Fibroids and pregnancy: Risks, symptoms, and how to manage fibroids during pregnancy

An illustration of uterine fibroids representing fibroids and pregnancy.
  • Updated Nov 28, 2024
  • Published

CRAFTED BY HUMAN

Crafted by human At Femia, we provide accurate and up-to-date information at every stage of your journey, from trying to conceive, pregnancy and postnatal support. All content is created by a real person based on in-depth research and own professional experience. Femia ensures that you will receive expert advice, strict accuracy and a personalized approach from our authors/medical experts. Learn more about our editorial policy.

FACT CHECKED

Fact checked At Femia Health, we maintain the highest standards of editorial excellence in delivering content focused on helping you conceive, guiding you through pregnancy, and supporting you postpartum. Explore our content review principles to learn how we ensure the accuracy and quality of our health and lifestyle tips for every stage of your journey.

Author picture

Created with Nataliia Yermolovych, MD, Obstetrician-Gynecologist

In this article
In a nutshell
  • Fibroids are common, non-cancerous growths in the uterus that often cause no symptoms though, in rare cases, can impact fertility.
  • Fibroids rarely affect fertility, but their impact depends on their size and location, particularly if they distort the uterine cavity (submucosal fibroids). While many women with fibroids conceive and carry healthy pregnancies, larger or multiple fibroids can increase the risk of complications such as pain, bleeding, miscarriage, placental issues, preterm birth, and fetal growth restrictions due to reduced blood flow caused by the fibroids.
  • While many women with fibroids have healthy, successful pregnancies, it is important to discuss your condition with your healthcare provider.

Uterine fibroids are benign (not cancer) growths in the uterus. They grow in the muscle wall of the uterus and can also be called ‘leiomyomas’ or ‘myomas.’ They are very common. The location of fibroids plays a significant role in how they may affect pregnancy and its progression, influencing risks such as miscarriage, preterm birth, or placental complications. 

Approximately two in three women will develop a fibroid at some point. According to the American College of Obstetricians and Gynecologists (ACOG), they’re most common between the ages 30 to 40. 

The size, location, and number of fibroids significantly influence their impact on pregnancy. While many women may not even know they have fibroids and can have problem-free, natural pregnancies, for some, fibroids can lead to complications.

Trying to get pregnant naturally?

Femia helped 35,000 couples to optimize their fertility

Try Femia now

What are fibroids and how do they relate to pregnancy?

Fibroids are noncancerous growths that grow inside, or around the outside of the uterus and can vary in size, number, and location. They can also significantly impact a woman’s quality of life, causing symptoms such as heavy menstrual bleeding (menorrhagia), pain, and compression of nearby organs.

We don’t know exactly what causes fibroids, but it’s believed that they’re linked to the reproductive hormones estrogen and progesterone. Fibroids are most common during the reproductive years when estrogen and progesterone levels are highest (before menopause). 

Fibroids can be as small as a grain of rice or as large as a grapefruit. Many women don’t even realize they have fibroids, but in rare cases, they can grow so large that they fill the stomach area, making someone appear pregnant.

Fibroids and pregnancy

Fibroids can sometimes impact the shape or function of the uterus, potentially affecting fertility or leading to complications during pregnancy. They may increase the risk of miscarriage, preterm birth, or the need for a cesarean delivery. Regular monitoring during pregnancy is crucial, especially for women with large fibroids (>5 cm), to address these potential risks and ensure a healthy pregnancy progression.

However, not all fibroids affect pregnancy, and many women with fibroids go on to have healthy pregnancies. 

👉Find out more: How to recognize signs of high fertility in a woman: A detailed guide

Types of fibroids

An illustration showing 3 types of fibroids.

Fibroids are characterized by where and how they grow, here are the different types of fibroids you can have:

  • Intramural fibroids. Grow within the muscle wall of the uterus and are the most common type of fibroid. They can cause symptoms such as heavy menstrual bleeding (menorrhagia) and chronic pelvic pain, significantly impacting a woman’s quality of life.
  • Submucosal fibroids. These fibroids develop beneath the endometrial lining and bulge into the uterus. They are the most likely to impact fertility as they can deform the uterine cavity, making it more difficult for implantation to occur. These fibroids can also cause severe menstrual bleeding, further affecting a woman’s reproductive health.
  • Subserosal fibroids. These fibroids develop on the outer wall of the uterus and can grow to a significant size. While they rarely affect the menstrual cycle, their large size can compress nearby organs, such as the bladder or bowel, potentially causing symptoms like urinary frequency, constipation, or pelvic discomfort.

