Uterine myomatosis is the formation of myomas or fibroids inside the uterus. These are benign tumors classified according to their location.
Depending on where they are found, fibroids are classified as:
- Intramural: within the muscular wall of the uterus. They can affect fertility if they exceed 4 cm.
- Submucosal: on the surface of the uterine lining. They hinder embryo implantation.
- Subserosal: in the outer layer of the uterus. They usually do not interfere with fertility.
What is uterine myomatosis and why does it matter for fertility?
Uterine myomatosis involves the growth of fibroids, benign smooth muscle tumors, inside the uterus. It affects about 20% of women of reproductive age, especially after age 30. Fibroids can range from microscopic nodules to masses over 4 kg, altering the shape of the uterus and reducing pregnancy chances.
How common is uterine myomatosis in those trying to conceive?
Uterine fibroids are the most common pelvic tumors in women of reproductive age, present in nearly 70–80% before menopause. Although many are asymptomatic, those that deform the uterine cavity—particularly large intramural and submucosal fibroids—are involved in up to 80% of uterine factor infertility cases.
How do fibroids affect embryo implantation?
Large submucosal and intramural fibroids can:
- Alter sperm transport and uterine peristalsis
- Reduce endometrial receptivity by compressing the lining
- Increase the risk of implantation failure and early miscarriage
Can fibroids complicate pregnancy?
Yes. During pregnancy, fibroids can cause:
- Higher risk of miscarriage and preterm birth
- Fetal growth restriction due to lack of space
- Cervical canal obstruction or labor dystocia
- Postpartum hemorrhage from poor uterine contraction
What symptoms may indicate fibroids?
About 25% are asymptomatic. When symptoms occur, they include:
- Sensation of pelvic pressure or heaviness
- Heavy or prolonged menstrual bleeding
- Pelvic cramps and irregular bleeding
- Frequent urination or difficulty urinating
- Secondary infertility or recurrent miscarriages
Severity depends on fibroid size, number, and location.
How is diagnosis confirmed?
Transvaginal ultrasound is the gold standard, with nearly 100% sensitivity (95% transabdominal). In complex cases, MRI is used. Always consult a reproductive medicine specialist to interpret results and design a treatment plan.
Fertility-preserving treatment options
Choice depends on age, fibroid characteristics, and reproductive goals:
- Expectant management for small, asymptomatic fibroids
- Myomectomy (surgical removal), followed by assisted reproduction techniques
- Controlled ovarian stimulation combined with in vitro fertilization (IVF) if cavity distortion persists
IVF bypasses uterine transport obstacles and allows for selecting the embryo with the highest implantation potential. For more information, see our guide on Endometriosis: what it is and how it impacts fertility.
FAQ
1. Can small fibroids disappear on their own?
Yes. Many remain stable or shrink after menopause due to estrogen decline. In reproductive age, asymptomatic fibroids under 2 cm are usually monitored with periodic ultrasounds. If you plan to conceive, even a small submucosal fibroid can affect implantation, so consult your doctor to assess intervention before trying to conceive.
2. Are there non-surgical treatments?
GnRH agonists and selective progesterone receptor modulators can temporarily shrink fibroids and reduce bleeding in 3–6 month cycles. They improve conditions before surgery or comfort but are not definitive solutions. Never self-medicate without medical supervision.
3. When can I attempt IVF after a myomectomy?
Ideally between 6 and 12 months after surgery, before recurrence risk increases. This timing allows the uterine lining to heal and optimizes pregnancy chances. Make sure your specialist confirms proper healing with ultrasound or hysteroscopy before starting treatment.
4. Does the risk of miscarriage increase?
Yes. Fibroids that deform the cavity or alter blood flow are associated with early pregnancy loss. Risk increases with fibroid size and location, especially submucosal and large intramural fibroids. Proper management, surgical or with assisted reproduction, significantly reduces miscarriage rates. Always consult a specialist before making decisions.
References
- Faerstein, E., Szklo, M., & Schwingl, P. J. (2001). Risk factors for uterine leiomyoma: a practice-based case–control study. American Journal of Epidemiology, 153(5), 463–469. doi:10.1093/aje/153.5.463
- Lau, W., & Shlisselberg, S. (2016). Management of uterine fibroids. American Family Physician, 94(2), 106–113. https://www.aafp.org/afp/2016/0715/p106.html
- MedlinePlus. (2021). Uterine fibroids. https://medlineplus.gov/uterinefibroids.html
- Stewart, E. A. (2015). Uterine fibroids. Lancet, 376(9745), 145–157. doi:10.1016/S0140-6736(10)60246-1
Remember: every body is unique. Stay informed, keep hope, and consult an assisted reproduction specialist for personalized care.