Fibroids and Pregnancy

Hearing the words "uterine fibroids" can feel scary, especially when you're pregnant or hoping to be. It could be a lot to take in. However, uterine fibroids are incredibly common, affecting up to 70-80% of women by age 50. Many of them are completely harmless and don't cause a single symptom. So, while a diagnosis might sound alarming, the reality is that many women with fibroids have perfectly healthy pregnancies and babies. But fibroids and pregnancy can raise a lot of questions. 

If you're pregnant or planning to conceive and have been diagnosed with fibroids, you likely have questions about their potential impact. This guide will walk you through what fibroids in pregnancy are, how they're diagnosed, possible risks, and what you can expect during each trimester and at delivery.

What Are Uterine Fibroids?

Think of uterine fibroids as non-cancerous growths that develop in or on the uterus (womb). You might hear them called leiomyomas or myomas, but in plain language, they're simply benign growths of muscle and fibrous tissue. Their size can vary, but their location usually determines their classification:

• Intramural fibroids, the most common type, grow within the uterine wall.

• Subserosal fibroids form on the outside of the uterus.

• Pedunculated fibroids are subserosal growths that have developed a slender base.

• Submucosal fibroids are growths that have developed under the endometrium, the uterine lining, into the uterine cavity.

It's very common to have no symptoms at all and only find out about them during a routine pelvic exam or ultrasound. Fibroids can be tiny, undetectable to the naked eye, or grow quite large, affecting the size and shape of the uterus. However, some women do experience symptoms like pelvic pressure or pain, heavy or prolonged periods, frequent urination, or constipation. So, what are the causes of fibroids in the uterus during pregnancy?

Why Fibroids Appear in Pregnancy

The exact cause of uterine fibroids isn't fully understood, but it's believed that a combination of genetic, hormonal, and environmental factors is at play. When it comes to pregnancy with fibroids, hormones are key.

Fibroids are sensitive to hormones, especially estrogen and progesterone. These hormones surge during pregnancy, which can cause existing fibroids to grow or new ones to develop. This is why a fibroid that was small or unnoticed before conception might become more significant during pregnancy. It’s your body's way of adapting to this beautiful, transformative time.

Genetic factors also contribute; for instance, fibroids are more common in Black women. While fibroids may be present before pregnancy, they can grow faster due to the significant hormonal shifts that occur when you're expecting.

How Are Fibroids Diagnosed During Pregnancy?

Often, fibroids during pregnancy are detected incidentally during routine prenatal care. Here are the most common and safe diagnostic methods:

• Ultrasound is the primary method for examining fibroids. It's safe and non-invasive, utilizing sound waves to create detailed images of the uterus and the fibroids. 

• In some cases, a transvaginal ultrasound may be performed to obtain a clearer view, particularly if the fibroids are small or located in a challenging location.

Doctors will typically detect fibroids during your initial dating scan or subsequent anatomy scans. A fibroid diagnosis doesn't automatically mean complications; it just means your healthcare provider will monitor them closely.

Understanding Your Fibroid Ultrasound

During the ultrasound, your doctor will assess several factors relating to the uterine fibroids and pregnancy:

• Size: The dimensions of each fibroid.

• Location: Where each fibroid is situated within or on the uterus.

• Number: How many fibroids are present?

You can think of these ultrasounds as a way to get to know your fibroids. They may be repeated throughout your pregnancy to track any changes in size or location. This is a safe and non-invasive way to monitor large fibroids during pregnancy, ensuring they're not causing issues for you or your baby.

While ultrasounds are the standard for fibroid tracking, hormone trends (like rising estrogen) can indicate growth potential. Tools like the Mira Hormone Monitor, Mira App, and Wands can help users visualize these shifts, providing another layer of understanding of their hormonal health as they track hormones such as LH, FSH, estradiol, and progesterone metabolites in urine, E3G, and PdG.

Disclaimer: The Mira Hormone Monitor, Wands, Mira App, and BBT tracking tools are intended for fertility awareness and cycle tracking purposes only. These products are not intended to diagnose, treat, cure, prevent any disease, to diagnose or track pregnancy, or serve as a form of contraception. The information provided through these tools should not substitute for professional medical advice, diagnosis, or treatment. Individual results and cycle patterns may vary. Users should always consult with qualified healthcare providers regarding fertility, conception, and reproductive health matters.

