Uterine Fibroids During Pregnancy: Symptoms And Treatment

When pregnant, a woman could be exposed to many health conditions. For example, uterine fibroids during pregnancy is a common and benign condition that may affect reproductive health in many ways. According to the researchers, about 1.6 to 16.7% of all pregnant women are diagnosed with fibroids at different stages during pregnancy (1). However, a few studies have demonstrated that uterine fibroids could pose certain pregnancy risks in the first trimester. On the contrary, others suggest that uterine fibroids could increase the risk of a C-section. Altogether the size and location of the fibroid in the uterus are vital factors that determine if it might cause any obstetricⁱRelated to pregnancy, childbirth, and the postpartum period. complications. Keep reading to learn about the types, diagnoses, possible risks, and treatment of uterine fibroids during pregnancy.

What Are Uterine Fibroids?

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Uterine fibroids, also referred to as leiomyoma or myoma of uterus, are non-cancerous tumors that grow abnormally in the uterine region. The good news is that in no way does fibroid tumor increase your chances of uterine cancer and it is not cancerous in any way. This is also known as myoma or leiomyoma. Let’s have a closer look here:

• It is a mass of fibrous tissue and compacted muscle that grows along the uterus wall.
• The tumor can be of the size of a pea or it may be as large as a grape fruit.
• Fibroid tumor is common among 50% to 80% of women.
• They usually develop after the commencement of menstrual cycle.

Who Gets Fibroids?

Although there are no concrete factors proved to trigger a fibroid growth, below are some factors that make women susceptible to them. Fibroids are more common among:

• Women around 35 years of age.
• Women who are overweight or obese.
• Women who are not on contraceptive pills

During pregnancy too, there is a possibility to develop fibroid complications. If you are planning to conceive or are already pregnant.

Types Of Fibroids During Pregnancy

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There are different kinds of fibroids based on the location where they sprout from in the uterine region:

1. Intramural Fibroids:

These fibroids are the most common types that grow within the muscle wall of the uterus. Intramural fibroids tend to grow large in size, making the uterus full.

2. Submucosal Fibroids:

These fibroids grow under the inner lining of the uterus known as endometrial lining.

They cause heavy and painful periods along with fertility problems.

Research finds

Submucous fibroids, which have been reported in 5%-18% of patients, are likely to be a cause of infertility. Submucous fibroids are thought to be responsible for menometrorrhagia (excessive uterine bleeding), preterm labor, and postpartum hemorrhageⁱHeavy blood discharge from blood vessels after childbirth. (8).

3. Subserosal Fibroids:

These fibroids grow on the outside of the uterus, stretching into the pelvis.

• Subserosal fibroids may put additional strain on the bladder or bowel.
• Both submucosal and subserosal fibroids may grow from a stalk like structure, thus getting the name pedunculated fibroid.

4. Cervical Fibroids:

As the name suggests, these fibroids grow in the neck of your cervix.

Uterine Fibroids During Pregnancy Symptoms

It is very important that you stay aware of the signs and symptoms of uterine fibrosis in pregnancy, so that you do not confuse it to be something else. Have a look here:

• You may feel the urge to urinate frequently
• Feel pressure on your pelvis
• Pain in the back
• Pain in legs
• Abdominal pains
• Vaginal bleeding
• Cramping
• Pain while urinating
• Fullness of abdomen that causes extra pressure and constipation
• Frequent unexplained miscarriages

You must always report to your doctor about vaginal bleeding and abdominal pains to avoid any further complications.

Diagnosis For Uterine Fibroids

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Once your doctor is informed about the above symptoms, he or she will diagnose the presence of fibroids with the below tests:

• An ultrasound scan to examine the inside of your uterus
• An obstetrics and gynecology specialist will check for the presence of any lumpy structures or abnormality in the shape of your uterus.

Uterine Fibroids And Pregnancy Complications

Fibroids generally develop before pregnancy. In many cases women remain unaware of the presence of the tumor until they get an ultrasound done.

