Uterine Fibroids: Understanding Their Impact on Women’s Health and Pregnancy

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the muscular wall of the uterus. These common benign tumors represent a significant health concern for women globally, affecting a substantial portion of the female population during their reproductive years. Crucially, there is a disproportionately higher prevalence and often more severe clinical manifestations observed among women of African descent, a disparity that demands urgent attention and tailored healthcare strategies. The presence of fibroids can profoundly impact a woman’s quality of life, leading to a wide spectrum of symptoms ranging from debilitating pain and heavy menstrual bleeding that can cause severe anemia, to significant reproductive challenges, including infertility, recurrent pregnancy loss, and a heightened risk of adverse pregnancy outcomes. This paper aims to provide a highly comprehensive and in-depth overview of uterine fibroids, including the less common but clinically significant cervical fibroids, and meticulously examine their intricate relationship with pregnancy. We will delve into their diverse characteristics, the latest diagnostic approaches, the unique and often complex challenges they pose during gestation, and the evolving strategies for their management. All discussions will maintain a human-centered perspective, acknowledging the diverse experiences of women across different cultural and socio-economic landscapes, with a particular emphasis on the African context where the burden of fibroid disease is particularly pronounced. This holistic approach seeks to illuminate pathways for improved diagnosis, treatment, and support, ultimately fostering better health outcomes for women worldwide.

The Silent Epidemic: Understanding Uterine Fibroids (Leiomyomas)

Uterine fibroids stand as the most common benign tumors of the female reproductive tract, impacting millions of women globally. While their precise etiology remains a subject of ongoing scientific inquiry, current research strongly points to a complex interplay of genetic predisposition, the influence of sex hormones (primarily estrogen and progesterone), and various growth factors that collectively stimulate their development and proliferation within the uterine musculature (Stewart et al., 2017). The role of genetics is particularly compelling, with studies identifying specific genetic mutations, such as those in the MED12 gene, present in a significant percentage of fibroid lesions, suggesting a strong hereditary component (Charifson et al., 2024). Hormonal fluctuations throughout a woman’s reproductive life, from early menarche to perimenopause, are also critical drivers, explaining why fibroids typically emerge during childbearing years and often regress after menopause.

Alarmingly, epidemiological studies consistently reveal a stark and persistent racial disparity in fibroid prevalence and severity. Fibroids are not merely more common in Black women; they are typically diagnosed two to three times more frequently compared to White women, often manifesting at a much younger age, growing to larger sizes, and causing more severe and debilitating symptoms (Marsh et al., 2020; Morhason-Bello et al., 2022; Charifson et al., 2024). For instance, by age 35, approximately 60% of Black women may have fibroids, a figure that rises to 80% by age 50, compared to 40% and 70% respectively in White women (Charifson et al., 2024). This profound disparity underscores a critical global health inequity, demanding not only focused research into underlying biological and socio-environmental factors but also equitable resource allocation and targeted healthcare interventions. Within African communities, where the highest burden of fibroid disease is observed, access to early diagnosis, comprehensive care, and advanced treatment options may be significantly limited due to systemic barriers, poverty, and inadequate healthcare infrastructure (Morhason-Bello et al., 2022). Tragically, for many women in Sub-Saharan Africa, the term “fibroid” is unfortunately a common part of daily conversations, yet comprehensive knowledge about their causes, true prevalence, diverse symptoms, and available treatment options remains elusive. This lack of awareness, coupled with cultural factors and economic constraints, often leads to significant delays in seeking medical attention, resulting in late presentations with very large fibroids that may appear to mimic advanced gestation, and prolonged suffering (Marsh et al., 2020). Addressing these disparities requires a multi-pronged approach, including community education, improved screening protocols, and investment in accessible, culturally competent healthcare services.

Fibroids are meticulously classified based on their precise anatomical location within the uterus, with each classification carrying distinct clinical implications, symptom profiles, and potential complications:

