A 40‑year‑old woman’s uterine fibroid grew huge during pregnancy, got infected after birth, and had to be removed by a hysterectomy. The case mentions that a GnRH antagonist was used before the fibroid was expelled, but the report is just a single medical case and does not give any advice that can be applied to health‑hacking or longevity.

Uterine myomas during pregnancy can cause significant complications, but postpartum expulsion is rare, particularly from intramural lesions without a stalk. We report the case of a 40-year-old primigravida whose posterior wall intramural myoma enlarged from 3 cm to 21 cm during infertility treatment and pregnancy. The myoma caused inferior vena cava compression, leading to deep vein thrombosis, and remained stable in size after mid-gestation. Vaginal delivery at term was uneventful. Postpartum, the patient developed recurrent genital bleeding and inflammatory signs. Magnetic resonance imaging initially suggested red degeneration, but later revealed penetration of the myoma into the cervical canal, indicating expulsion. Intraoperative findings showed a necrotic, malodorous myoma; cultures grew <i>Escherichia coli</i> and <i>Morganella morganii</i>. Histopathology confirmed pyomyoma with extensive neutrophil infiltration. Given the absence of a stalk and the high risk of sepsis and hemorrhage, a total abdominal hysterectomy was performed, resulting in full recovery. This is the first documented case of postpartum intramural myoma expulsion requiring abdominal hysterectomy following gonadotropin-releasing hormone (GnRH) antagonist administration. Early recognition of infection-related degeneration, careful assessment of myoma morphology, and timely surgical intervention are essential to prevent life-threatening complications in similar cases.