• You can also detect the tumor with a pelvic exam. Also, watch out for the above mentioned symptoms.
• When you know about your fibroids beforehand, you can ask your doctor about the probable complications in your pregnancy.
• These are non-cancerous developments that generally do not interfere with your pregnancy.
• Around 30% of the women face complications in pregnancy such as abdominal pains along with vaginal bleeding.
• Unless your bleeding is substantial, your baby will be rarely affected.
• Submucosal fibroids directly affect the ability to conceive as they distort the entire uterus, thereby disturbing the implantation of the embryo even after fertilization.
• The sooner you try to conceive, the lesser the chances of infertility due to fibroids or even the occurrence of the fibroids.

Brittany Hyden, a mother to a lovely boy, reflects on the challenges she faced during her pregnancy, primarily caused by uterine fibroids. She shares, “I experienced horrible cramping around 12 weeks … For the first few days, I just went with it. Then, it got worse. Like, so much worse. I could barely move! So we went to urgent care to get looked at (since it was the weekend and I didn’t have a doctor in the new town we were living in).

“Turns out, the fibroid, which had grown from 4 cm to 8 cm, was “degenerating,” meaning it was fighting the growing baby for blood supply, and the fibroid was losing. The baby was okay, but the doctor was concerned about how large the fibroid was. I was so anxious to get to the real OB… After my first visit with the new OB, she suggested monthly anatomy scans to watch the fibroid. By 4 months, it had grown to 10cm, the size of a grapefruit. It was positioned right above my pubic bone and above my bladder. My doctor started calling it the baby’s twin… After the 10 cm measurement around 4 months, it did not grow anymore (YAYAYAY!)… (i).” Hyden ended up delivering a healthy baby vaginally.

Research finds

Two studies indicate that the risk of placenta previa is two times higher when fibroids are present (9).

• If your doctor feels that the presence of a fibroid is affecting your plans to conceive, he or she may recommend you to try conceiving for up to two more years.
• If you are over 34, chances of conceiving become lower. This is the instance where your doctor will recommend treating the fibroid through any of the above options except UAE.

Things to know

Other uterine fibroids complications include placenta abruption (a condition where the placenta separates early from the uterus) and labor dystocia (difficult labor) (9).

Uterine Fibroids And The Effect On Your Baby

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Well, most probably your baby will not be affected in any way by the uterine fibroids. Let’s take a closer look here:

• Even though there are no such huge risk factors involved, the chances of premature delivery or miscarriage may be slightly high in this case.
• Your baby may be in an abnormal position at times during pregnancy.
• The fibroids can stall labor or may even block the passage if located near the opening of the cervix.
• These are rare problems that might increase the chances of a cesarean section.

Quick fact

A systematic review found that women with fibroids had a 3.7-fold higher risk of cesarean delivery (9).

Should Fibroids Be Treated?

The fibroids are not required to be removed unless they are seriously interfering with your routine, causing pain and discomfort.

• If you are already pregnant and the fibroids are fast growing inside, it is stated that pregnancy itself will minimize the growth.
• The more number of pregnancies you have, the lesser are the chances for the fibroids to develop.

Treatment During And After Pregnancy

If you are already in the vicious trap of symptoms such as heavy menstrual bleeding, pain and difficulty in conceiving, you can insist your doctor to explain to you, the different treatments that are available for fibroids.

The final call will be taken by your health care provider looking at the seriousness of the condition. The main forms of fibroid during pregnancy treatment available are as below:

1. Hormone-Balancing Drugs:

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Uterine fibroids are responsive to both estrogen and progesterone. Drugs that release a hormone called gonadotrophinⁱHormones that work in the ovaries of a woman and the testes of a man and help in the maturation and functioning of the sex glands. may be prescribed. This hormone acts like a counteroffensive to your estrogen levels, reducing the production and thereby limiting the possibility of more fibroids growing.

• Gonadotrophin based drugs also help in shrinking the size of the existing fibroids.
• These drugs, also known as GnRHas are either prescribed in the form of injection, nasal spray or implants that are placed under your skin.
• GnRHas drugs have heavy side effects that result in hot flashes, dry vagina and weaker bones. Hence these are given over a long stretch of 3 to 6 months.