• Intramural Fibroids: These constitute the most common type, embedding themselves deeply and growing within the thick muscular wall of the uterus (myometrium). As they expand in size, they can cause the entire uterus to enlarge and become boggy, leading to a persistent sensation of pelvic pressure or fullness, generalized discomfort, and often the hallmark symptom of heavy menstrual bleeding (menorrhagia). The sheer volume of blood loss can be profound, leading to severe iron-deficiency anemia, chronic fatigue, and a significant impact on daily energy levels and cognitive function. Their size can vary dramatically, from microscopic nodules detectable only by advanced imaging techniques to substantial masses that visibly distort the uterine shape, sometimes leading to a mistaken diagnosis of an advanced pregnancy due to abdominal distension (Marsh et al., 2020; Verywell Health, 2025).
• Subserosal Fibroids: These fibroids develop on the outer surface of the uterus, extending outwards into the pelvic cavity. They can sometimes be attached by a slender stalk, becoming “pedunculated.” Unlike intramural or submucosal fibroids, they may not directly cause heavy menstrual bleeding unless they are exceptionally large and affect overall uterine contractility. However, their primary impact stems from exerting pressure on adjacent pelvic organs. Large subserosal fibroids can compress the bladder, leading to bothersome urinary symptoms such as increased urinary frequency, urgency, difficulty initiating urination, or the sensation of incomplete bladder emptying. Similarly, pressure on the rectum can cause constipation, painful bowel movements, or a persistent feeling of fullness. A particularly acute and painful complication arises if a pedunculated subserosal fibroid twists on its stalk, which can abruptly cut off its blood supply, resulting in sudden, excruciating abdominal pain requiring immediate medical attention (Verywell Health, 2025).
• Submucosal Fibroids: Though statistically the least common type, submucosal fibroids are often the most clinically significant and symptomatic due to their intimate proximity to the uterine lining. They grow just beneath the uterine lining (endometrium) and protrude directly into the uterine cavity. Even relatively small submucosal fibroids can trigger extremely heavy and prolonged menstrual bleeding, often described as gushing or flooding, leading to severe iron-deficiency anemia, chronic fatigue, and debilitating cramping that can interfere with daily life. Crucially, their presence within the uterine cavity can significantly interfere with a woman’s fertility, by distorting the uterine cavity, making successful embryo implantation challenging, and substantially increasing the risk of early pregnancy loss (spontaneous abortion) (Donnez & Jadoul, 2002; Mayo Clinic, 2023). They can also contribute to recurrent pregnancy loss, presenting a heartbreaking challenge for couples trying to conceive.

The symptoms associated with uterine fibroids are highly diverse and their severity is heavily influenced by the fibroids’ size, number, and precise location. Beyond the common manifestations of heavy or prolonged menstrual periods (which, as noted, can lead to severe anemia, profound fatigue, and generalized weakness), women may experience chronic pelvic pain or pressure that can be dull and aching or sharp and localized, persistent backache radiating down the legs, and frequent urination or difficulty emptying the bladder. For many women, these pervasive and often unpredictable symptoms can severely diminish their quality of life, impacting daily activities, work productivity, social engagements, intimate relationships, and overall emotional and physical well-being (Cleveland Clinic, 2023; Michigan Medicine, 2020). A significant challenge in diagnosis is that symptoms like unusually heavy bleeding, prolonged periods, or pain during sexual activity are often mistakenly considered “normal” by women, either due to lack of awareness or cultural normalization of discomfort, leading to significant delays in seeking medical attention and prolonged, unnecessary suffering (Michigan Medicine, 2020). This highlights the critical need for public health campaigns to raise awareness about what constitutes normal menstrual health and when to seek medical advice.

Diagnosis typically commences with a detailed medical history, meticulously focusing on menstrual patterns (duration, flow, regularity), pain characteristics (onset, severity, aggravating/alleviating factors), and the woman’s reproductive goals. This is followed by a thorough pelvic examination. During the bimanual examination, a healthcare provider may palpate an enlarged, irregularly shaped, or firm uterus, strongly suggesting the presence of fibroids (Mayo Clinic, 2023). Imaging techniques are paramount for confirming the diagnosis, precisely mapping the fibroids, and guiding treatment decisions. Transvaginal and abdominal ultrasound are the primary diagnostic tools due to their accessibility, cost-effectiveness, and non-invasiveness, providing initial insights into fibroid number, size, and location. They can also assess the impact on the uterine cavity and surrounding organs. For more complex cases, particularly when surgical planning is being considered, or to differentiate fibroids from other pelvic masses (e.g., adenomyosis, ovarian masses), Magnetic Resonance Imaging (MRI) offers superior soft tissue contrast and can precisely delineate fibroid characteristics, identify different types of tumors, and provide a comprehensive anatomical overview (Khan et al., 2014; Mayo Clinic, 2023). Other specialized imaging techniques are invaluable for specific scenarios: hysterosonography (saline infusion sonogram) involves introducing saline into the uterine cavity to enhance visualization of submucosal fibroids and the endometrial lining, which is crucial for fertility assessments. Hysteroscopy, a direct visualization method using a small telescope inserted through the cervix, allows for direct inspection of the uterine cavity and can be used for both diagnosis and removal of submucosal fibroids. These are especially important in cases of infertility or heavy bleeding where the exact impact on the uterine cavity needs to be assessed (Mayo Clinic, 2023). Finally, laboratory tests, such as a complete blood count, are essential to check for iron-deficiency anemia resulting from chronic blood loss, which is a common sequela of symptomatic fibroids and requires management alongside fibroid treatment (Mayo Clinic, 2023).

