Degenerated Fibroid During Pregnancy and Fibroids: What to Know

September 13, 2025

Degenerated Fibroid During Pregnancy and Fibroids: What to Know

Uterine fibroids (leiomyomas) are common, benign growths of the muscle of the uterus. Many people do not realize they have fibroids until pregnancy makes them more noticeable. Most pregnancies with fibroids are healthy, but a subset experience a painful complication called “degeneration,” often referred to as red (carneous) degeneration. Understanding what it is, why it happens, and how it is managed can help you make informed decisions and know when to seek care.

What is fibroid degeneration?

Fibroids grow under the influence of hormones such as estrogen and progesterone. During pregnancy, increased blood flow and hormones can cause fibroids to enlarge. Sometimes, a fibroid outgrows its blood supply, leading to tissue breakdown and inflammation. This process is called degeneration. In pregnancy, the classic form is red degeneration, which can cause sudden, localized pain and tenderness over the fibroid.

How common are fibroids and degeneration during pregnancy?

Fibroids are very common overall; by age 50, most people assigned female at birth will have them. Estimates suggest 2–10% of pregnancies are affected by fibroids.
Degeneration is most likely in the second trimester, when fibroids can grow quickly, though it can occur later as well.

Symptoms to watch for

Symptoms of degenerating fibroids can vary, but often include:

Sharp or severe, localized abdominal pain (often over a known fibroid)
Tenderness to touch in a specific area of the uterus
Low-grade fever, nausea, or vomiting
Uterine irritability or contractions

Because symptoms can overlap with other conditions—such as appendicitis, ovarian torsion, urinary tract issues, or placental problems—contact your obstetric clinician promptly if you have severe or persistent pain, fever, vaginal bleeding, decreased fetal movement, painful contractions, or any concern that feels out of the ordinary.

How is it diagnosed?

Your clinician will begin with a history, physical exam, and a review of your pregnancy. Imaging helps confirm the diagnosis and rule out other causes:

Ultrasound is the first-line tool in pregnancy. A degenerating fibroid may look heterogeneous (mixed texture) with areas of cystic change.
MRI without gadolinium contrast can be used if ultrasound is inconclusive or if the location/number of fibroids complicates the picture. MRI is considered safe in pregnancy without contrast; gadolinium contrast is generally avoided unless it would significantly improve care.

Could it affect the pregnancy or baby?

Most people with fibroids—and even those who experience degeneration—go on to deliver healthy babies. However, fibroids can be associated with certain risks, which often depend on their number, size, and location:

Pain and hospitalization due to degeneration
Miscarriage risk may be slightly higher, especially with submucosal fibroids that distort the uterine cavity
Preterm contractions or birth
Fetal malpresentation (e.g., breech) and a higher chance of cesarean delivery
Placental issues (abruption is uncommon but possible)
Postpartum hemorrhage due to reduced uterine contractility

Most pregnancies with fibroids are managed with careful monitoring and individualized delivery planning.

Treatment: What’s safe during pregnancy?

The cornerstone of management for degenerating fibroids in pregnancy is supportive care and pain control while closely monitoring mother and baby.

Rest, hydration, and heat: Bed rest during the acute pain phase, plenty of fluids, and a warm compress or heating pad can help.
Acetaminophen (paracetamol): First-line pain reliever in pregnancy when used as directed. Discuss dosing with your clinician.
NSAIDs: Generally avoided in pregnancy. The U.S. FDA recommends avoiding NSAIDs at 20 weeks’ gestation or later because they can reduce fetal kidney function and amniotic fluid. If an NSAID is considered between 20 and 30 weeks, it should be for the shortest time and lowest dose with clinician supervision and monitoring of amniotic fluid. Before 20 weeks, clinicians may still be cautious and weigh risks and benefits carefully. Do not start NSAIDs without medical guidance.
Short-course opioids: May be used for severe, short-term pain under close obstetric supervision when other measures are insufficient.
Tocolytics: If painful contractions occur and preterm labor is a concern, your clinician may use medications to calm the uterus as appropriate for gestational age.
Hospital observation: Sometimes needed to manage pain, ensure maternal-fetal well-being, and rule out other causes.

Surgery during pregnancy is rarely needed. Myomectomy (surgical removal) is generally avoided due to bleeding risk, but it may be considered for select cases such as a torsed, pedunculated subserosal fibroid causing intractable pain. Uterine artery embolization is not performed during pregnancy.

Delivery planning

Vaginal birth is often possible. Decisions depend on fibroid size and location, fetal position, and obstetric history.
Cesarean birth may be recommended if a large fibroid obstructs the lower uterus or cervix, if there is persistent malpresentation, or for typical obstetric indications.
Myomectomy at cesarean is usually avoided because of hemorrhage risk, though a pedunculated fibroid may be safely removed in some cases.
Postpartum hemorrhage preparedness: Your team will be ready with active third-stage management and uterotonic medications if needed.

After pregnancy: What to expect

Natural shrinkage: Many fibroids shrink in the months after delivery, particularly with breastfeeding.
Reassess symptoms: If heavy bleeding, bulk symptoms, or pain persist postpartum, discuss options. These may include medical therapy (e.g., hormonal options), myomectomy, or uterine-sparing procedures. If you wish to preserve fertility, review the pros and cons with a gynecologist; some procedures (e.g., uterine artery embolization) may affect future pregnancy plans.
Future pregnancies: If you had a prior deep intramural myomectomy, your clinician may recommend a planned cesarean in subsequent pregnancies due to a small risk of uterine rupture.

Practical self-care and when to call

Stay hydrated and use a gentle heat source for comfort.
Use acetaminophen as directed by your clinician; avoid NSAIDs unless your obstetric provider specifically advises and monitors their short-term use.
Keep bowel movements regular (fiber, fluids) to reduce abdominal strain.
Call urgently for severe or worsening pain, fever, vaginal bleeding, painful regular contractions, decreased fetal movement, or if something feels wrong.

Key takeaways

Fibroid degeneration in pregnancy is painful but usually self-limited and managed with supportive care.
Most people with fibroids still have healthy pregnancies and births.
Acetaminophen is the first-line analgesic in pregnancy; avoid NSAIDs at 20 weeks or later per FDA guidance.
Work with your obstetric team to tailor monitoring and delivery planning to your specific fibroid size and location.

This article is for educational purposes and is not a substitute for personalized medical advice. Always consult your obstetric clinician about your symptoms and treatment options.

Trusted sources and further reading

National Institutes of Health (NICHD) – Uterine Fibroids: https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
MedlinePlus (NIH/NLM) – Uterine Fibroids: https://medlineplus.gov/uterinefibroids.html
U.S. Food and Drug Administration (FDA) – NSAIDs in Pregnancy Safety Communication: https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic
ACOG – Guidelines for Diagnostic Imaging During Pregnancy and Lactation: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation
ACOG – Uterine Fibroids (Patient FAQ): https://www.acog.org/womens-health/faqs/uterine-fibroids
NCBI/PMC – Contemporary Management of Fibroids in Pregnancy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876313/
NCBI Bookshelf – StatPearls: Uterine Leiomyoma: https://www.ncbi.nlm.nih.gov/books/NBK546680/