2. Myomectomy:

This is a surgical procedure that is used to remove the fibroids via operation. During this procedure, a surgery is performed with the help of laparoscopyⁱA surgical technique that enables a surgeon to reach the belly and pelvis from the inside through a small incision. or hysteroscopyⁱA procedure used to examine and treat the uterus for any abnormality through a tube called a hysteroscope. .

• The recovery time from a myomectomy largely depends on the size of the fibroids removed.
• For larger fibroids, the period to recover is quite long where after you will be recommended a strict bed rest for many number of days.
• Myomectomy is highly useful for women who are seriously planning to conceive and have children. However, there is no guarantee that fibroids will not grow back again.

3. Endometrial Resection Or Ablation:

An endometrial resection or ablation is a non surgical process. This procedure is largely used for the treatment of submucosal fibroids that grow in the inner lining of the uterus.

• During this process, the endometrial tissue from the inner lining is surgically removed, in the area where the fibroid is growing.
• After the completion of treatment, women can try conceiving again.

4. Myolysis:

Myolysis is a procedure that is carried out with a keyhole surgery using a laparoscope or hysteroscope.

• A sonogram or MRI is then used to detect the exact position of the fibroid.
• The surgeon will then insert a needle probe or electric current into the fibroid to cauterise both the fibroid and the surrounding blood vessels.

5. Uterine Artery Embolisation (UAE):

This process is performed by an experienced radiologist, who will use the magnetic resonance imaging (MRI) scan to detect the location of the fibroid.

• The MRI will also show a clearer view of all the blood vessels surrounding the fibroid.
• The radiologist will then inject a plastic plug into the blood vessel to cut off the blood supply to the growing fibroid.
• This is an effective procedure where fibroids are shrunk completely. This procedure also cannot guarantee that fibroids will never return again.
• Most women may have to repeat the procedure after few years once there is another onset.
• Unlike myomectomy or endometrial resection, UAE does not guarantee as whether women who undergo the process will conceive again.

In most of the cases, fibroids are nothing more than pain in the belly. Thus, there is no need to worry unless the symptoms are causing too much problem in your pregnancy.

Tips And Caution

Your doctor will mostly put you on bed rest and medications for uterine fibroids while pregnant.

• Also, you will constantly check throughout your pregnancy, via ultrasound, to see how the fibroids present themselves from time to time.
• A necessary course of action will be taken by your doctor if he or she feels that there is an immediate threat to maternal health or pregnancy because of the fibroid.
• It is indeed an uncomfortable condition to have, but do not worry – there are many options available to treat fibroids. We hope this article has given you the info on such options and makes your decision a little easier.

Infographic: Types Of Uterine Fibroids And Their Symptoms

Uterine fibroids are common in women of reproductive age and menopause; however, they may also occur during pregnancy. But knowing the symptoms and the type of uterine fibroids can help you seek timely treatment. The infographic below includes information on different types of uterine fibroids and their symptoms you should be aware of.

Illustration: Momjunction Design Team

Image: Dall·E/MomJunction Design Team

Learn about the effects of fibroids on pregnancy, menopause, and natural remedies to help manage symptoms. Discover how to reduce the risk of complications and improve your quality of life.

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Reviewer Author Editor Fact Checker

Dr. Surakshith BattinaMD

Dr Surakshith Battina is a reproductive medicine specialist, an endoscopic surgeon and a cosmetic gynecologist with over eight years of experience. He completed his MBBS from Sri Ramachandra University and his MD in Obstetrics and Gynecology from Annamalai University and currently practices at Indigo Womens Center, Chennai.

Read full bio of Dr. Surakshith Battina

Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

Read full bio of Rebecca Malachi

Swati PatwalM.Sc. (Food & Nutrition), MBA

Swati Patwal is a clinical nutritionist, a Certified Diabetes Educator (CDE) and a toddler mom with more than a decade of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children.

Read full bio of Swati Patwal

Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer.

Read full bio of Dr. Joyani Das