Subserosal or submucosal fibroids can grow on a stalk, referred to as pedunculated fibroids. These fibroids are at risk of twisting (torsion), which can cause sudden, severe pain. This condition is considered a gynecological emergency requiring immediate medical attention and treatment to prevent further complications.

Large intramural or submucosal fibroids can significantly increase the risk of pregnancy complications, such as abnormal placental attachment, including placenta previa (placenta covering the cervix) or placenta accreta (placenta abnormally attached to the uterine wall). Proper evaluation and monitoring are essential to manage these risks effectively.

Fibroids during pregnancy: Symptoms and what to expect

Many women with fibroids aren’t aware they have them during pregnancy and experience no symptoms or complications. However, depending on the fibroid’s size and location, some may experience the following:

  • Pain. Fibroids can grow during pregnancy or twist and cause sudden severe pain.  
  • Pressure. They can cause an increased feeling of pressure or fullness in the abdomen (tummy).
  • Bleeding. A review published in Obstetrics and Gynecology noted there is an increased risk of bleeding in early pregnancy, especially if the placenta develops closely to the fibroid.

Do fibroids move during pregnancy?

No, fibroids themselves don’t move around. However, as the uterus grows, fibroids may shift slightly within it, which can create sensations of pressure or movement. Regular checkups with your healthcare provider can help monitor your fibroids and keep symptoms manageable.

Can fibroids affect pregnancy?

Sometimes, fibroids can affect pregnancy by causing complications, but the chance of having a complication will depend on the number, size, and type of fibroid you have. In general, having fibroids can increase the risk of:

  • Miscarriage. Miscarriage is defined as the loss of the pregnancy before the 20th week. Depending on where the fibroid is located and if you have more than one you may be at increased risk of miscarriage.  
  • Preterm delivery. This is when a baby is born before 37 weeks. One review found that 16% of women with fibroids deliver early compared to 10.8% of women without fibroids. Having multiple fibroids or fibroids that touch the placenta may increase this risk further.
  • Placental issues. Complications like placental abruption and placenta previa are more likely in some women with fibroids depending on the location.
  • Cesarean section. One systematic review published in the American Journal of Obstetrics and Gynecology (AJOG) found that women with fibroids are 3.7 times more likely to have a cesarean delivery.
  • Postpartum (after birth) complications. A review published in the journal Obstetrics and Gynecology found that women with fibroids might be more likely to have a postpartum hemorrhage. The increased risk is believed to occur because, in rare cases, the fibroid can prevent the uterus from contracting properly after birth.

Fibroids and infertility: Do fibroids cause infertility?

While fibroids are present in up to 10% of women with infertility, they’re the sole cause of infertility in 1–2.4%. Here’s how fibroids can affect fertility:

  • Blocked fallopian tube 
  • Distort the shape of the uterus
  • Distort the lining of the uterus
  • Prevent implantation 
  • Prevent sperm from reaching the egg

While fibroids can, in rare cases, cause infertility, the majority of women with fibroids can still conceive either naturally or with medical assistance. If you are thinking about getting pregnant and have fibroids then have a chat with your healthcare provider. They will be able to offer personalized advice and recommend any necessary support you may need. For patients with submucosal fibroids, it may be advisable to consider removal of these fibroids, as this can significantly increase the chances of a successful pregnancy.

Can you get pregnant with fibroids and ovarian cysts?

Yes, it’s possible to get pregnant with both fibroids and ovarian cysts, though each condition can impact fertility in different ways. Fibroids, depending on their size and location, can occasionally make it harder for an egg to be fertilized or an embryo to implant. Ovarian cysts, meanwhile, are more common and can disrupt the menstrual cycle and prevent ovulation, especially if they’re part of conditions like polycystic ovary syndrome (PCOS) or endometriosis.Though fibroids and ovarian cysts can affect conception, many women still successfully conceive, especially with support from their healthcare provider. Fertility treatments, lifestyle adjustments, or, in some cases, surgery can increase the chances of a healthy pregnancy.

