Are Uterine Fibroids Hereditary? What Your 23andMe Result Really Means

Are Uterine Fibroids Hereditary? What Your 23andMe Result Really Means

This article is for educational purposes only. It is not a substitute for advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. For any decisions about testing, treatment, or care, consult a qualified clinician. In emergencies, call 911.

Bottom line: A 23andMe “higher likelihood” score for uterine fibroids adds up small nudges from many common gene variants. It is not a diagnosis. Fibroids are also very common on their own. Most women develop them by age 50, with or without a “higher likelihood” score. The score shifts your odds a little. It does not tell you whether fibroids are growing in your body right now. And it does not decide your fertility future.

Maybe your mother had fibroid surgery. Maybe your sister was just diagnosed after months of heavy periods. Or maybe you opened a 23andMe report out of curiosity, and a “higher likelihood” result stopped you cold. This article walks through what the genetics actually say. It’s written in plain language, so you feel ready for your next OB-GYN visit.

What you’ll learn:

• Why fibroid risk comes from more than 80 gene regions, not one inherited mutation
• How to turn “higher likelihood” into a real, absolute number
• Why a DNA score can never replace an ultrasound
• What the newest FDA- and Health Canada-approved treatment can and cannot do

How fibroid risk is inherited: a polygenic condition, not a single gene

Some conditions run in families through one gene. BRCA1 and breast cancer work that way. Uterine fibroids do not.

A 2025 study in Nature Communications searched the genomes of women across several ancestry groups. The team found 11 newly discovered gene regions linked to fibroid risk. That adds to 72 regions already known from earlier research. None of these regions act alone. Each one nudges risk up or down by a small amount. Scientists call this a polygenic pattern. It means many genes act together, instead of one gene acting alone.

The same study used a method called colocalization analysis. In plain terms, it checks whether a gene region tied to fibroid risk also changes how active a nearby gene is in uterine tissue. This method flagged 46 further candidate genes worth studying. One gene stood out across every ancestry group studied: HEATR3. Women with higher predicted activity of HEATR3 in the uterus showed higher fibroid risk. This held true no matter their ancestry.

The study also measured heritability. That word describes how much of the difference in fibroid risk between people traces back to inherited DNA, rather than to environment or chance. Among participants of African ancestry, common gene variants explained about 15.9% of that difference. That is a real, measurable signal. But it is far from the whole story. The rest comes from factors this kind of study cannot capture through genetics alone.

This is exactly what a 23andMe “Health Predisposition” report for fibroids measures. It is a polygenic score built by adding up many common variants. Each variant carries only a tiny weight. Think of it like a large jury, where each juror casts one small vote. No single vote decides the outcome. The combined tally shifts the odds. But it never guarantees a verdict.

• Single-gene conditions (like BRCA1 breast cancer risk): one strong genetic signal, often with a clear inheritance pattern
• Polygenic conditions (like uterine fibroids): more than 80 gene regions, working together. No single gene dominates
• What a 23andMe fibroid score measures: a weighted sum of many common variants. It is reported as a population-percentile “likelihood,” not a diagnosis

A “higher likelihood” result means your combined genetic score sits above average for the group 23andMe compared you to. It does not mean a doctor has found a fibroid in your uterus. Only an exam and imaging can do that. The next sections cover exactly how.

Section recap: Fibroid risk comes from more than 80 gene regions working together, not one inherited mutation. A DTC polygenic score adds these signals into one probability estimate. That’s useful context, but it is not a diagnosis. Talk with your OB-GYN about what your family history, and any test result, mean for you.

From “higher likelihood” to real numbers: how common are fibroids, really?

A score like “higher likelihood” means little without a baseline. So start with the baseline. How common are fibroids in general?

A long-running ultrasound study scanned a random sample of women, ages 35 to 49, near Washington, DC. Researchers tracked how many developed fibroids by age 50. The results were striking. About 70 out of 100 white women had developed fibroids by age 50. Among Black women, it was more than 80 out of 100. The gap between the two groups was large and consistent, at every age the study checked.

