Pregnant with Fibroids: What to Know

Learning you are pregnant when you also have uterine fibroids can raise many questions. The good news: most people with fibroids have healthy pregnancies and deliveries. Still, fibroids can influence symptoms, monitoring plans, and—in some cases—delivery choices. Here is what evidence-based sources say, and how to navigate pregnancy confidently and safely.

What Are Fibroids, and How Common Are They?

Uterine fibroids (leiomyomas) are noncancerous growths of the uterine muscle. They can vary in size, number, and location—within the uterine wall (intramural), bulging into the cavity (submucosal), or on the outer surface (subserosal). Fibroids are very common: by age 50, up to 70–80% of women will have them, and they are more prevalent and often more severe in Black women. Sources: NICHD/NIH, MedlinePlus/NIH.

Can You Get Pregnant with Fibroids?

Yes. Many people conceive and carry pregnancies without complication. Fertility can be affected when fibroids significantly distort the uterine cavity—especially submucosal fibroids—or when very large intramural fibroids alter uterine shape. In some cases, removing such fibroids before pregnancy (myomectomy) may improve fertility; this is individualized. Source: NICHD/NIH, ACOG.

How Fibroids Can Affect Pregnancy

Most people with fibroids have routine pregnancies. When problems occur, they often relate to fibroid size, number, and location:

• Pain and degeneration: Fibroids can outgrow their blood supply, especially in the second trimester, causing “red degeneration”—sharp localized pain, feverish feeling, and tenderness. This is uncomfortable but usually not dangerous to the pregnancy.
• Bleeding: First-trimester spotting can occur with or without fibroids. Submucosal fibroids are more associated with miscarriage risk than other types, but most pregnancies continue normally.
• Growth patterns: Fibroids may enlarge early in pregnancy and often shrink after delivery.
• Position and growth of the baby: Large or lower-uterine-segment fibroids can increase the chance of breech or transverse position and may raise the likelihood of cesarean birth.
• Preterm contractions or birth: Risk is slightly increased with multiple or large fibroids.
• Placental issues and bleeding after birth: Fibroids may increase the risk of placental abruption and postpartum hemorrhage in some cases because the uterus may not contract as efficiently. Source: ACOG.

Symptoms to Expect During Pregnancy

Many people are symptom-free. When symptoms occur, they can include:

• Pelvic pressure or a feeling of heaviness
• Localized sharp pain (especially with degeneration)
• Constipation, urinary frequency, or back pain from pressure effects

Severe or persistent pain should always prompt a call to your obstetric clinician to rule out other causes and ensure you and your baby are well.

Safe Tests and Monitoring

• Ultrasound: The first-line, safe way to monitor fibroids and your baby throughout pregnancy.
• MRI: If needed for complex cases, MRI without gadolinium contrast is generally considered safe in pregnancy; gadolinium is avoided unless essential. Source: ACOG.

Treatment Options During Pregnancy

Management focuses on symptom control and preventing complications while keeping your baby safe:

• Rest, hydration, gentle heat, and support belts: Often help with discomfort and pressure symptoms.
• Pain relief: Acetaminophen is generally the first-line pain reliever in pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually avoided, especially after 20 weeks because they can reduce amniotic fluid and affect fetal kidneys, per the U.S. Food and Drug Administration. If an NSAID is considered for short-term use earlier in pregnancy (for severe degeneration pain), it should be under close clinician guidance. Source: FDA.
• Iron and anemia management: If fibroid-related bleeding before pregnancy caused anemia, your clinician may monitor iron status and recommend supplementation during pregnancy. Source: NIH ODS.
• Surgery during pregnancy: Myomectomy is rarely performed during pregnancy due to bleeding and preterm labor risks; it is reserved for select situations by experienced surgeons. Uterine artery embolization is not performed during pregnancy. Source: ACOG.

Birth Planning

Most people with fibroids can plan for a vaginal birth. Reasons your clinician might recommend a cesarean include a very large fibroid in the lower uterus that could obstruct the birth canal, persistent breech or transverse position related to fibroid location, or heavy bleeding concerns. In some cases, a fibroid may be removed at the time of cesarean by experienced teams, but this is individualized because blood loss risk can be higher. Source: ACOG.

After Delivery

• Fibroid size often decreases postpartum, particularly after the hormonal shifts of childbirth and breastfeeding.
• Future family planning: If fibroids caused infertility, miscarriages, severe pain, or heavy bleeding before pregnancy, discuss postpartum options. Treatments include medication, myomectomy, and uterine artery embolization (generally for those not planning future pregnancies). Source: ACOG.

Preconception Tips if You Have Fibroids

• Schedule a pre-pregnancy visit to review fibroid size and location.
• Address heavy bleeding and correct anemia before conceiving.
• Discuss whether cavity-distorting fibroids (especially submucosal) should be removed beforehand to optimize fertility and pregnancy outcomes. Sources: NICHD/NIH, ACOG.

When to Call Your Clinician Right Away

• Severe or worsening abdominal pain, especially with fever
• Vaginal bleeding or leakage of fluid
• Regular contractions before 37 weeks
• Decreased fetal movements after you have established a movement pattern

Key Takeaways

• Most pregnancies with fibroids proceed normally.
• Fibroid effects depend on size, number, and location; submucosal fibroids are more likely to affect fertility and miscarriage risk.
• Ultrasound is safe and guides monitoring. MRI without contrast may be used if needed.
• Pain can often be managed conservatively; avoid NSAIDs after 20 weeks per FDA guidance unless advised otherwise by your clinician.
• Birth plans are individualized; vaginal birth is often possible, but cesarean may be recommended if fibroids obstruct the birth canal or alter fetal position.

Trusted Sources

• NIH MedlinePlus: Uterine Fibroids
• NICHD/NIH: Uterine Fibroids Overview
• ACOG: Uterine Fibroids (FAQ) and Imaging in Pregnancy
• FDA Drug Safety: Avoid NSAIDs at 20 weeks or later in pregnancy

This article is for educational purposes and should not replace individual medical advice. Always consult your obstetric care team for recommendations tailored to you and your pregnancy.