I have uterine fibroids and heavy menstrual periods. Someday I want to have a family. Can I get pregnant and have a normal pregnancy?

Although uterine fibroids can increase the risk of complications during pregnancy, most women with fibroids have healthy pregnancies. How fibroids affect fertility and pregnancy greatly depends on the location of the fibroids.

Three main types of fibroids

Uterine fibroids are very common. It's estimated that 80% of African American women and 70% of white women will have uterine fibroids by age 50.

Of that, approximately 25% of all women with fibroids have symptoms that require treatment. Fibroids can be as small as a pea or larger than a grapefruit, and women can have multiple fibroids of differing sizes.

Uterine fibroids can usually be classified into three categories, based on where they grow.

  • Subserosal fibroids grow on the outside of the uterus.
  • Intramural fibroids grow within the wall of the uterus.
  • Submucosal fibroids grow inside the cavity of the uterus.

How do fibroids affect infertility?

Most fibroids do not cause infertility. According to the American Society for Reproductive Medicine, approximately 5% to 10% of women who are infertile have fibroids.

The types of fibroids that most likely affect fertility are located inside the cavity of the uterus (submucosal) or are ones that are very large and growing inside the wall of the uterus (intramural).

Uterine fibroids can reduce fertility in a number of different ways. They can:

  • Block fallopian tubes
  • Cause changes in the shape of the cervix that may reduce the number of sperm entering the uterus
  • Cause changes in the shape of the uterus and interfere with the movement of the sperm or embryo
  • Impact the size of the lining of the uterine cavity
  • Affect blood flow to the uterine cavity and decrease the ability of an embryo to stick (implant) to the uterine wall or to develop

In general, fibroids that cause changes to the shape of the uterus have more impact on fertility and pregnancy.

If you have fibroids and are having problems conceiving, both you and your partner should be thoroughly evaluated before treating your fibroids. A fertility specialist can help assess if fibroids, or something else, are affecting your ability to become pregnant.

How do fibroids affect pregnancy?

Most uterine fibroids don't grow while you're pregnant. If a fibroid grows, it will usually be in the first 12 weeks of pregnancy. In addition, most fibroids don't cause symptoms during pregnancy. If they do, signs and symptoms usually include pain, pelvic pressure and vaginal bleeding.

Although women who have fibroids are more likely to experience complications during pregnancy, this doesn't mean you will have problems. The most common complications seen in pregnant women with fibroids are:

  • Cesarean delivery (C-section). The risk of needing a C-section is greater for women with fibroids.
  • Breech baby. Fibroids may cause the baby's position in the womb to be breech — when the baby's bottom or feet are pointed toward the birth canal instead of the head.
  • Labor fails to progress. Fibroids may cause the labor process to slow down and delay delivery.
  • Placental abruption. Some fibroids may cause the placenta to break away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
  • Preterm delivery. Some women with fibroids may give birth too early.

Although women with fibroids do have miscarriages, recent research is showing that uterine fibroids alone rarely cause miscarriage.

Talk to your obstetrician if you have fibroids and become pregnant. Many obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant don't need to see a specialist who deals with high-risk pregnancies.

With

Kristina Butler, M.D., M.S.

May 27, 2021 See more Expert Answers