Read that again. Fibroids affect most women by age 50. They are not a rare risk. They are closer to a near-universal finding for women of reproductive age. What actually varies is not whether fibroids form, but whether they ever cause symptoms, and how severe those symptoms get.

Group	Cumulative incidence by age 50	Source
White women	About 70 out of 100	Baird et al., ultrasound cohort study
Black women	More than 80 out of 100	Baird et al., ultrasound cohort study
SNP-based heritability (African ancestry)	15.9% of risk difference explained by common gene variants	2025 multi-ancestry GWAS

Against that backdrop, what does one “higher likelihood” score really add? Not much on its own. Any single common variant found in the 2025 study shifts individual risk only a small amount. A 23andMe “higher likelihood” result reflects a percentile shift within a large population. It is not a personal guarantee that you will ever develop symptomatic fibroids. Many women with fibroids never even know they have them, because most fibroids stay small and silent.

There is also a well-known racial gap researchers are still working to explain. Fibroids are diagnosed earlier, grow larger, and cause more severe symptoms in women of African ancestry than in white women. The 2025 genetics study is part of an active effort to understand why, at the biological level. That gap has not been fully explained yet.

Section recap: Fibroids affect roughly 70 to 80+ out of every 100 women by age 50. That makes them common, not rare. A “higher likelihood” genetic score is a small nudge on top of an already-high baseline, not a personal forecast.

Testing options: a DNA report is not the same as a diagnosis

Two very different things get called “fibroid testing.” Knowing which one you have matters.

A direct-to-consumer report, like 23andMe’s Health Predisposition category, draws on genome-wide statistics from many common variants. It gives you a probability, compared with other people. It is built for curiosity and context. It is not built to confirm or rule out a physical finding in your body.

A real fibroid diagnosis works differently. It starts with a talk about your periods and symptoms. Next comes a pelvic exam. If anything looks worth a closer look, the next step is a transvaginal ultrasound. That’s a scan that uses sound waves to picture the uterus from inside the vagina. Pelvic MRI is a more detailed scan, using magnets and radio waves. It is saved for surgical planning, or for when the ultrasound picture is unclear.

	23andMe polygenic report	Clinical diagnostic workup
What it measures	Many common gene variants, statistical model	Physical exam plus imaging of the uterus
Result type	Population-percentile “likelihood”	Confirmed presence, size, and location of any fibroids
Tells you if fibroids exist now	No	Yes
Insurance-billable in US/Canada	No	Usually yes, through insurance or provincial plans
Who orders it	Self, via mail-order kit	A clinician, based on symptoms or routine exam

Many women learn they have fibroids by accident. A routine pelvic exam, or imaging done for an unrelated reason, often finds them first. Sometimes this happens years before anyone even considers a genetic test. That is one more reason a DNA score should never replace regular gynecologic care.

If a “higher likelihood” result has you wondering whether to get checked, bring that question to your OB-GYN, not a DNA kit. A board-certified genetic counselor — a professional trained to explain what a genetic result does and doesn’t mean for you — can also help. Find one at NSGC.org.

Section recap: A 23andMe report estimates statistical likelihood. A pelvic exam plus ultrasound confirms an actual physical finding. Only the second one is a real diagnosis. Bring any DNA result to your OB-GYN rather than acting on it alone.

Interpreting your result: a probability shift is not a diagnosis

So you have a “higher likelihood” result, and no symptoms. What does that actually mean for you right now?

Start with what the score cannot do. It cannot rule fibroids in or out. It explains only part of total fibroid heritability. And it says nothing about hormones, weight, or other factors that also shape your risk. An elevated score does not confirm that fibroids exist in your body today. It also cannot predict how many fibroids you might eventually have, how large they might grow, or where they might sit in the uterus.

That last detail matters more than most people expect. When a doctor does find a fibroid, they classify it using a standard system from the International Federation of Gynecology and Obstetrics, known as FIGO. This system separates two kinds of fibroids. Ones that grow into the uterine cavity more often affect periods and fertility. Ones that grow outside the cavity often cause no symptoms at all. A DNA score cannot supply any of that location or size detail. Only imaging can.