The Less Common but Significant: Cervical Fibroids

While the body of the uterus is overwhelmingly the most common site for fibroid development, these benign growths can also arise from the cervix, the cylindrical lower part of the uterus that extends into the vagina. Cervical fibroids are considerably rarer than their uterine counterparts, accounting for less than 5% of all leiomyomas (MSD Manual, 2023). However, their unique anatomical location within the narrow and critical cervix can pose distinct and often more challenging clinical problems compared to fibroids located elsewhere in the uterus. This is due to the cervix’s pivotal roles in facilitating menstrual flow, enabling sexual function, and, most importantly, its indispensable role in childbirth as the gateway to the birth canal. Their presence can significantly impact these physiological processes, sometimes leading to more severe complications or requiring more complex management strategies than similarly sized fibroids in the uterine fundus (Goyal et al., 2014; MSD Manual, 2023).

The symptoms of cervical fibroids are largely determined by their size, their precise location within the cervical tissue (e.g., anterior, posterior, lateral), and critically, whether they obstruct the cervical canal. Small cervical fibroids may remain entirely asymptomatic and are often discovered incidentally during a routine pelvic examination or imaging performed for other reasons. However, larger or strategically located fibroids can lead to a range of distressing and impactful issues, including:

• Abnormal Vaginal Bleeding: This is a common and often alarming symptom, manifesting in various forms. It can present as heavy menstrual bleeding (menorrhagia) due to increased surface area or altered uterine contractility, irregular bleeding between periods (intermenstrual bleeding), or even bleeding after sexual intercourse (postcoital bleeding) due to trauma to the fibroid or overlying cervical mucosa (MSD Manual, 2023). The unpredictable nature of this bleeding can cause significant anxiety and impact a woman’s daily life.
• Pelvic Pressure and Pain: Similar to uterine fibroids, cervical fibroids can exert significant pressure on surrounding pelvic organs, given the confined space of the pelvis. This can lead to bothersome urinary symptoms such as increased urinary frequency, urgency, a hesitant start to urination, dribbling at the end, or the persistent sensation of incomplete bladder emptying. If the fibroid presses on the rectum, it can cause constipation, painful bowel movements (dyschezia), or a constant feeling of heaviness or fullness in the pelvis (Cleveland Clinic, 2023; MSD Manual, 2023).
• Dyspareunia: Pain during sexual intercourse (dyspareunia) is a common complaint if the fibroid is large, protrudes into the vagina, or is located in a sensitive area of the cervix. This can significantly impact a woman’s intimacy, relationship, and overall quality of life (Cleveland Clinic, 2023; MSD Manual, 2023).
• Obstruction of the Cervical Canal: This is a particularly serious and potentially dangerous complication. A fibroid obstructing the cervical canal can impede the normal flow of menstrual blood, leading to severe pain (dysmenorrhea), a buildup of blood within the uterus (hematometra), and an increased risk of ascending infections, including endometritis or pelvic inflammatory disease. More critically, during pregnancy, a large cervical fibroid can physically block the birth canal, making a vaginal delivery impossible and necessitating a Cesarean section, often planned in advance to avoid emergency situations (MSD Manual, 2023).
• Hydronephrosis: In rare but severe cases, particularly with very large cervical fibroids, their expansive growth can compress the ureters (the delicate tubes that carry urine from the kidneys to the bladder). This compression can lead to a backup of urine in the kidneys (hydronephrosis), which, if left untreated, can progressively impair kidney function and potentially lead to kidney damage (MSD Manual, 2023).

Diagnosis of cervical fibroids typically begins with a thorough pelvic examination. During this examination, the fibroid may be directly visualized protruding from the cervical os or palpated as a firm, irregular mass within the cervical tissue. If a cervical mass is detected, imaging studies are absolutely essential to confirm the diagnosis, precisely determine the size, exact location, and extent of the fibroid, and crucially, to differentiate it from other, potentially more serious, cervical pathologies like cervical cancer or polyps. Transvaginal ultrasound is often the first-line imaging modality due to its ability to provide clear images of the cervix and surrounding structures. For more detailed assessment, particularly if the diagnosis remains uncertain, if the fibroid is complex, or if surgical planning is required, Magnetic Resonance Imaging (MRI) offers superior soft tissue resolution and can provide a comprehensive anatomical map. Furthermore, a Papanicolaou (Pap) test and/or human papillomavirus (HPV) test (cervical cytology tests) are routinely performed to rule out cervical malignancy, especially given that some cervical cancers can mimic fibroid appearance. In cases where the nature of the mass remains unclear, a biopsy of the cervical mass is often necessary for definitive histological diagnosis (MSD Manual, 2023). The management of cervical fibroids is highly individualized, depending on their size, the severity of symptoms, the woman’s reproductive desires, and the potential for complications. Treatment often involves surgical removal (myomectomy) if they are symptomatic, obstructive, or significantly impacting quality of life. In some cases, if the fibroid is very large, deeply embedded, or difficult to access without compromising cervical integrity, removal of the entire uterus (hysterectomy) may be considered as a definitive solution (MSD Manual, 2023).

