Fibroids and polyps are common, non-cancerous growths in the uterus. Many have no effect on fertility. Whether one matters depends mostly on where it is, especially whether it bulges into the cavity where an embryo implants.
The uterus and fertility
After fertilisation, an embryo needs to implant in the lining of the uterus (the endometrium) and grow there. Anything that changes the shape of the inside of the uterus, or affects the lining, may make implantation harder or affect a pregnancy. A lining that is thinner than expected is covered in our guide to thin endometrium and fertility.
Fibroids and polyps are two common findings. Most are harmless, and many need no treatment at all.
Fibroids
Fibroids are non-cancerous growths of muscle in the wall of the uterus. They are very common, and many people with them have no symptoms. When they do cause symptoms, these can include heavy or long periods, pelvic pressure or pain, needing to pass urine often, or a swollen tummy.
Doctors describe fibroids by where they are:
| Type | Where it is | Effect on fertility |
|---|---|---|
| Submucosal | Bulges into the cavity of the uterus | Most likely to matter; removal is often discussed |
| Intramural | Within the muscle wall | May matter if large or if it distorts the cavity; decided case by case |
| Subserosal | On the outer surface | Usually does not affect fertility |
Good to know. Finding a fibroid on a scan does not mean it is the reason you haven't conceived. Location matters much more than simply having one.
Polyps
Endometrial polyps are small, usually non-cancerous growths of the lining of the uterus. They may cause bleeding between periods or after sex, or no symptoms at all. Because they sit inside the cavity, doctors often suggest removing them when someone is trying to conceive or preparing for treatment.
How they are found
- Transvaginal ultrasound is usually the first step. It shows most fibroids and many polyps.
- 3D ultrasound or saline infusion sonography, where a little sterile fluid is passed into the uterus during a scan, gives a clearer view of the cavity.
- Hysteroscopy uses a thin camera passed through the cervix to look directly inside the uterus. Polyps and some fibroids can often be removed at the same time.
- MRI is sometimes used to map larger or multiple fibroids before surgery.
Options
The plan depends on the size, number and position of fibroids or polyps, your symptoms, your age, and other fertility factors for both partners, which the first fertility tests look at.
- No treatment. Many fibroids, especially those on the outer surface, can simply be left alone.
- Hysteroscopic removal. Polyps, and fibroids that bulge into the cavity, can often be removed through the cervix without any cuts on the tummy.
- Myomectomy. Surgery to remove fibroids from the wall of the uterus, by keyhole or open surgery. It keeps the uterus in place. After a myomectomy, your doctor will advise how long to wait before trying and whether a caesarean birth may be recommended later.
Caution. Some fibroid treatments, including certain medicines and procedures, are not suitable if you want to become pregnant. Before agreeing to any treatment, tell your doctor about your pregnancy plans and ask how it may affect them.
Adenomyosis
Adenomyosis is a related condition where tissue like the lining of the uterus grows into its muscle wall. It can cause heavy, painful periods and an enlarged uterus. It is diagnosed with ultrasound or MRI, and it can occur alongside endometriosis.
Adenomyosis may affect fertility and the chance of implantation for some people, but the evidence is still developing. Treatment is individual, and a specialist can explain what is known for your situation.
Other differences in shape
A small number of people are born with a uterus of a different shape, for example with a band of tissue dividing the cavity (a septum). These are usually found on 3D ultrasound or hysteroscopy, and whether treatment helps depends on the type.
When to see a doctor
- Periods are heavy enough to soak through pads quickly, last longer than usual, or leave you tired or short of breath, which can be a sign of low haemoglobin.
- You have bleeding between periods or after sex.
- You have pelvic pressure, pain, or a swelling in your tummy.
- You have a known fibroid or polyp and are planning a pregnancy.
Very heavy bleeding with dizziness or fainting, or sudden severe pelvic pain, needs urgent care: call 112 or go to the nearest hospital.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.