Adenomyosis Getting Pregnant and Fibroids: What to Know

September 13, 2025

Adenomyosis, Getting Pregnant, and Fibroids: What to Know

Trying to conceive while managing adenomyosis or uterine fibroids can raise a lot of questions. Both conditions are common, can overlap, and may affect fertility and pregnancy in different ways. This guide explains the differences, how each may impact your chances of getting pregnant, the diagnostic steps, and evidence-based treatment options to discuss with your clinician.

Quick takeaways

Adenomyosis and fibroids are different conditions that can both cause heavy periods and pelvic pain—but they affect the uterus in distinct ways.
Both can be associated with subfertility and increased risk of certain pregnancy complications, though many people with either condition conceive and deliver healthy babies.
Evaluation usually includes pelvic ultrasound and sometimes MRI; treatment depends on symptoms, fertility goals, and the size/location of disease.
Medication options can control symptoms before pregnancy, but most are not used during pregnancy and some require contraception while taking them.

Adenomyosis vs. fibroids: what’s the difference?

Adenomyosis occurs when endometrial tissue (the lining of the uterus) grows into the uterine muscle (myometrium). It can enlarge the uterus and cause heavy, painful periods and chronic pelvic pain.^1,2

Uterine fibroids (leiomyomas) are benign muscle tumors that grow in or on the uterus. They vary in size and location (submucosal, intramural, subserosal) and are very common during reproductive years.^3,4

While symptoms overlap, the structural differences matter. Fibroids that distort the uterine cavity can interfere with embryo implantation. Adenomyosis can alter the muscle and lining interface, potentially affecting implantation and uterine contractility.

How do they affect fertility and pregnancy?

Fertility

Adenomyosis: Studies suggest an association with reduced fertility, higher miscarriage rates, and lower IVF success in some patients, likely due to changes in uterine function and inflammation.^1,2
Fibroids: Submucosal and some intramural fibroids that distort the cavity are associated with decreased fertility and increased miscarriage risk; removing these can improve outcomes in select cases. Many fibroids, especially small subserosal ones, have minimal fertility impact.^3,4

Pregnancy

Adenomyosis: Linked in some reports to higher risks of miscarriage, preterm birth, preeclampsia, and small-for-gestational-age infants, though risk varies by severity and coexisting conditions.^1,2
Fibroids: Associated with miscarriage, preterm birth, malpresentation, cesarean delivery, and postpartum hemorrhage; most people still have uncomplicated pregnancies.^3,4

Your individual risk depends on fibroid number, size, location, degree of adenomyosis, age, and other health factors. A gynecologist or reproductive endocrinologist can help tailor a plan.

Getting evaluated when trying to conceive

History and exam: Focus on menstrual bleeding, pain, prior pregnancy outcomes, anemia, and pelvic exam findings.
Imaging: Transvaginal ultrasound is first-line for both conditions. MRI may clarify diagnosis and mapping, especially for adenomyosis or complex fibroids.^1,3
Uterine cavity assessment: Saline-infusion sonography or hysteroscopy can detect cavity-distorting fibroids or polyps that may affect implantation.³
Labs: Blood counts to check iron-deficiency anemia from heavy bleeding; other fertility labs as indicated. (Tumor markers like CA-125 are not diagnostic.)

Treatment options before trying to conceive

Management aims to reduce symptoms, optimize the uterine environment, and align with your timeline for pregnancy.

Non-surgical symptom control

Levonorgestrel intrauterine system (LNG-IUD), combined hormonal pills, or progestins: Can reduce heavy bleeding and pain in adenomyosis and fibroids, but are typically paused when trying to conceive.^1,3,4
Tranexamic acid: An antifibrinolytic taken during menses to reduce bleeding; not a contraceptive and not used during pregnancy.⁵
GnRH analogs and GnRH antagonists with add-back therapy: Temporarily suppress estrogen to reduce bleeding and shrink fibroids; used as short-term preconception optimization in select cases. FDA-approved combinations such as elagolix with add-back (ORIAHNN) and relugolix with add-back (MYFEMBREE) are indicated for heavy menstrual bleeding due to fibroids in premenopausal women. These are not for use during pregnancy; reliable contraception is needed while taking them.^6,7

