Genetic Predisposition and Fibroids: What to Know

Uterine fibroids—also called leiomyomas—are common, noncancerous growths in the muscle wall of the uterus. By age 50, most women will have fibroids, though many never have symptoms. While hormones and life stage influence fibroid growth, genetics also play an important role. If a parent or sibling has fibroids, you may wonder what that means for your own risk, symptoms, and treatment options. Here’s what to know, grounded in evidence from trusted sources such as the NIH, FDA, and ACOG.

What Are Uterine Fibroids?

Fibroids are benign tumors that can vary in size—from seed-like spots to masses the size of a grapefruit or larger—and in location (within the uterine wall, projecting into the uterine cavity, or bulging outward). Symptoms depend on size and location and may include heavy menstrual bleeding, pelvic pressure or pain, frequent urination, constipation, back pain, painful intercourse, and fertility or pregnancy complications. Many fibroids cause no symptoms and are found incidentally during a pelvic exam or ultrasound.

How Genetics Influence Fibroids

Family History and Heritability

Family history is a well-established risk factor. If a first-degree relative (mother or sister) has fibroids, your chance of developing them is higher than average. Studies suggest fibroid development has a heritable component, meaning genes can predispose someone to develop fibroids, although the exact risk varies from person to person.

Specific Genetic Changes in Fibroids

Many fibroids carry characteristic gene changes. For example, alterations in the MED12 gene and rearrangements involving HMGA2 are frequently identified in fibroid tissue. These are changes within the fibroids themselves and do not necessarily mean you will pass fibroids to your children. In rare cases, an inherited syndrome called hereditary leiomyomatosis and renal cell cancer (HLRCC) caused by changes in the FH gene can lead to multiple, early-onset fibroids and an increased risk of a type of kidney cancer. If many relatives develop severe fibroids at an early age or there is a family history of kidney cancer, discuss genetic counseling with your clinician.

Ancestry and Risk

Fibroids affect people of all backgrounds, but prevalence, severity, and age of onset are higher among Black women in the United States. The reasons are multifactorial and may include inherited susceptibility, environmental exposures, structural inequities, and differences in access to care. Regardless of background, awareness of symptoms and early evaluation are key.

Genes vs. Environment: What Else Shapes Risk?

While genes set a baseline risk, hormones and life factors influence whether fibroids form or grow:

• Hormones: Estrogen and progesterone stimulate fibroid growth. Fibroids often develop during reproductive years and tend to shrink after menopause.
• Age and Reproductive History: Risk increases in the 30s and 40s, and decreases after menopause. Pregnancy and childbirth can influence risk and symptom patterns.
• Body Weight and Metabolic Health: Higher body mass index is associated with increased risk.
• Vitamin D: Low vitamin D status has been associated with higher fibroid risk in some studies, though causation isn’t proven.
• Lifestyle and Environment: Diet, stress, and exposures may play a role, but definitive evidence on specific modifiable risks is limited.

Bottom line: You can’t change your genes, but managing overall health—healthy weight, balanced diet, and regular medical care—supports well-being and may help with symptom control.

When to Get Evaluated

Consider seeing a healthcare professional if you have:

• Heavy menstrual bleeding (soaking through pads/tampons every 1–2 hours, passing large clots, or anemia)
• Pelvic pressure or pain, bloating, or back pain
• Frequent urination or constipation not explained by other causes
• Painful intercourse
• Trouble getting or staying pregnant, or recurrent pregnancy loss

There’s no routine screening program for fibroids, but if you have a strong family history—especially of early, severe fibroids—mention it to your clinician. Early evaluation can help you plan care around symptoms, fertility goals, and life schedule.

How Fibroids Are Diagnosed

Diagnosis typically starts with a pelvic exam and imaging. Ultrasound is the first-line tool to identify and measure fibroids. In select cases, pelvic MRI provides detailed mapping to guide treatment planning. Your clinician may also assess for anemia and discuss how symptoms affect quality of life.

Treatment Options: Does Genetics Change the Plan?

Treatment is individualized based on symptoms, fibroid size and location, age, and reproductive goals. For most people, genetic predisposition informs risk rather than dictating a specific treatment. However, a family history of very early, severe fibroids—or features suggesting HLRCC—may prompt referral for genetic counseling and can influence surveillance and decision-making.

Common options include:

• Watchful Waiting: If symptoms are mild and anemia is absent, monitoring may be appropriate.
• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
  • Hormonal options (combined estrogen-progestin pills, progestin-only pills, or the levonorgestrel intrauterine system) can reduce bleeding for some, though cavity-distorting fibroids may limit IUD use.
  • Tranexamic acid to reduce heavy bleeding during menses.
  • Gonadotropin-releasing hormone (GnRH) antagonists with add-back therapy: FDA-approved oral combinations such as elagolix/estradiol/norethindrone (Oriahnn) and relugolix/estradiol/norethindrone (Myfembree) can reduce heavy menstrual bleeding associated with fibroids in premenopausal women. These are typically used for defined durations and require monitoring.
  • GnRH agonists (short-term) to shrink fibroids preoperatively or bridge to menopause.
• Procedures:
  • Uterine artery embolization (UAE) to block blood flow and shrink fibroids.
  • Myomectomy to surgically remove fibroids while preserving the uterus; can be hysteroscopic, laparoscopic/robotic, or open, depending on size and number.
  • Hysterectomy (removal of the uterus) for definitive treatment, generally for those who have completed childbearing or when other options are unsuitable.
  • Focused ultrasound (MR-guided focused ultrasound) is available in select centers.

Your care team will help weigh benefits, risks, and how each option aligns with your symptoms and fertility plans. If a hereditary syndrome is suspected, specialized counseling and coordination of care are important.

Planning Ahead if You Have a Family History

• Track symptoms: Note cycle length, bleeding volume, clots, and pain. Bring a log to appointments.
• Screen for anemia: If heavy bleeding occurs, ask about checking iron levels and hemoglobin.
• Discuss timing: If you’re considering pregnancy and have symptoms or known fibroids, discuss a preconception plan.
• Ask about imaging: If symptoms escalate, ultrasound or MRI can guide next steps.
• Consider nutrition and bone health: If using medications that affect hormones, ask about calcium, vitamin D, and bone density considerations.

Key Takeaways

• Genetics influences fibroid risk—family history increases your chances, and rare inherited syndromes exist—but most fibroids arise from a mix of genetic and hormonal factors.
• Symptoms, not just size, drive treatment. Many options—from medications to minimally invasive procedures—can be tailored to your goals.
• If multiple relatives had severe, early-onset fibroids or there’s a history of kidney cancer, ask about genetic counseling.
• Partner with a clinician you trust; early evaluation can expand your choices and protect fertility and quality of life.

Trusted Sources

• NIH MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
• NIH NICHD: Uterine Fibroids – https://www.nichd.nih.gov/health/topics/uterine-fibroids
• ACOG Patient FAQ: Uterine Fibroids – https://www.acog.org/womens-health/faqs/uterine-fibroids
• FDA: Approval for Oriahnn (elagolix/estradiol/norethindrone) for heavy menstrual bleeding due to fibroids – FDA press announcement
• FDA: Approval for Myfembree (relugolix/estradiol/norethindrone) for heavy menstrual bleeding associated with uterine fibroids – FDA.gov
• NIH GARD: Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC) – https://rarediseases.info.nih.gov/diseases/6717/hereditary-leiomyomatosis-and-renal-cell-cancer

This article is for general education and does not replace personalized medical advice. If you have symptoms or questions about your risk, consult a qualified healthcare professional.