Good to know:
If you’re considering pregnancy, it’s a good idea to talk to your healthcare provider. They can offer personalized advice on ways you can naturally boost your fertility through diet, exercise and supplements. If necessary, they can also recommend when to consult a fertility specialist.

Successful pregnancy with fibroids

Many women have a successful pregnancy with fibroids. While fibroids can sometimes present challenges, most pregnancies progress without major issues. With regular checkups and guidance from your healthcare provider, you can navigate pregnancy with fibroids confidently. Monitoring typically includes ultrasounds to assess the growth and dynamics of fibroids, especially during the second and third trimesters, as hormonal fluctuations during this time can stimulate fibroid enlargement.

How to deal with fibroids during pregnancy

Fibroids during pregnancy can sometimes cause discomfort, here are some ways you can manage mild symptoms at home:

  • Regular checkups are essential to monitor any changes or growth of the fibroid. 
  • Avoid heavy lifting to limit strain on the uterus. 
  • Bed rest is occasionally recommended to manage pain or when there is a risk of preterm labor. However, prolonged bed rest is generally not advised for managing fibroids due to the increased risk of thromboembolic complications. Always follow your healthcare provider’s recommendations for individualized care.
  • Pain relief can help manage discomfort, but it’s important to consult a healthcare professional before taking any medication, even over-the-counter options.

Staying in close communication with your healthcare provider, seeking support for any concerns, and getting medical advice for any worrisome symptoms can help keep both you and your baby healthy throughout pregnancy.

👉Find out more: How many eggs does a woman have? Understanding egg count and fertility by age

What are the treatment options for fibroids?

Treatment is often not necessary, especially if you don’t have any symptoms. But, sometimes your healthcare provider might recommend a surgical or non-surgical procedure to treat your fibroids before you get pregnant, possible options include:

Surgical options for fibroids

  • Myomectomy. During this surgery, the fibroid is removed from the wall of the uterus. It is not suitable for all types of fibroids but for those where it is an option it can increase the chances of getting pregnant afterwards. After myomectomy, women are often advised to wait 6–12 months before attempting pregnancy to allow the uterus to heal fully. Additionally, the possibility of natural delivery depends on the depth and location of the scar left by the surgery, as this may influence the mode of delivery recommended by the healthcare provider.
  • Hysteroscopy. A small telescope is passed through the vagina into the uterus and the fibroid is then cut away using small surgical instruments. This method offers a quicker recovery time and preserves fertility. 

Non-surgical options for fibroids

  • Uterine artery embolization. This is sometimes recommended for women with large fibroids. A radiologist passes a small tube through your blood vessels to reach the fibroid using X-ray to guide it. Pregnancy is possible after this procedure but it may be associated with a higher risk of miscarriage and complications during pregnancy and is therefore not currently recommended for women who desire future pregnancy.
  • MRI-guided ablation and ultrasound. These relatively new techniques use laser or ultrasound energy to destroy the fibroid. The exact effect it can have on fertility is still not fully known but pregnancy is possible.   

If fibroids are discovered during pregnancy, most treatments are delayed until after delivery to avoid risks to the baby. Your healthcare provider can help you decide on the best approach for your situation.

Trying to get pregnant naturally?

Femia helped 35,000 couples to optimize their fertility

Try Femia now

Questions from the Femia community

  • Can fibroids get bigger during pregnancy?

    Yes, fibroids can grow during pregnancy, particularly in the first trimester. This is thought to occur due to increased hormone levels during pregnancy. Regular monitoring can help monitor any changes.

  • Do fibroids go away after pregnancy?

    Some fibroids shrink naturally during the third trimester and after pregnancy due to hormone level changes, but many will remain the same size.

  • Can fibroids cause early labor?

    Fibroids can increase the risk of going into labor before 37 weeks (preterm labor). The chances of early labor depend on the size, location, and number of fibroids but it is thought that having multiple fibroids, or fibroids that touch the placenta increase the risk.

The bottom line

While fibroids can present challenges for some women during pregnancy, many women will have healthy, complication-free pregnancies. If you know you have fibroids, or have concerns, talking with your healthcare provider can help you plan and ease your worries. In some cases, they may recommend fibroid treatment before pregnancy, especially if fertility might be affected.

If you’re pregnant, or hoping to conceive with fibroids, remember that, with proper monitoring and support from your healthcare provider, many women will have happy, successful pregnancies.

Facebook
Twitter
Threads
In this article
Related articles