February 18, 2025

Uterine Fibroids and Fertility: What Every Woman Needs to Know in 2025

Uterine fibroids, medically known as leiomyomas, are noncancerous growths of the uterus that often appear during a woman’s childbearing years. While many women with fibroids experience no symptoms, these growths can sometimes lead to complications, including challenges with fertility and pregnancy.

Uterine Fibroids and Fertility

Understanding Uterine Fibroids

Fibroids are composed of smooth muscle cells and connective tissue and can vary in size and location within the uterus. They are classified into several types based on their position:

  • Subserosal Fibroids: Develop on the outer uterine wall.
  • Intramural Fibroids: Grow within the muscular wall of the uterus.
  • Submucosal Fibroids: Protrude into the uterine cavity.
  • Pedunculated Fibroids: Attached to the uterine wall by a stalk-like structure.

The exact cause of fibroid development remains unclear, but factors such as hormonal fluctuations, genetics, and lifestyle may contribute to their growth.

Uterine Fibroids and Fertility

While many women with fibroids can conceive naturally, certain fibroids, depending on their size and location, can impact fertility. For instance, submucosal fibroids that distort the uterine cavity can interfere with embryo implantation, potentially leading to infertility. Fibroids may also block the fallopian tubes, preventing sperm from reaching the egg. It’s estimated that fibroids are the sole cause of infertility in approximately 2–3% of women.

PubMed Central

Impact on Pregnancy

During pregnancy, fibroids can pose various challenges:

  • Miscarriage: Fibroids, especially submucosal types, have been associated with an increased risk of miscarriage.
  • Preterm Birth: The presence of fibroids may lead to premature labor.
  • Placental Abruption: Fibroids can cause the placenta to separate from the uterine wall prematurely.
  • Fetal Growth Restriction: Large fibroids may reduce space in the uterus, restricting fetal development.

However, many women with fibroids have successful pregnancies. The specific risks often depend on the size, number, and location of the fibroids.

Treatment Options

Several treatment options are available for women with fibroids, especially those experiencing symptoms or facing fertility challenges:

  • Medications: Drugs like gonadotropin-releasing hormone (GnRH) agonists can shrink fibroids temporarily but are not suitable for long-term use.
  • Surgical Interventions:
    • Myomectomy: Surgical removal of fibroids, preserving the uterus. This procedure is often recommended for women who wish to maintain fertility.
    • Hysterectomy: Complete removal of the uterus; considered when other treatments are ineffective or not desired.
  • Minimally Invasive Procedures:
    • Uterine Artery Embolization (UAE): Blocks blood flow to fibroids, causing them to shrink.
    • Radiofrequency Ablation: Uses heat to destroy fibroid tissue.
    • Magnetic Resonance Guided Focused Ultrasound (MRgFUS): Non-invasive procedure that uses focused ultrasound waves to destroy fibroids.

Overview of uterine fibroids (leiomyomas)

The choice of treatment depends on factors like the severity of symptoms, size and location of fibroids, and the patient’s desire for future pregnancies.

Recent Advances

As of 2025, new medical treatments have emerged. For instance, in England, the National Institute for Health and Care Excellence (NICE) approved a daily tablet called Linzagolix (Yselty) for women with moderate to severe fibroid symptoms. This medication works by reducing hormone levels that control estrogen and progesterone production, thereby shrinking fibroids and alleviating symptoms.

The Guardian

Conclusion

Uterine fibroids are a common concern among women of reproductive age. While they can impact fertility and pregnancy, many women with fibroids can conceive and have healthy pregnancies. It’s essential to consult with a healthcare provider to understand the specific implications of fibroids and explore appropriate treatment options tailored to individual needs.

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