Uterine Fibroids and Pregnancy: Here's What Doctors Want You to Know

Should you have surgery and, if so, when?

Whether you are already pregnant, trying to get pregnant, or even just thinking about a future pregnancy, the news that you have one or more uterine fibroids can be worrying. You may be wondering what, if anything, you should do to treat uterine fibroids during or before pregnancy, whether those treatments are even safe, and how treating fibroids affects the possibility of getting pregnant later on.

"Most of the time, uterine fibroids don't affect pregnancy, per se," says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. "But they can pose challenges—it all depends on their location."

To help you better understand your overall fertility outlook after a fibroids diagnosis, we asked experts to answer the most common questions prospective and expectant mothers have about the relationship between uterine fibroids and pregnancy; here's what they had to say.

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Can I get pregnant if I have uterine fibroids?

Yes. According to the American Society for Reproductive Medicine, only 5-10% of infertile women have fibroids. In other words, it's not a primary cause of infertility, and having fibroids doesn't necessarily mean you'll have trouble getting pregnant.

But it is important to note that fibroids can interfere with both conception and implantation, per a 2016 study in Current Obstetrics and Gynecology Reports, which outlines a variety of ways uterine fibroids can prevent a pregnancy from happening. This includes anatomical abnormalities that block the passage of sperm, changes to normal uterine contractions, anti-inflammatory responses, and changes to the uterine lining.

The good news, though, is that the link between fibroids and miscarriage is no longer as widely accepted as it used to be. A 2017 study in the American Journal of Epidemiology found no evidence of an increase in miscarriage associated with fibroids. Researchers flagged the evidence behind the prior fibroid-miscarriage connection as "potentially biased," finding that once other factors were considered (such as the age and race of participants and their ultrasound-confirmed fibroid status), the miscarriage rate was the same between women who had fibroids and those who didn't, reports the National Institutes of Health.

Should I treat uterine fibroids before I get pregnant?

Ideally, yes. If you are diagnosed with fibroids outside of pregnancy and your doctor determines that the size or location of your fibroids could interfere with your chances of conceiving or carrying a baby to full term, it would be best to treat them via surgery before you become pregnant, says Dr. Lisa Hansard, board-certified reproductive endocrinologist at Texas Fertility Center. However, you should work closely with your doctor on the timing of that treatment.

"You should try to plan the surgery in a timeline that's close to when you want to conceive," Dr. Hansard explains. "We can't change what it is about a woman that makes her prone to making fibroids, and they have a 33% recurrence rate, so as soon as the uterus heals, you should try to become pregnant."

Otherwise, Dr. Hansard adds, you could have more fibroids or fibroid regrowth after waiting too long post-surgery to try and conceive.

But again, working with your doctor is important here; while Dr. Ruiz echoes the same recommendation about not waiting too long, he also adds that fibroid surgery can affect how a baby is delivered if the uterus hasn't fully healed: "If woman has had fibroid surgery and gets pregnant afterwards, we recommend she wait three to six months to get pregnant—but depending on how big the fibroid was and how deeply we had to cut into the uterus, she may need a C-section to deliver."

Dr. Ruiz says the risks of vaginal birth after fibroid surgery are similar to the risks of vaginal birth after prior C-section, or VBAC; while it's sometimes possible and doesn't always cause complications, some doctors prefer not to place added pressure on a uterus that has been previously operated on.

How do uterine fibroids affect pregnancy?

In many cases, says Dr. Ruiz, fibroids won't affect a pregnancy at all, but sometimes the size of fibroids can interfere with your prenatal care.

"If they're really big, it can be hard to measure the size of the baby and assess fetal growth, so we may have to do regular ultrasounds to make sure the baby is growing normally," he explains.

Additionally, the Society for Maternal-Fetal Medicine reports that fibroids can increase your risk for placental problems, including placental abruption and placenta previa. The other issue of concern during pregnancy is growth of existing fibroids; the increases in hormone production during pregnancy can lead to changes in the size of fibroids, per UT Southwestern Medical Center, whether that's an increase or a decrease in size.

An increase is more common, says Dr. Lisa Hansard, board-certified reproductive endocrinologist at Texas Fertility Center, and if that happens, it can raise problems during your baby's delivery.

"If a uterine fibroid grows, it will be extremely vascular," she explains, "so if you need a C-section at delivery, it's become dramatically more risky because of [the increased likelihood of] blood loss."

Can I treat uterine fibroids during pregnancy?

Unfortunately, UT Southwestern Medical Center says there's not much you can do during pregnancy to treat fibroids; most surgical procedures on the uterus won't be performed to protect the baby except in rare cases.

Your doctor will probably recommend you manage any pain symptoms during pregnancy conservatively, per a 2010 study in Reviews in Obstetrics & Gynecology, which may include increasing the amount of rest you get and taking pregnancy-safe pain relievers.

How do uterine fibroids affect delivery?

Many pregnant women have fibroids and no complications during pregnancy, and while the same is true for labor and delivery, Dr. Ruiz warns that there are still risks, including preterm labor and postpartum hemorrhaging.

"If the fibroids are big, you could be predisposed to preterm labor because the fibroids make the uterus itself bigger," he explains. "There's an increased risk for abnormal bleeding during delivery for the same reason, plus the uterus may not contract as readily as a non-fibroid uterus after delivery."

Dr. Ruiz also adds that the location of fibroids can change the outcome of your baby's birth, because fibroids in the lower segment of the uterus can cause the baby to present in a breech position, increasing your chances of needing a C-section. While some breech babies can be delivered vaginally, the American College of Obstetrics and Gynecology says most breech babies are born via scheduled C-section to reduce complications.

What should I do about my fibroids after pregnancy?

That depends on what happens to them after pregnancy, since the hormonal changes associated with childbirth and breastfeeding may help to shrink fibroids, per a 2019 study in Scientific Reports. Among a group of 157 postpartum women, a significant size reduction in fibroids was observed in all of them compared to pre-pregnancy ultrasounds, and in some cases, fibroids seemed to have disappeared completely; breastfeeding was also associated with shrinking or stopped growth in participants.

But if your fibroids are still an issue after delivery, UT Southwestern Medical Center suggests that the typical fibroid treatments used for non-pregnant women remain largely safe. They do, however, recommend waiting at least six months postpartum to undergo any surgical procedures so that the uterus has time to heal and shrink back down to its normal size.

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