How Fibroids Affect Getting Pregnant and Pregnancy
- Fibroids may affect pregnancy and fertility
- Black women get more fibroids and worse ones, possibly due to systemic harms like racism
- Fibroids are treatable, but surgical removal of fibroids (myomectomy) may make it harder to conceive naturally
You may worry about the effect of uterine fibroids on pregnancy. Some fibroids are worse for your fertility than others. Here we share everything you need to know about these common growths, including whether surgery to remove fibroids can improve your pregnancy chances or not.
What are fibroids?
Fibroids are common, largely noncancerous growths. The growths vary greatly in size and location. The vast majority of fibroids appear in the uterus, but some also occur in the cervix.
You may have a single fibroid or many. A fibroid may remain tiny for a long time or swiftly balloon in size. If you go to the doctor for fibroids, you may hear them called by the medical names, myoma or leiomyoma.
Fibroids may affect fertility and cause pregnancy complications. The good news is these growths are often symptomless and treatable. Still, in some instances, surgical treatment may make it harder to conceive or carry a healthy pregnancy.
What are the types of fibroids?
There are three main kinds of fibroids, which are classified based on where they’re found:
- 55% – Subserosal: In the outer uterine wall
- 40% – Intramural: In the muscular layers of the uterine wall
- 5% – Submucosal: Project into the uterus
Submucosal fibroids and large intramural fibroids are most closely linked to infertility or miscarriage.
Who gets fibroids?
Fibroids occur in 20% of women in their childbearing years, and 50%-80% of Black women of reproductive age. Black women tend to develop fibroids earlier, and their fibroids tend to be larger and more numerous, causing more severe symptoms.
Other factors also heighten the risk for uterine fibroids:
- Age: Premenopausal women between the ages of 25 – 44 are more likely to experience these growths, and the risk rises with age within this group.
- High blood pressure
- Family history
- Soy consumption
Although it’s not entirely clear why Black women are hit hardest by fibroids, research suggests that stress, systemic racism, and barriers to obtaining quality healthcare might play a role.
Black women experience a harmful phenomenon called physical “weathering” that makes their bodies age faster than white women. Research suggests that weathering is due to prolonged exposure to stress linked to a lifetime of discrimination and socioeconomic disadvantage, thereby increasing their risk for pregnancy complications and maternal death. It isn’t known if weathering somehow triggers the growth of fibroids.
What are the symptoms of fibroids?
Fibroids may have the following symptoms:
- Changes in menstruation (longer, heavier periods, and bleeding between periods)
- Abdominal cramps
- Anemia (from blood loss)
- Pain in the lower back or abdomen (dull, heavy, aching, and sometimes sharp)
- Pain during sex
- Feeling of pressure
- Difficulty urinating or frequent urination
- Constipation, rectal pain, or difficulty moving your bowels
- A swollen abdomen that looks like you’re pregnant
About half of fibroids are symptomless, so it’s possible to have these growths without knowing it. Your doctor might discover fibroids during a routine pelvic or abdominal exam, but likely won’t recommend treatment if the growths aren’t causing symptoms.
Can you get pregnant with fibroids?
Many women can get pregnant naturally even with fibroids. However, roughly 5-10% of infertile women have fibroids.
Whether fibroids affect fertility hinges on the size and location of the growth. For example, submucosal fibroids, which can protrude into the uterine cavity, heighten the risk of infertility and pregnancy loss. Big intramural fibroids (>6 cm in diameter) may have a similar result.
The number of fibroids also seems to harm fertility. A 2018 paper noted that women with 6 or more fibroids were significantly less likely to become pregnant than women with fewer fibroids.
If you’ve been diagnosed with fibroids, talk to your doctor about monitoring the development of the growths.
How do fibroids cause infertility?
Fibroids affect fertility by altering reproductive organs. This may happen when a fibroid:
- Changes the shape of the uterus to interfere with the movement of the blastocyst or sperm
- Grows into the cervical canal, preventing sperm from reaching the uterus
- Blocks fallopian tubes
- Alters the endometrium
- Changes uterine blood flow to hamper implantation or development of the blastocyst
Do fibroids cause miscarriage?
Women with asymptomatic fibroids had slightly more pregnancy losses (14% vs. 7.6%) in one small study, but a more sweeping investigation of more than 5,500 women didn’t find higher rates of miscarriage among pregnant women with fibroids.
Because fibroids range in size and location (and it’s not uncommon to have multiple fibroids at a time), more research is needed to understand whether there’s a clear link between fibroids and miscarriage, per the latest committee statement from the American Society of Reproductive Medicine.
What happens to fibroids during pregnancy?
Between 2% and 12% of pregnant women have fibroids. Fibroids that grow typically do so in the first 12 weeks of pregnancy, but not all fibroids grow or cause problems in a pregnancy.
Fibroids that do affect pregnancy tend to either interfere with fetal development, affect the position of the fetus, or increase the risk of pregnancy complications, such as detachment of the placenta or preterm delivery. Fibroids also might increase the need for cesarean delivery.
Doctors rarely recommend surgical removal of fibroids during pregnancy. Any treatment that your provider may recommend will be based on your individual circumstances.
How are fibroids treated?
There are three main categories of treatment options for fibroids:
- Pain management: If the growths are minor, your doctor may recommend over-the-counter pain relievers like ibuprofen or acetaminophen. It’s important to know that if you’re trying to conceive and need to manage pain, it is recommended to avoid NSAIDs during implantation and use acetaminophen-based drugs like Tylenol instead.
- Hormone-based treatments: Hormonal treatments, like the oral contraceptive pill or gonadotropin-releasing hormone agonists, can shrink fibroids. However, these options can prevent conception.
- Surgery: Depending on the severity of the fibroids, your doctor may recommend surgically removing them in a procedure called myomectomy. The surgery isn’t always a lasting solution because fibroids can grow back. In extreme cases, your doctor may suggest a hysterectomy as a last resort for large growths after other treatments have failed. Hysterectomy is the surgical removal of the uterus, including the fibroids. After surgery, you can no longer become pregnant.
Can I get pregnant after myomectomy?
Whether you had just a single fibroid or several fibroids removed via myomectomy affects your fertility. Women who’ve had more than 6 fibroids surgically removed are less likely to conceive than women who had fewer fibroids taken out. Nearly half of the women in one study who had more than 6 fibroids removed needed some form of reproductive assistance (Clomid, letrozole, IUI, or IVF) to get pregnant.
Myomectomy also appeared to elevate the risk of preterm birth, and that was true even among women who had fewer than 6 fibroids removed by myomectomy.
The Practice Committee of the American Society of Reproductive Medicine, Removal of Myomas in Asymptomatic Patients to Improve Fertility and/or Reduce Miscarriage Rate: A Guideline, Fertility and Sterility, 2017.