Procedures that preserve the uterus

Myomectomy: Surgical removal of fibroids (hysteroscopic for submucosal, laparoscopic or open for intramural/subserosal). It can improve fertility when the cavity is distorted. After surgery, clinicians typically advise a healing interval before attempting conception.^3,4
Adenomyomectomy (select cases): Targeted excision of adenomyosis in focal disease; technically complex and not appropriate for everyone. Discuss risks (including uterine rupture in future pregnancy) and benefits with a specialist.^1,2
Uterine artery embolization (UAE): Effective for fibroid symptoms; data on subsequent fertility are mixed, and some guidelines caution against UAE if pregnancy is a priority.³
MR-guided focused ultrasound (HIFU): Noninvasive option for selected fibroids; long-term fertility data are evolving.³

Fertility treatments

Ovulation induction and intrauterine insemination (IUI): May be options if tubal and uterine factors are favorable.
In vitro fertilization (IVF): Adenomyosis and certain fibroids can reduce implantation; treating cavity-distorting fibroids before IVF may improve success in select patients. Individualize decisions with a reproductive endocrinologist.

During pregnancy: what to expect

Monitoring: Your obstetric team may recommend additional ultrasounds to assess fetal growth and placental position, especially with large fibroids or significant adenomyosis.
Pain management: Fibroids can outgrow blood supply and cause acute pain (“red degeneration”), usually managed conservatively. Always consult your clinician before taking medications during pregnancy.
Labor and delivery planning: Large or lower-segment fibroids may increase the likelihood of cesarean delivery or malpresentation. Your team will plan mode of delivery based on obstetric indications.

Practical steps to optimize your chances

Address heavy bleeding and correct iron deficiency before trying to conceive.
Clarify whether fibroids distort the uterine cavity; consider hysteroscopic or surgical options if they do.
Discuss the role and timing of medical therapies to control symptoms, knowing most are paused before conception.
If you’ve had uterine surgery, ask about recommended wait time and delivery planning in a future pregnancy.
Consider early consultation with a reproductive endocrinologist if you’re over 35 or have been trying for 6–12 months without success.

Questions to ask your specialist

Do my imaging results suggest adenomyosis, fibroids, or both? How severe is it?
Are any fibroids distorting the uterine cavity?
What are my options to reduce bleeding and pain while preserving fertility?
Would surgery improve my fertility or pregnancy outcomes in my case?
How might this affect my plan for IVF or other fertility treatments?
What is the safest timeline to try to conceive after treatment?

The bottom line

Adenomyosis and fibroids are common, often manageable, and compatible with healthy pregnancies. The right plan depends on your symptoms, imaging, and goals. A personalized, stepwise approach—optimize health, map the uterus, address cavity-distorting lesions, and time conception after appropriate therapy—offers the best chance of success.

This article is for general information and does not replace individualized medical advice. Partner with your clinician to choose the safest, most effective path to pregnancy for you.

References

U.S. Office on Women’s Health. Adenomyosis. https://www.womenshealth.gov/a-z-topics/adenomyosis
NCBI Bookshelf (StatPearls). Adenomyosis. https://www.ncbi.nlm.nih.gov/books/NBK532254/
NICHD (NIH). Uterine Fibroids—Condition Information. https://www.nichd.nih.gov/health/topics/uterine/conditioninfo
ACOG. Uterine Fibroids (FAQ). https://www.acog.org/womens-health/faqs/uterine-fibroids
MedlinePlus. Tranexamic Acid. https://medlineplus.gov/druginfo/meds/a608021.html
FDA. ORIAHNN (elagolix, estradiol, and norethindrone acetate). https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/oriahnn-elagolix-estradiol-and-norethindrone-acetate-capsules-separate-elagolix-capsules
FDA. MYFEMBREE (relugolix, estradiol, and norethindrone acetate). https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/myfembree-relugolix-estradiol-and-norethindrone-acetate-tablets
NCBI Bookshelf (StatPearls). Uterine Leiomyoma. https://www.ncbi.nlm.nih.gov/books/NBK546680/