Infertility usually is not a consequence of uterine fibroids. When the two situations occur together, the myomas can exert an effect by mechanical obstruction, distortion or interference with implantation. Most women with myomas are fertile. When mechanical obstruction of the uterine cavity is present, and no other cause for the infertility can be identified, myomectomy is usually followed by prompt achievement of pregnancy (within the first year) in a high percentage of patients.

Intracavity myomas usually require surgery. This is best achieved by hysteroscopic resection. Large myomas of greater than 5 cms in diameter may be difficult to resect hysteroscopically. Medical therapy with a GnRH agonist is not recommended in these situations.

Most myomas do not grow during pregnancy. If they do, they usually regress in size after delivery. Myomas occasionally undergo red degeneration in pregnancy. This is a condition associated with central hemorrhagic infarction and can result in severe pain, nausea, fever, rebound tenderness and leucocytosis. Conservative management is called for, with surgery as a last resort.