Fibroids are small – normally benign – tumors that grow from the muscle tissue in the uterus. They can range in size from a grapefruit to a pea. They can grow in multiple places from inside the uterine cavity, outside or inside the uterine wall. Many women commonly have multiple fibroids of varying sizes. But can fibroids affect pregnancy?

Around 40% to 60% of women have fibroids by the age of 35, and 50% by the age of 50. However, when it comes to pregnancy, detecting them can be more difficult. This is because when the woman’s uterus muscles thicken during pregnancy, it can be hard for doctors to tell if fibroids have formed.

Most women who develop fibroids during pregnancy go on to have normal pregnancies. However, it’s possible that they can be the cause of some challenges in rare cases. Depending on the position and size of the fibroids, some factors can determine how significant a fibroid is during pregnancy.

Can Fibroids Affect Pregnancy?

If fibroids are found to be present during pregnancy, it can cause several issues within the development of the baby. It may also cause a difficult labor.

Fibroids can increase the risk of premature labor and cause pain during pregnancy. If the fibroids block the birth canal, a cesarean section (C-section) may be required for delivery. In other rare cases, fibroids can cause a miscarriage during the first 23 weeks of pregnancy.

It’s good to talk to your doctor to make sure there is no fibroid development. If there is, your healthcare provider can give you further information and advice on how to handle them if you are pregnant.

Infertility

Infertility is the inability to become pregnant. Where fibroids are present, large fibroids can make a woman infertile. Fibroids can prevent fertilized eggs from attaching themselves to the lining of the womb or prevent the sperm from reaching the egg. However, this doesn’t happen often.

If a woman develops a submucosal fibroid, it can block the fallopian tube which makes it harder to become pregnant.

How Fibroids Affect Each Pregnancy

Most women don’t have to worry about experiencing any fibroid complications. However, studies show that 10-30% develop complications due to fibroids. These can be:

• Pain (most common)
• Vaginal bleeding
• Spontaneous miscarriage
• Preterm labor
• Placenta abruption
• Cesarean delivery
• Postpartum hemorrhage

Pregnancy not only increases the risk of complications, but it can also worsen some of the symptoms. Pain and discomfort from fibroids may intensify during pregnancy due to the surge in hormones. This is because fibroids rely on estrogen to grow.

First Trimester

The first trimester is already challenging enough with morning sickness. Yet, it is also the most common time for fibroids to develop. During these first 12 weeks, about ⅓ of pregnant women grow fibroids.

Complications during the first trimester may include:

• Pain: Throughout pregnancy, pain is the most common issue caused by fibroids. It may occur in the pelvis, abdomen, lower back, hip, or down the leg.
• Vaginal Bleeding: Although spotting during early pregnancy is common and often harmless, any bleeding can be alarming. If you experience any, we recommend contacting your doctor immediately. During research, out of 4500 women, 59% just had pain, 30% had both bleeding and pain, and 11% had bleeding.
• Early Miscarriage: Early miscarriage rates are nearly twice as high in women with fibroids. They occur in 14% of pregnancies for women with fibroids vs. 7.6% for women without them. Multiple fibroids, as opposed to large individual ones, appear to increase this possibility.

Second and Third Trimesters

During these trimesters, your uterus expands so your baby can grow. Unlike the first trimester, fibroid growth is very seldom. If fibroids develop during the second or third trimester, complications can still arise. These may include:

• Preterm Labor

Any birth contractions that begin before 37 weeks gestation are considered preterm labor. Symptoms can include changes in vaginal discharge, pelvic pressure, back pain, abdominal cramps, and contractions.

In addition, your water can break. Your doctor may try to stop or slow down preterm labor with the use of medication. Although some preterm babies go on to have healthy lives, others experience lifelong consequences.

• Pain

This is one of the most common symptoms. If the fibroids grow large, they may potentially twist. This can cause discomfort – specifically cramping. At other times, the fibroid dies after it outgrows its blood supply. This is called “red degeneration” and can cause severe stomach pains, and in some cases, miscarriage.

While treatment for fibroids is often avoided during pregnancy, pain relief is possible. Tylenol is typically recommended, but over-the-counter medications like ibuprofen are avoided due to potential risks to the pregnancy. It could cause a reduced amount of amniotic fluid. This may result in a miscarriage or cause heart problems in your baby.