• A DTC “higher likelihood” score: a probability shift based on population data, not a personal diagnosis
• A confirmed fibroid on ultrasound: a real physical finding, further classified by size and location using the FIGO system
• A small, symptom-free fibroid: very common, often needs no treatment at all, and is unrelated to whether your DNA score was “average” or “higher likelihood”

None of this means a “higher likelihood” score is meaningless. It is useful context to raise with your OB-GYN, especially alongside your family history. It just is not a stand-in for an actual exam. Bring the result to your next visit. Let your clinician help you decide what, if anything, to do next.

Section recap: A polygenic score is a probability estimate, not a diagnosis. It cannot rule fibroids in or out. And it says nothing about a fibroid’s eventual size or location. Only imaging, classified by systems like FIGO, does that.

Prevention and early detection: realistic follow-up, not a promise

There is no known way to prevent the underlying genetic susceptibility to fibroids. That susceptibility is written into your DNA before birth. So what does “prevention” actually mean here?

In practice, it means paying attention, not trying to stop something that cannot be stopped. A “higher likelihood” score, or a strong family history, is a reasonable prompt to act. Take abnormal bleeding or pelvic pressure seriously. Keep up with routine gynecologic visits, rather than waiting it out.

Guidelines on managing fibroids also stress watching for anemia. Anemia is a drop in healthy red blood cells. It can result from months of heavy bleeding, and leave you feeling tired or short of breath. This matters even more before starting certain hormone-based treatments, where your clinician will also want to understand your broader heart health.

One area of ongoing research deserves a careful frame. A cohort study followed a group of Black women, ages 23 to 35 at the start, with regular ultrasounds over about five years. Women with enough vitamin D had roughly 32% lower odds of having a fibroid, compared with women who had too little. That is an association, not proof of cause and effect. It has not been tested as a way to prevent fibroids. No guideline currently recommends vitamin D supplements for that purpose.

• What can’t be prevented: the underlying polygenic susceptibility itself. It’s part of your genetic makeup
• What can be managed: earlier attention to heavy bleeding, pelvic pressure, or anemia, through regular gynecologic follow-up
• What’s still under study: a possible link between vitamin D and fibroid risk, seen in cohort research but not yet proven to cause anything
• What hormonal birth control does and doesn’t do: it can help manage symptoms once fibroids exist. It does not prevent fibroids from forming

No drug currently carries FDA approval to stop fibroids from forming before symptoms begin. Every approved option today works after fibroids already exist, to manage the symptoms they cause. The next section covers what those options are.

Section recap: You cannot prevent the genetic susceptibility to fibroids. But you can catch symptoms early through regular checkups. Vitamin D’s link to lower fibroid risk is a promising association under study, not an established way to prevent them.

Current treatment landscape: what’s approved, and by whom

Fibroid treatment headlines move fast, and the word “approved” gets used loosely. Here is the treatment picture with exact regulator names and dates attached, so you can tell a real approval apart from ordinary research progress.

MYFEMBREE is a once-daily pill. It combines relugolix, estradiol, and norethindrone acetate. It works as a GnRH antagonist combination. That means it lowers the hormones that drive fibroid growth. A small, steady dose of estrogen and progestin is added back, to limit side effects. The FDA first approved MYFEMBREE on 2021-05-26, under application NDA214846. It was approved specifically for heavy menstrual bleeding linked to uterine fibroids in women before menopause. Several supplemental approvals followed as the label was updated. The most recent came 2025-08-27, with the current FDA label taking effect 2025-09-04.

Health Canada’s approval history is a little more layered, and it is worth getting exactly right. Health Canada issued its Notice of Compliance — the actual regulatory approval — for MYFEMBREE on 2023-09-22. The drug’s first commercial sale in Canada came later, on 2024-01-29. Casual coverage sometimes calls this later date the “approval date,” but it is not. These are two different milestones. One is regulatory sign-off. The other is when the product reached pharmacy shelves. MYFEMBREE is listed in Canada’s Drug Product Database under DIN 02541742. It is currently marketed by Knight Therapeutics Inc..

One safety detail matters for anyone considering this option. MYFEMBREE carries a 24-month limit on continuous use. Longer use is linked to irreversible loss of bone density.

