I’m pregnant AND have fibroids. Is this bad?
Q: I’m about two months pregnant, and my doctor just told me I have fibroids. Will this complicate the pregnancy? Should I be worried?
A: Probably not. However, you — and your doctor — should be cautious, as I’ll explain below.
First, a little background. Fibroids are very common. Recent estimates suggest that as many as 35 percent of women over the age of 35 develop these benign uterine growths. But 35 is an arbitrary “start-off” age used by medical statisticians; and it is common for a younger woman to be given a fibroid diagnosis during routine pregnancy ultrasound, especially if she has a family history of fibroids or if she is African-American (in which case the incidence of fibroids is much higher).
Yes, a fibroid can affect a woman’s pregnancy, but, surprisingly, the numerous studies that have been performed often disagree on the extent. (This is most likely because fibroids come in varying sizes and locations, and the studies often vary in what they are addressing.) What we do know is that pregnancy hormones cause the uterus to grow in order to accommodate the enlarging fetus, and a co-existing fibroid may grow simultaneously. The majority of fibroid growth seems to occur during the first few months of pregnancy.
Although most fibroids will not cause harm during pregnancy or delivery, it is important to be aware of the following potential complications:
If the fibroid outgrows its blood supply, it may undergo “red degeneration” (it bleeds into itself) or “white degeneration” (portions of the fibroid undergo cell death and liquefy or become cystic). Both of these conditions can cause pelvic and/or abdominal pain. Usually the pain (which is temporary) can be controlled with oral pain medications. In rare cases, the pain becomes severe enough to necessitate hospitalization for epidural pain management and in the worse case scenario, necessitate fibroid removal surgery (myomectomy).
Complications during early pregnancy
Fibroids may cause bleeding and increase the risk of early miscarriage, but even here studies are not very conclusive. The type of fibroid most likely to cause problems is one that grows into the uterine cavity (submucosal). Because it disrupts the lining of the uterus it can prevent normal implantation of the pregnancy or the ongoing growth of the placenta. Some data show that uterine fibroids may also increase the risk of second-trimester miscarriage, but that risk seems to be fairly small. Procedures such as amniocentesis or chorion villus sampling (CVS) may be more difficult in women with fibroids and result in complications such as ruptured membranes, contractions and miscarriage.
Complications during late pregnancy
The major concerns regarding fibroids are preterm labor, abnormal separation of placenta — placental abruption — or fetal growth restriction. If a fibroid is large or there are multiple fibroids, the risk of preterm labor may be higher. Placental abruption is more likely to occur if the fibroid is large or has grown into the area where the placenta has attached. It’s not clear whether fibroids restrict fetal growth. One recent study of more than 12,000 pregnant women did not demonstrate that fetal growth restriction was more common among the women with fibroids.
Complications during delivery
A strategically “misplaced” fibroid can cause the baby to lie in breech or transverse position and an elective C-section may be in order. Even if the baby is positioned head-down (vertex) the fibroid can block its descent and the progress of labor, again necessitating a C-section. Sizable fibroids also increase the risk of heavy bleeding after delivery (postpartum hemorrhage). In addition, they can block the expulsion of the placenta, and may also prevent proper contraction of the uterus after delivery.
Because of these potential problems your doctor may indeed opt to perform a Cesarean section. However, you should know that most doctors will not attempt to remove the fibroid during this surgery for fear of heavy bleeding. The fibroids may shrink considerably once your uterus “recovers” from its pregnancy state (about six weeks). If they remain large, continue to grow or cause abnormal bleeding, surgery — or one of the other fibroid treatments such as embolization (essentially, cutting off the blood supply to the fibroid so they shrivel up) — should be considered at a later date.
I realize this is a scary list of potential complications, but there is no certitude that they’ll occur. And though many physicians will suggest undergoing some form of fibroid removal or treatment before conceiving, there’s still no consensus on when to categorically recommend a pre-pregnancy procedure.
Once you’re pregnant, most doctors will monitor you conservatively, with a “let’s-wait-and-see” attitude. If pain develops, or if there is any bleeding or suspicion of premature labor, medication and bed rest may be advised. If the pain becomes severe or a uterine fibroid seems to be growing rapidly, your doctor may recommend a myomectomy (fibroid removal), even during the pregnancy.
I myself underwent this type of surgery when I was pregnant with my last child. Admittedly, it was many years ago and methods of ultrasound were fairly simplistic, but the doctors and I feared that the rapidly developing “tumor” I had was of ovarian origin. Thankfully, it turned out to be a pedunculated fibroid — one on a stalk — and was removed without complications during my fourth month of pregnancy. I was put on bed rest for the next four months and ultimately delivered a healthy, seven-pound baby girl.
Dr. Reichman’s Bottom Line: Fibroids, while generally harmless, can increase the risk of complications during pregnancy both for you and for your baby. It is important to have supportive, vigilant prenatal and delivery care.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.