Women can often become pregnant even with uterine fibroids. These common, non-cancerous growths develop in or on the wall of the uterus. While many women with fibroids experience normal fertility and pregnancy outcomes, understanding their potential impact is important for conception and a healthy pregnancy.
Understanding Fibroids
Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that form within the uterus. They are the most common non-cancerous tumors found in females, affecting up to 70% of women of reproductive age. Many individuals remain unaware of their presence due to a lack of symptoms.
Fibroids vary significantly in size, ranging from a seed to larger than a grapefruit. Their location within the uterus is a key factor influencing symptoms or impacts. Intramural fibroids develop within the muscular wall. Subserosal fibroids grow on the outer surface, while submucosal fibroids develop just beneath the inner lining and protrude into the uterine cavity. Some fibroids, known as pedunculated, attach to the uterus by a stalk.
Impact on Conception
Many women with fibroids can conceive naturally and experience successful pregnancies. However, conception can be influenced by the fibroids’ size, number, and most significantly, their location. Fibroids positioned closer to the uterine cavity or endometrium are more likely to interfere with fertility. Submucosal fibroids, in particular, are noted for their potential to reduce conception rates, sometimes by as much as 70%.
Fibroids can hinder conception by altering the shape of the uterus or cervix, impeding sperm transport or embryo implantation. Submucosal fibroids can distort the uterine cavity, making it difficult for an embryo to attach and develop. Additionally, fibroids can affect blood flow to the uterine lining or create an inflammatory environment, impacting embryo implantation. In some instances, fibroids near the fallopian tubes may obstruct them, preventing the egg and sperm from meeting.
Fibroids During Pregnancy and Delivery
During pregnancy, fibroids may grow, especially in the first trimester, or remain stable or shrink due to hormonal changes. The most common complication fibroids cause is pain, often experienced by women with larger fibroids (over 5 cm) during the second and third trimesters. This pain results from degeneration, a process where the fibroid outgrows its blood supply, leading to symptoms such as severe pain, nausea, and fever.
Fibroids can increase the risk of pregnancy complications. These include a higher likelihood of miscarriage, particularly with fibroids located within the uterine cavity. They may contribute to preterm labor, as pain associated with fibroids can trigger uterine contractions. Other potential complications include placental abruption, where the placenta separates from the uterine wall, and fetal growth restriction, as large fibroids can limit space for the baby’s development. Fibroids can also lead to an abnormal fetal presentation, such as a breech position, especially if located in the lower part of the uterus.
Fibroids can also affect the delivery process. Women with fibroids have an increased risk of needing a C-section, sometimes up to six times higher than those without fibroids. This may occur if fibroids block the birth canal or interfere with the uterus’s ability to contract effectively during labor. Additionally, fibroids can increase the risk of postpartum hemorrhage, or excessive bleeding after delivery, due to their potential to interfere with uterine contractions that normally help control blood loss.
Management and Treatment Approaches
For women with fibroids who wish to conceive, surgical removal (myomectomy) is a primary approach when fibroids significantly affect conception, particularly if they distort the uterine cavity. Laparoscopic myomectomy, a minimally invasive procedure, can improve fertility outcomes by enhancing endometrial receptivity. After myomectomy, a waiting period of three to six months is advised before attempting pregnancy to allow for complete uterine healing.
During pregnancy, fibroid management is primarily conservative due to potential risks to the fetus. Most fibroids are monitored throughout pregnancy, and many women experience no significant problems. If pain occurs, it can often be managed with bed rest, hydration, and mild pain relievers such as acetaminophen. Surgery to remove fibroids during pregnancy is rare, generally reserved for emergency situations where conservative measures are insufficient. Regular prenatal care, including ultrasound monitoring, is important for assessing both fetal health and fibroid size, and consulting with a reproductive health specialist is recommended for a personalized plan.