Boil salted water in a large pot and cook the fettuccine according to package instructions. Drain and set aside.
In a large skillet, melt butter over medium heat. Add minced garlic and sauté until fragrant (about 1 minute).
Stir in the pumpkin puree and cook for 1–2 minutes to let the flavors blend.
Slowly pour in the heavy whipping cream while stirring. Simmer gently for 4–5 minutes until slightly thickened.
Add Parmesan cheese and stir until melted and creamy.
Season with salt and pepper to taste.
Toss in the cooked pasta and coat well with the sauce.
Serve warm, topped with extra cheese or fresh herbs if desired.