The newest evidence on MYFEMBREE comes from a 2025 subgroup analysis of two earlier randomized trials, LIBERTY 1 and LIBERTY 2. Researchers looked closely at one subgroup: 111 of 611 participants, or 18.2%, also had adenomyosis confirmed on ultrasound. Adenomyosis is a related condition, where uterine-lining tissue grows into the muscular wall of the uterus. Among that subgroup, 83.8% responded to MYFEMBREE, meaning their heavy bleeding met a defined improvement mark. That compares with 27.6% on placebo. Amenorrhea, meaning periods stopped completely, happened in 64.9% of the treatment group, versus 6.9% on placebo. Average uterine volume dropped 22.2% with treatment, versus 5.8% with placebo.

Treatment	What it is	Regulatory status	Key result
MYFEMBREE (relugolix/estradiol/norethindrone)	Daily GnRH antagonist combination pill	FDA-approved 2021-05-26 (NDA214846); Health Canada Notice of Compliance 2023-09-22, first sale 2024-01-29	83.8% responder rate in the adenomyosis subgroup, vs 27.6% on placebo
Uterine artery embolization (UAE)	Procedure that blocks blood flow to fibroids	Established procedural option, reviewed in a Cochrane meta-analysis of 7 trials (n=859)	Shorter hospital stay and faster recovery than surgery, similar patient satisfaction
Myomectomy	Surgery that removes fibroids, keeping the uterus	Established surgical option	Preferred when future fertility matters
Hysterectomy	Surgery that removes the uterus entirely	Established surgical option; remains the leading reason for hysterectomy in the US	Ends fibroid symptoms for good, ends future fertility

Procedural options remain central to fibroid care, especially for larger or more numerous fibroids. A Cochrane review pooled seven randomized trials, covering 859 patients, comparing uterine artery embolization with surgery. UAE patients spent about 2.7 fewer days in the hospital. They needed roughly 17 fewer days to recover, with fewer major complications. Most trials found similar satisfaction to surgery. Myomectomy removes fibroids while keeping the uterus. It remains the standard choice for women who want to keep the option of future pregnancy. Hysterectomy removes the uterus entirely. It ends fibroid symptoms for good. And fibroids remain the leading reason American women undergo the procedure.

None of this replaces a talk with your OB-GYN about which option fits your symptoms, your fertility plans, and your overall health.

Section recap: MYFEMBREE has a documented FDA approval from 2021, and a separate Health Canada approval from 2023, distinct from its later Canadian launch in 2024. New 2025 data shows strong results, even for patients with adenomyosis. Options like UAE, myomectomy, and hysterectomy remain established choices too.

Family implications: what this means for your daughters and sisters

Fibroid risk is polygenic. It is not tied to one inherited mutation. That means there is no clean, single-gene testing path to offer relatives. Compare this with BRCA1 or Lynch syndrome, where a lab can test family members for one exact known change.

Instead, first-degree relatives — your mother, sisters, and daughters — carry a somewhat higher likelihood of also developing fibroids. This reflects shared genes, and often shared ancestry-linked risk factors. That likelihood is real, but it is not fixed. And it cannot be pinned down with a single test, the way a BRCA1 result can.

Practical guidance here is about awareness, not genetic screening. If your daughter later has heavy periods, pelvic pain, or unexplained tiredness that could point to anemia, family history is worth mentioning to her own clinician. There is little benefit to a daughter taking a DTC polygenic test purely as a screening step. A low score would not rule out future fibroids. And there is no early action to take from a polygenic result alone.

• What to share: if fibroids ran early or severe in your family, that’s worth mentioning at a daughter’s or sister’s first gynecologic visit
• What not to rely on: a DTC polygenic score as a screening tool for relatives. A reassuring score doesn’t rule out future fibroids
• What actually helps: routine gynecologic care, plus prompt attention to heavy bleeding or pelvic pain in any first-degree relative

Here’s a useful comparison. A confirmed BRCA1 mutation is like one specific key. It either fits a lock or it doesn’t, and relatives can be tested for that exact key. Fibroid risk is more like a regional weather pattern. It comes from many small, shared factors. It’s useful information in general. But no relative can be tested for it with one clean yes-or-no answer.

