Fibroids and Pregnancy mm03

Approximately 40% to 60% of women of childbearing age have fibroids. The percentage could be even higher because only about 25% of women experience symptoms. Fibroids are often discovered for the first time during a routine pelvic exam or prenatal care.

There are risks associated with fibroids while pregnant. Fibroids can interfere with becoming pregnant and pregnancy itself. The degree to which they interfere with becoming pregnant, or having a healthy pregnancy, depends on the size and location of the fibroid(s).

What Are Fibroids?

Uterine fibroids are nodules of smooth muscle cells and fibrous connective tissue that grow within the wall of the uterus (womb). They’re the most frequently diagnosed tumors of the female pelvis. Fibroids don’t increase a woman’s risk of developing cancer and almost never develop into cancer.

The medical term for fibroids is uterine leiomyomata (multiple fibroid tumors) or leiomyoma (single fibroid tumor). Other names for fibroid tumors include:

  • Fibromas
  • Fibromyomas
  • Myofibromas
  • Myomas

Fibroids can grow slowly or quickly. They can also stay about the same size.

Fibroids can grow as a single nodule or in clusters. They range from pea-sized to larger than a cantaloupe.

What Causes Uterine Fibroids?

What causes uterine fibroids is unclear. Researchers think more than one factor could play a role.

Women with a family history of fibroids are more likely to develop the condition. Fibroids also occur two to three times more frequently in Black women.

Fibroid growth seems related to hormones, especially estrogen. The vast majority of fibroids occur during childbearing years.

Uterine fibroids can expand rapidly during pregnancy when estrogen levels are high. Hormonal changes in pregnancy may not affect them.

Fibroids are rare in young women who haven’t started menstruation. They usually shrink or stop growing after menopause when estrogen levels decrease. Other hormones, such as progesterone, may also affect fibroid growth.

Other factors that may contribute to fibroids include:

  • Age.
  • Dietary factors.
  • First period before age 10.
  • High blood pressure.
  • Hormonal birth control.
  • Obesity.
  • Race or ethnicity.

What Are the Symptoms of Fibroids?

Most women don’t have any symptoms associated with fibroids. Serious symptoms from fibroids are also uncommon. The 25% of women who do have fibroid symptoms may experience:

  • Excessive or painful bleeding during menstruation or bleeding between periods.
  • Frequent urination from large fibroids pressing on the bladder.
  • Pain during sexual intercourse or low back pain.
  • Reproductive symptoms.
  • Swelling, bloating, and a sensation of fullness in the lower abdomen.

Can Fibroids Cause Infertility?

Infertility because of fibroids is rare. However, fibroids can make getting pregnant more challenging.

Depending on the location and size of fibroids, they can block the fallopian tubes or interfere with embryo implantation in the uterus. Fibroids can also change the shape of your uterus, which can make getting pregnant more difficult.

You may want to talk to your doctor about your options to remove or shrink the fibroids if you experience multiple miscarriages. There are medications and minimally invasive procedures to treat fibroids without removing your uterus.

What Are the Risks of Fibroids While Pregnant?

There are some risks associated with having fibroids while pregnant. The majority of women who have fibroids when they become pregnant will have a healthy, uncomplicated pregnancy.

There’s no significant cause for concern if you already have small fibroids that aren’t causing symptoms when you get pregnant. Having fibroids doesn’t mean you have a high-risk pregnancy. An increase in estrogen during pregnancy may cause them to grow. They’re likely to get smaller again after delivery.

All obstetricians have experience dealing with fibroids and pregnancy. Most women don’t need to see a specialist, but talk with your care team about your risks if you have fibroids and become pregnant.

What Are the Complications of Fibroids During Pregnancy?

Women who have fibroids are more likely to have problems during pregnancy and delivery than women who don’t. The risks are very low; however, these are the most common problems associated with pregnancy and fibroids:

  • Breech birth. A breech presentation occurs when a baby’s buttocks, feet, or both come out first during birth instead of the head.
  • Cesarean section. The risk of needing a C-section is six times greater for women with fibroids.
  • Labor fails to progress (prolonged labor). The cervix starts to dilate but stops before it fully dilates to 10 centimeters. Another possibility is that the cervix has fully dilated, but the baby has stopped moving down the birth canal.
  • Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus doesn’t get enough oxygen.
  • Preterm delivery. When a baby is born prior to 37 weeks of pregnancy.

What Are the Treatment Options for Fibroids?

There are a variety of treatment options for fibroids. Patients with uterine fibroids had limited treatment options until recently.

The most common way to treat fibroids has historically been a hysterectomy, or removal of the uterus. The number of hysterectomies has declined in recent years. The procedure is still the only way to completely prevent fibroids from recurring.

Today’s medical advances offer more choices and alternatives to manage fibroid symptoms for women who are planning to have children and/or some years away from menopause. UPMC Magee-Womens Hospital offers a variety of treatment options, including:

  • Hormonal and nonhormonal medication therapy. Hormonal therapy includes most forms of birth control as well as gonadotropin-releasing hormone (GnRH) antagonists/agonists. Tranexamic acid is a nonhormonal medication that helps to decrease heavy bleeding during periods.
  • Surgical treatments. These may include laparoscopic radiofrequency ablation, myomectomy, or hysterectomy.
  • Uterine fibroid embolization. A minimally invasive procedure that uses thermal energy to shrink uterine fibroids.
  • Watchful waiting. Monitoring fibroid growth and watching for any new symptoms or changes in symptoms.

If you’re having trouble with fibroid symptoms, talk to your doctor about the treatment options available to you.

The type of treatment that is best for you will depend on factors including the size, location, and number of fibroids you have, your medical history, and your childbearing status.

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