Navigating the Crossroads: Fibroids in Pregnancy

The presence of fibroids during pregnancy introduces a significant and often unpredictable layer of complexity, transforming what should ideally be a straightforward and joyful journey into one requiring careful monitoring, individualized management, and a heightened awareness of potential complications for both mother and fetus. The prevalence of fibroids in pregnant women is estimated to be between 2% and 12%, though this figure may be an underestimate given that many fibroids are asymptomatic and only discovered incidentally during routine prenatal ultrasounds (Laughlin et al., 2010; Fibroids.com, 2021). The unique hormonal milieu of pregnancy, characterized by significantly elevated levels of estrogen and progesterone, can profoundly influence fibroid growth and behavior. While some fibroids may remain stable or even spontaneously shrink, others can grow rapidly, particularly during the first trimester, fueled by this intense hormonal surge and increased uterine blood flow (WebMD, 2024; Verywell Health, 2025). This growth can lead to new symptoms or exacerbate existing ones.

A common and often distressing complication specifically associated with fibroids during pregnancy is “red degeneration” or necrobiosis of a fibroid. This phenomenon occurs when a fibroid outgrows its blood supply, leading to ischemic necrosis (tissue death) within the fibroid. Red degeneration is most frequently observed in pregnant women with larger fibroids (typically greater than 5 cm) during the second and third trimesters, but it can occur at any point during gestation (Verywell Health, 2025; Fibroids.com, 2021). The symptoms are acute and often severe, including sharp, stabbing abdominal pain localized directly over the affected fibroid, which can be intense enough to radiate to the back or groin. This pain is frequently accompanied by low-grade fever, nausea, vomiting, and localized uterine tenderness upon palpation (WebMD, 2024; Verywell Health, 2025). While this condition is usually self-limiting, resolving with conservative management within a few days to a couple of weeks, it can be profoundly distressing for the expectant mother and may sometimes trigger uterine contractions, potentially leading to preterm labor or even miscarriage in severe cases (Fibroids.com, 2021). Differentiation from other causes of abdominal pain in pregnancy, such as appendicitis or placental abruption, is crucial.

The impact of fibroids on pregnancy outcomes can be significant, varied, and often unpredictable, depending on the fibroid’s size, number, and, most critically, its precise location within the uterus:

• Increased Risk of Miscarriage: Submucosal fibroids, due to their direct proximity to and potential distortion of the endometrial lining, can significantly impair successful embryo implantation and increase the risk of early pregnancy loss (spontaneous abortion) (Vitale et al., 2015; Karlsen et al., 2020; WebMD, 2024). The risk of miscarriage is further elevated when multiple fibroids are present or when fibroids are exceptionally large (WebMD, 2024). The presence of fibroids can create a less hospitable environment for the developing embryo, affecting blood flow and uterine receptivity.
• Preterm Labor and Delivery: Large or numerous fibroids can act as persistent irritants to the uterus, leading to increased uterine irritability and an elevated risk of premature uterine contractions, culminating in preterm labor and subsequent preterm delivery (before 37 weeks of gestation). Preterm birth carries significant risks for the newborn, including respiratory distress syndrome, intraventricular hemorrhage, neurological complications, and long-term developmental delays, necessitating specialized neonatal care (Saleh et al., 2015; WebMD, 2024).
• Placental Complications: Fibroids located near or directly beneath the placental implantation site can interfere with adequate blood supply and proper placental development. This significantly increases the risk of serious obstetric emergencies such as placenta previa (where the placenta partially or completely covers the cervix, blocking the birth canal) or placental abruption (the premature detachment of the placenta from the uterine wall before the baby is born). Both conditions can lead to severe maternal hemorrhage, fetal distress, or even fetal demise, requiring urgent medical intervention (Saleh et al., 2015; WebMD, 2024).
• Fetal Malpresentation: Large fibroids, particularly those situated in the lower uterine segment or those that significantly distort the uterine cavity, can physically obstruct the baby’s descent into the birth canal or prevent the fetus from assuming the optimal head-down (cephalic) presentation for vaginal delivery. This can result in abnormal fetal positions such as breech (feet or buttocks first) or transverse lie (lying sideways), complicating vaginal delivery and often necessitating a Cesarean section (Saleh et al., 2015).
• Increased Cesarean Section Rates: The presence of fibroids significantly increases the likelihood of requiring a Cesarean section. This may be due to a fibroid physically obstructing the birth canal, their large size making vaginal delivery difficult, or their interference with the uterus’s ability to contract effectively during labor (uterine inertia), leading to prolonged or arrested labor. Studies indicate that women with fibroids are six times more likely to require a C-section compared to those without, making it a major consideration in delivery planning (Saleh et al., 2015; WebMD, 2024).
• Postpartum Hemorrhage: Fibroids can interfere with the physiological process of uterine contraction after delivery (uterine atony), which is crucial for compressing blood vessels and preventing excessive bleeding from the placental site. This increases the risk of postpartum hemorrhage, a leading cause of maternal morbidity and mortality worldwide, necessitating vigilant monitoring and prompt intervention (Saleh et al., 2015).
• Pain Management Challenges: As highlighted, red degeneration can cause severe and acute pain, necessitating careful pain management strategies that are safe for both the mother and the developing fetus. This often involves a delicate balance of rest, hydration, and analgesics like acetaminophen. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used with extreme caution for short durations, particularly in the second trimester, but are generally avoided in the third trimester due to potential adverse fetal effects, including premature closure of the ductus arteriosus (a fetal blood vessel) and impaired kidney function (Verywell Health, 2025).

Management of fibroids during pregnancy is primarily conservative, focusing on symptom relief and meticulous monitoring of both maternal and fetal well-being. Surgical removal of fibroids (myomectomy) during pregnancy is generally avoided due to the high risks of hemorrhage, uterine rupture, and potential miscarriage or preterm labor. It is reserved only for extremely rare and life-threatening situations where the fibroid poses an immediate and severe threat to the mother or fetus, such as intractable pain unresponsive to conservative measures, rapid growth causing significant obstruction, or suspicion of malignancy (Vitale et al., 2015; Saleh et al., 2015). Even in such rare instances, the decision is made after careful consideration of risks versus benefits.

Delivery planning is a crucial and highly individualized aspect of care for pregnant women with fibroids. While a vaginal delivery is often achievable, especially with smaller or favorably located fibroids (e.g., subserosal fibroids not obstructing the birth canal), a Cesarean section may be recommended if fibroids obstruct the birth canal, if there are concerns about fetal malpresentation (e.g., breech presentation due to fibroid interference), or if the fibroids are very large and numerous, potentially compromising effective uterine contractions during labor. The decision for the mode of delivery is made collaboratively between the woman and her healthcare team, based on the fibroid’s characteristics, the progress of labor, and the overall clinical picture at term. A multidisciplinary approach involving obstetricians, radiologists, and sometimes gynecologic surgeons is essential to provide comprehensive, individualized care for women navigating pregnancy with fibroids. This collaborative effort ensures that every aspect of the woman’s health and the baby’s development is closely monitored and managed effectively, from conception through the postpartum period, including follow-up for fibroid regression or ongoing management.

Conclusion

Uterine fibroids, including their less common but clinically significant cervical counterparts, represent a profound and often challenging aspect of women’s reproductive health, with their impact profoundly amplified during pregnancy. Their disproportionately higher prevalence, earlier onset, and greater symptom severity in women of African descent highlight a critical global health inequity and underscore the urgent need for enhanced awareness, early screening initiatives, and culturally sensitive, equitable healthcare approaches within these communities. While fibroids can lead to a range of distressing symptoms and potential obstetric complications, continuous advancements in diagnostic imaging and a nuanced understanding of their behavior during gestation allow for increasingly proactive and personalized management strategies. The journey through pregnancy with fibroids underscores the critical importance of comprehensive prenatal care, a collaborative and empathetic healthcare team, and a deep, unwavering commitment to ensuring optimal outcomes for both mother and child. By continuing to invest in robust research into fibroid etiology and disparities, improving equitable access to timely diagnosis and diverse treatment options, and empowering women with accurate knowledge about their bodies and available care, we can collectively work towards mitigating the burden of fibroids and fostering healthier, more fulfilling reproductive lives for women everywhere. This requires a global commitment to addressing not just the clinical manifestations but also the underlying social, economic, and systemic factors that contribute to these health disparities.

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