Section recap: There’s no single-gene cascade test for fibroids, because the risk is polygenic. First-degree relatives have a somewhat higher likelihood of developing fibroids. But the right response is awareness and routine care, not DTC genetic screening.

Psychosocial impact: insurance protections, gaps, and disparities in care

A “higher likelihood” result can trigger a worry that has nothing to do with biology. Could this be used against you?

In the US, a law called GINA addresses part of that worry. GINA stands for the Genetic Information Nondiscrimination Act. Passed in 2008, it stops health insurers and most employers from using a genetic test result — including a 23andMe polygenic score — to discriminate against you. That protection has a well-known gap, though. GINA does not cover life insurance, disability insurance, or long-term-care insurance. That gap is worth knowing before you apply for any of those policy types.

Canadian readers have a comparable but separate law. The federal Genetic Non-Discrimination Act blocks anyone from requiring a genetic test, or a genetic result, as a condition of getting most goods, services, or jobs. Canada’s Supreme Court upheld the law as constitutional in 2020. Like GINA, it does not extend the same protection to life, disability, or critical-illness insurance. Canadian readers should also check current provincial rules before assuming full coverage.

Beyond insurance law, fibroids carry a real day-to-day weight. Heavy bleeding can disrupt work and daily routines. Fertility worry can weigh heavily, when fibroids affect the uterine cavity. And there is a clear pattern in the research. Fibroids are diagnosed earlier, and cause more severe symptoms, in Black women than in white women. Researchers are still working to explain this gap at the genetic level. This article cannot resolve it. But it is worth naming, so readers can advocate for themselves.

• What GINA covers: most US health insurance and employment decisions
• What GINA does not cover: life, disability, and long-term-care insurance
• What Canada’s law covers: most goods, services, and jobs tied to a genetic test
• What it does not cover: life, disability, and critical-illness insurance in the same way

None of this worry means anything is wrong with you. It’s a normal response to an unfamiliar result. A genetic counselor can help you sort the legal facts from the emotional weight. Find one at NSGC.org.

Section recap: GINA and Canada’s Genetic Non-Discrimination Act both protect against genetic discrimination in health insurance and most jobs. But neither covers life, disability, or long-term-care insurance. A well-known racial disparity in fibroid severity remains an active area of genetics research.

Frequently asked questions

If my 23andMe result shows a higher likelihood for uterine fibroids, does that mean I already have them or will definitely get them? No. A “higher likelihood” result is a probability shift based on population data. It is not a diagnosis, and not a guarantee. Fibroids are already common in the general population. About 70 to 80+ out of 100 women develop them by age 50, no matter their DNA score. Only a pelvic exam and ultrasound can confirm whether fibroids exist in your body right now.

Can my employer find out? In the US, GINA blocks most employers from using a genetic test result against you. That includes a 23andMe polygenic score. Canada’s Genetic Non-Discrimination Act offers similar protection for most jobs. As with insurance, a genetic counselor can walk through the details that apply to your own situation.

Should I get a second opinion? Maybe a “higher likelihood” score, a strong family history, or a confirmed fibroid has left you unsure what to do next. A second opinion from an OB-GYN, or a genetic counselor, is a reasonable, low-cost step. It’s especially worth taking before any decision about testing, treatment, or fertility plans.

Will my daughter inherit fibroids from me? There’s no single-gene path to pass on, so there’s no clean yes-or-no answer. Your daughter has a somewhat higher likelihood, reflecting shared genes and often shared ancestry-linked risk factors. But it is not a fixed outcome. Family history is worth mentioning at her first gynecologic visit.

Can a genetic fibroid result affect my health or life insurance? In the US, GINA blocks health insurers and most employers from using the result against you. But it does not cover life, disability, or long-term-care insurance. Canada’s Genetic Non-Discrimination Act works in a similar way, with a similar gap for those same insurance types.

