Uterine fibroids are common, non-cancerous growths that develop in the uterus. These growths can range significantly in size, from as small as a pea to larger than a grapefruit. During pregnancy, individuals often have concerns about how fibroids might behave and impact their journey.
Fibroid Behavior During Pregnancy
During pregnancy, uterine fibroids can vary in behavior, but most tend to remain stable in size or grow. This growth is influenced by elevated estrogen and progesterone hormones, and increased uterine blood flow. While some fibroids, especially smaller ones, may grow in the first trimester, most do not show significant changes in volume throughout pregnancy. Factors like the fibroid’s initial size, type, location, and an individual’s hormonal response can influence these changes, with some even decreasing in size or showing no notable change.
Potential Pregnancy Complications
While many pregnancies with fibroids proceed without issues, these growths can sometimes lead to complications. Pain is a common symptom, particularly for larger fibroids, often occurring in the second and third trimesters. This pain can result from “red degeneration,” where the fibroid outgrows its blood supply, causing severe abdominal discomfort. Fibroids may also increase the risk of early pregnancy loss, with a higher miscarriage rate compared to pregnancies without fibroids.
Later in pregnancy, fibroids can be associated with an increased chance of preterm labor, meaning delivery before 37 weeks of gestation. Placental abruption, a serious condition where the placenta detaches from the uterine wall prematurely, is another potential risk, especially if the fibroid is near the placenta. During delivery, fibroids may lead to challenges such as fetal malpresentation, where the baby is not in a head-down position, or obstruction of the birth canal. This can increase the likelihood of needing a Cesarean section.
Managing Fibroids During Pregnancy
The management of fibroids during pregnancy focuses on monitoring and alleviating symptoms, as active treatment is avoided to minimize risks to the developing fetus. Healthcare providers monitor the fibroids’ size and location through regular ultrasounds. For pain relief, rest, hydration, and certain pain medications like acetaminophen are recommended. Non-steroidal anti-inflammatory drugs (NSAIDs) are avoided, especially in late pregnancy, due to potential risks to the baby. Surgical removal of fibroids during pregnancy, known as myomectomy, is rarely performed and only considered in severe cases, such as intractable pain from a degenerating fibroid or if a fibroid obstructs the birth canal.
Post-Pregnancy Fibroid Changes
Following childbirth, uterine fibroids commonly shrink in size. This natural regression is primarily due to the decrease in pregnancy hormones, particularly estrogen and progesterone, and the process of uterine involution, where the uterus contracts to return to its pre-pregnancy size. Many women experience a significant reduction in fibroid volume after delivery. While many fibroids may revert to their pre-pregnancy dimensions, some may persist or continue to cause symptoms, potentially requiring future monitoring or treatment.