• Fibroid Pain During Pregnancy

Pain is the most common symptom reported during the second and third trimesters. It is often experienced with large fibroids that are over five centimeters. Although rare, severe pain can also occur in cases of red degeneration. This process typically involves the torsion of a thyroid stalk (pedunculated fibroid). Symptoms include acute pain, fever, and abdominal tenderness.

• Fetal Growth Restriction

This refers to a fetus that doesn’t grow at a normal rate within the womb. When born, the baby may have a low birth weight, low Apgar scores, meconium aspiration, decreased oxygen levels, low blood sugar, or a variety of other health challenges. Your doctor will take fundal measurements at each prenatal visit to help detect any growth abnormalities.

• Placental Abruption

This condition occurs when the placenta partially or completely separates from the uterus before childbirth –– putting both the mother and baby at risk. Data suggests that women with fibroids are three times more likely to experience placental abruption than women without fibroids.

Symptoms include vaginal bleeding, abdominal pain, back pain, uterine tenderness, and contractions. If you are experiencing any of these, please seek emergency care. Placental abruption is deemed very serious because of the lack of oxygen that your baby receives. This can cause heavy bleeding and cause the mother to go into shock.

Postpartum

Fibroids can cause an increased risk during delivery. However, it is also known to create issues even after delivery.

• During Delivery

Studies indicate that the odds of a woman with fibroids having a C-section are up to six times greater than for a woman without fibroids. Uterine fibroids can prevent contractions, block the birth canal, or lead to a breech position.

Babies born via C-section can experience both short and long-term health problems. A breech birth presents another potential issue, where the baby is positioned to come out buttocks or feet first instead of head first.

• After Delivery

Postpartum hemorrhage –– more bleeding than normal after delivery –– is another potential complication that individuals with fibroids are significantly more likely to experience.

Fibroids are known to shrink after pregnancy. In some studies, 70% of women who had live births saw their fibroids shrink more than 50% 3 to 6 months after delivery.

• Beyond Delivery

You may be wondering what happens to symptomatic fibroids after your baby is born. The good news is that fibroids often shrink at this point –– though unfortunately for some, this isn’t always the case. If you continue to suffer from fibroid symptoms after giving birth, it’s important to alert a fibroid specialist.

Treatment For Pregnant Women With Fibroids

For most pregnant women, treating fibroids is generally avoided. There are natural treatments that healthcare providers can recommend to help expectant mothers avoid discomfort throughout the nine months of pregnancy. To help manage symptoms, healthcare providers may suggest:

• Apply a warm water bottle to painful areas
• Exercise to increase your body’s natural painkiller, endorphins
• Take warm baths
• Eat a healthy diet with plenty of fiber and beta carotene-rich foods
• Manage your blood pressure
• Reduce stress through relaxation techniques like yoga, massage, meditation and Tai chi
• Drink plenty of water
• Avoid alcohol and smoking

Uterine Fibroid Embolization

Some healthcare providers offer a procedure called Uterine Fibroid Embolization (UFE) – a minimally invasive, outpatient procedure that involves less risk and a significantly shorter recovery time than fibroid surgery. If you think you are suffering from symptomatic fibroids, talk to your doctor about your concerns. Your doctor may suggest the UFE procedure if they believe you are a good candidate.

Talk To Your Healthcare Provider

If you are still concerned about your pregnancy and possible fibroid development, discuss your concerns with your doctor or a fibroid specialist. It is critical to understand the increased risks involved for you and your baby if you have detectable fibroids. Just being aware of the signs can help you know when to seek medical attention and possibly save yourself from future complications.

If your fibroid symptoms don’t naturally improve after pregnancy, it’s necessary to contact your doctor for a consultation to address the issue. They can help you get back on track, free from fibroids and their symptoms.

Make sure you are always under the care of a medical professional. If you develop complications via a uterine fibroid, it’ll be worth it to have a doctor keep an eye on you and the development of your baby. Maintain good health and use potential signs of trouble to avoid complications in the future. The key is early intervention!

Concerned About Fibroids During Pregnancy? Contact Us Today

Uterine fibroids represent the most common gynecologic tumors, affecting about 20-50% of women of reproductive age.

These uterine growths can produce pain and heavy bleeding and may interfere with your ability to get pregnant. The OBGYN specialists at Rosh Maternal & Fetal Medicine have years of experience treating fibroids, including using minimally invasive surgery. If you have pelvic pain, please call our office in the Midtown East area of New York City, or schedule an appointment online.