Summary

Uterine fibroids are common, and polygenic. More than 80 gene regions shape risk, rather than one inherited mutation. A 23andMe “higher likelihood” score reflects that polygenic pattern. But it is a probability estimate, not a diagnosis. Only a pelvic exam and ultrasound can confirm whether fibroids exist. Fibroids are already very common regardless of genetic score. Roughly 70 to 80+ out of 100 women develop them by age 50. A racial disparity in severity is well known, and still being studied. Treatment has moved forward with MYFEMBREE. It has a documented FDA approval from 2021, and a separate Health Canada approval from 2023, distinct from its later Canadian launch in 2024. Established procedural options remain too: uterine artery embolization, myomectomy, and hysterectomy. Because inheritance is polygenic, there is no single-gene cascade test for relatives. So family guidance centers on awareness, not genetic screening. And US and Canadian law both offer real, but incomplete, protection against genetic discrimination. None of this replaces a conversation with your own OB-GYN about your specific history, symptoms, and fertility plans.

This article is for educational purposes only. It is not a substitute for advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. For any decisions about testing, treatment, or care, consult a qualified clinician. In emergencies, call 911.

References

1. Kim J, Velez Edwards DR, Hellwege JN, et al. “Genome-wide meta-analysis identifies novel risk loci for uterine fibroids within and across multiple ancestry groups.” Nature Communications. 2025;16(1):2273. PMID 40050615. https://www.nature.com/articles/s41467-025-57483-5
2. “Efficacy and safety of relugolix combination therapy in women with uterine fibroids and adenomyosis: subgroup analysis of LIBERTY 1 and LIBERTY 2.” Fertility and Sterility. 2025;124(3):523-533. PMID 40320117. https://pubmed.ncbi.nlm.nih.gov/40320117/
3. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. “High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence.” American Journal of Obstetrics and Gynecology. 2003;188(1):100-107. PMID 12548202. https://pubmed.ncbi.nlm.nih.gov/12548202/
4. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH. “Uterine Fibroids.” https://www.nichd.nih.gov/health/topics/uterine
5. US Food and Drug Administration. Drugs@FDA — MYFEMBREE, NDA214846, approval and supplement history. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/214846s012lbl.pdf
6. Health Canada. Drug Product Database — MYFEMBREE, DIN 02541742. https://dhpp.hpfb-dgpsa.ca/dhpp/resource/103029
7. US Equal Employment Opportunity Commission. Genetic Information Nondiscrimination Act of 2008 (GINA). https://www.eeoc.gov/statutes/genetic-information-nondiscrimination-act-2008
8. Government of Canada. Genetic Non-Discrimination Act, S.C. 2017, c. 3. https://laws-lois.justice.gc.ca/eng/acts/g-2.5/
9. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas. Obstetrics & Gynecology. 2021;137(6):e100-e115. PMID 34011888. https://pubmed.ncbi.nlm.nih.gov/34011888/
10. Gupta JK, Sinha A, Lumsden MA, Hickey M. “Uterine artery embolization for symptomatic uterine fibroids.” Cochrane Database of Systematic Reviews. 2014. DOI 10.1002/14651858.CD005073.pub4. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005073.pub4/full
11. Harmon QE, et al. “Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study.” Fertility and Sterility. 2022. PMID 36150919. https://pubmed.ncbi.nlm.nih.gov/36150919/
12. Munro MG, Critchley HOD, Broder MS, Fraser IS, for the FIGO Working Group on Menstrual Disorders. “FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.” International Journal of Gynecology & Obstetrics. 2011;113(1):3-13. PMID 21345435. https://pubmed.ncbi.nlm.nih.gov/21345435/

Last updated: 2026-09-18

Author: Yu Mizuno (Editor-in-Chief, non-physician), GeneLumen editorial team. This article aggregates 12 sources from peer-reviewed medical literature and public health agencies (tier 1=9 / tier 2=3), including NIH, FDA, Health Canada, ACOG guidelines, and PubMed-indexed publications.

This article is for educational purposes only and is not a substitute for medical advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. In emergencies, call 911 (US/Canada) or 119 (Japan).

Image: Illustrations via Irasutoya (https://www.irasutoya.com/).

Related: Genetic Diseases category

🇯🇵 For readers in Japan — a separate Japanese edition written for Japan’s healthcare system (not a translation): https://genelumen.com/ja/ja-genetic-diseases/uterine-fibroids-genetic-risk