Wellness Mama Fertility and Fibroids: What to Know

If you’re focused on holistic well-being while planning a family, understanding uterine fibroids—and how they can intersect with fertility—is essential. Fibroids are common, benign growths of the uterus that can affect bleeding, pelvic comfort, and sometimes the ability to conceive or carry a pregnancy. Below, we break down what matters most, with guidance drawn from leading medical sources including the NIH, ACOG, and the FDA.

What are fibroids?

Uterine fibroids (also called leiomyomas) are noncancerous tumors arising from the uterine muscle. By age 50, most women will have fibroids; they’re especially common among women of African ancestry. Many cause no symptoms and are found incidentally during routine exams or pregnancy ultrasounds.

Common symptoms

• Heavy or prolonged menstrual bleeding (which can lead to iron-deficiency anemia)
• Pelvic pressure or pain, bloating
• Frequent urination or constipation (from pressure on bladder or bowel)
• Pain during intercourse
• Reproductive challenges in some cases (infertility, miscarriage)

Can fibroids affect fertility?

The impact depends on number, size, and location:

• Submucosal fibroids (bulging into the uterine cavity) are most clearly linked with reduced fertility and increased miscarriage risk. Removing them often improves pregnancy rates.
• Intramural fibroids (within the uterine wall) may impair fertility if large or if they distort the uterine cavity; evidence is mixed for smaller lesions that don’t affect the cavity.
• Subserosal fibroids (on the outer surface of the uterus) generally have minimal effect on fertility.

Some women with fibroids conceive and carry healthy pregnancies, but certain fibroids can increase the risks of miscarriage, preterm birth, malpresentation (breech), cesarean birth, and postpartum hemorrhage. A fertility-focused evaluation can clarify your individual risk.

How fibroids are diagnosed

• Pelvic exam may detect an enlarged or irregular uterus.
• Transvaginal ultrasound is the first-line imaging test.
• Saline infusion sonohysterography evaluates whether fibroids distort the uterine cavity.
• MRI can map number, size, and location for surgical planning.

Treatment options when you want to conceive

Your plan should factor in symptoms, fibroid characteristics, age, ovarian reserve, and how soon you want to try for pregnancy. Shared decision-making with a gynecologist—and often a reproductive endocrinologist—is key.

Watchful waiting

If symptoms are mild and fibroids don’t distort the cavity, observation may be reasonable, particularly if you’re already trying to conceive.

Medications

• Nonhormonal options for bleeding: Tranexamic acid (Lysteda) is FDA-approved for heavy menstrual bleeding. It can reduce flow on period days but does not shrink fibroids. It isn’t a contraceptive, but you should discuss clotting risk and use it only as prescribed.
• Hormonal approaches: Combination pills, progestins, and levonorgestrel IUDs can reduce bleeding. However, they generally inhibit ovulation or alter the uterine lining—so they’re not compatible with actively trying to conceive.
• GnRH antagonists with add-back therapy: FDA-approved combinations such as elagolix/estradiol/norethindrone acetate (Oriahnn) and relugolix/estradiol/norethindrone acetate (Myfembree) can reduce heavy bleeding due to fibroids and sometimes shrink them modestly. These are typically time-limited (up to 24 months due to bone density concerns) and are not used when trying to conceive; pregnancy should be avoided during treatment.
• Preoperative therapy: Short courses of GnRH agonists or antagonists may correct anemia and reduce fibroid size before surgery.

Note: Selective progesterone receptor modulators (like ulipristal for fibroids) are not FDA-approved in the U.S. due to safety concerns.

Surgical and procedural options

• Myomectomy (removing fibroids while preserving the uterus) is the most established option when fertility is a priority.
  • Hysteroscopic myomectomy removes submucosal fibroids via the cervix and often improves pregnancy rates.
  • Laparoscopic/robotic or open myomectomy treats intramural or subserosal fibroids. There’s a small risk of scar tissue and a future recommendation for cesarean delivery depending on incision depth. Many clinicians advise waiting 3–6 months after myomectomy before trying to conceive.
• Uterine artery embolization (UAE) can relieve symptoms by cutting off blood supply to fibroids. Pregnancies can occur after UAE, but there may be higher risks of miscarriage and pregnancy complications; it’s generally not the first choice if future fertility is a goal.
• Radiofrequency ablation (laparoscopic or transcervical) and MRI-guided focused ultrasound are uterus-sparing options with growing but still limited pregnancy data. Discuss risks and benefits carefully if fertility is desired.
• Endometrial ablation is not appropriate for anyone planning future pregnancy.
• Hysterectomy is definitive for symptoms but ends fertility.

Lifestyle, nutrition, and wellness

While no diet or supplement can reliably eliminate fibroids, supportive steps can help overall reproductive health:

• Optimize iron stores if you have heavy bleeding. Ask for a ferritin test and consider iron-rich foods or supplements as advised.
• Maintain a healthy weight; higher BMI is associated with increased fibroid risk.
• Dietary patterns: Observational studies suggest that limiting red/processed meat and emphasizing fruits, vegetables, and whole foods may be associated with lower fibroid risk. Evidence is not definitive but aligns with general wellness.
• Vitamin D: Low levels are associated with fibroids in some studies; discuss testing and safe supplementation with your clinician.
• Supplements: Early research (e.g., green tea extract/EGCG) suggests potential symptom benefits, but data are limited and safety in preconception/pregnancy isn’t established—consult your clinician.

Pregnancy with fibroids: what to expect

Many pregnancies proceed normally, but your obstetric team may monitor more closely for growth restriction, malpresentation, preterm labor, and postpartum hemorrhage. If you’ve had a myomectomy that entered the uterine cavity or involved deep muscular incisions, your doctor may recommend a scheduled cesarean delivery.

When to seek care

• Heavy bleeding that soaks pads/tampons hourly, passes large clots, or causes fatigue, dizziness, or anemia
• Pelvic pain or pressure impacting daily life
• Difficulty conceiving (12 months under age 35, six months at 35 or older, or sooner if periods are very heavy or painful)
• Recurrent miscarriage

Smart questions to ask your clinician

• Do my fibroids distort the uterine cavity?
• Would removing specific fibroids improve my chances of pregnancy or reduce miscarriage risk?
• What’s the best procedure for my goals (hysteroscopic vs laparoscopic vs open myomectomy)?
• How long should I wait after treatment before trying to conceive?
• Are there medical options to manage anemia or shrink fibroids before surgery?

Key takeaways

• Fibroids are common and often harmless, but certain types can affect fertility and pregnancy outcomes.
• Submucosal fibroids are most likely to impair fertility; removing them often helps.
• Medications can control bleeding, but many suppress ovulation and aren’t used while trying to conceive.
• Myomectomy is the most established fertility-sparing procedure; UAE and newer technologies require careful consideration if future pregnancy is desired.

Trusted resources and references

• NIH MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
• NICHD (NIH): Fibroids Overview – https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
• ACOG: Uterine Fibroids FAQ – https://www.acog.org/womens-health/faqs/uterine-fibroids
• ASRM Guideline: Myomas and Fertility – ASRM guideline
• FDA Label: Oriahnn (elagolix/estradiol/norethindrone) – FDA label
• FDA Label: Myfembree (relugolix/estradiol/norethindrone) – FDA label
• FDA Label: Lysteda (tranexamic acid) – FDA label

This article is for informational purposes and does not replace personalized medical advice. Speak with your healthcare professional for guidance tailored to your health and fertility goals.