Do Fibroids Grow During Pregnancy?

Yes, fibroids can grow during pregnancy, but not always. The majority of fibroid growth typically occurs in the first half of pregnancy, mainly due to the surge in estrogen and progesterone. However, it's reassuring to know that not all fibroids grow, and some may even shrink. It's common for a woman who is 19 weeks pregnant with a baby and with fibroids to notice changes in fibroid size during her anatomy scan.

What Does Fibroid Pain During Pregnancy Feel Like?

Fibroid pain during pregnancy can vary. It's often described as a dull ache, pressure, or a sharp, localized pain. The feeling can depend on the size and location of the fibroid. Here's what it might feel like:

• A dull ache or pressure

• Sharp, localized pain

• Mild cramping, similar to menstrual cramps

While these sensations can be unsettling, for many women, uterine fibroids don't cause significant issues during pregnancy. It’s all about understanding what's normal and when to reach out for help.

Seek help if you experience fever, chills, or intense pain that worsens with time. Any heavy vaginal bleeding, especially with severe pain, is also a concern. Additionally, contact your doctor immediately if you notice a decrease in your baby's movements. For many women, uterine fibroids don't cause issues during pregnancy, but it's essential to understand the potential effects and how to manage them. 

Can Fibroids Affect Pregnancy?

This is a very common question, and it's a valid one. The truth is, many women with uterine fibroids have perfectly normal pregnancies and healthy babies. However, it's important to be aware of potential risks. Your healthcare provider will monitor you closely to prevent or manage any potential complications.

Potential risks associated with pregnancy with fibroids include:

• Miscarriage: While not inevitable, certain fibroid types (especially submucosal) and large fibroids may increase the risk.

• Preterm labor: Fibroids can sometimes irritate the uterus, leading to contractions before full term.

• Fetal growth restriction: In rare cases, very large or numerous fibroids can take up space or reduce blood flow to the baby, impacting growth.

• Placental issues: Such as placental abruption (where the placenta separates from the uterus too early) or placenta previa (where the placenta might partially or entirely cover the opening of the uterus).

• Fetal malposition: Large fibroids and pregnancy can sometimes distort the uterus, making it difficult for the baby to get into a head-down position for birth (e.g., breech presentation).

• Delivery complications: Increased likelihood of C-section.

Can Fibroids Cause Miscarriage?

This is a sensitive concern, and honestly, yes, the location and size of fibroids can increase the risk of miscarriage, particularly with intramural fibroids and pregnancy. Fibroids that develop in the central part of the uterus are more likely to cause miscarriage than fibroids located in the lower part of the uterus.

Studies suggest that while 7% of pregnancies without fibroids result in miscarriage, this number can rise to about 14% for those with fibroids. It's crucial to remember that this isn't a guaranteed outcome, and the vast majority of women with fibroids carry their pregnancies to term successfully. 

How to Avoid Miscarriage With Fibroids

While you can't guarantee preventing a miscarriage, you can empower yourself with proactive care:

• Regular obstetric monitoring: This is paramount. Your doctor will track your fibroids and your baby's growth closely.

• Early ultrasound: To assess the fibroids' size and location and their potential impact.

• Tracking fetal growth: Regular measurements and scans to ensure your baby is growing well.

• Managing pain and bleeding: Promptly report any unusual symptoms to your doctor for evaluation and management.

• Follow medical advice: Adhere to all recommendations from your healthcare provider regarding rest, activity, and medication.

How to Deal With Fibroids During Pregnancy

Managing fibroids during pregnancy often involves close monitoring and symptom relief. Many cases are manageable with good prenatal care.

First Trimester – Monitoring Early Symptoms and Risks

In the first trimester, fibroid growth often begins, triggered by rising estrogen and progesterone. Some studies indicate that up to 60% of women with fibroids experience pain, and around 10-15% have spotting in early pregnancy.

Symptoms to note:

• Spotting: Mild spotting can occur. While common and often manageable, it should always be reported to your doctor.

• Mild cramping: Similar to early pregnancy cramps.

• Early round ligament pain: As the uterus grows, you might feel sharp, fleeting pain on one or both sides.

Management:

• Hydration and rest: Drink plenty of fluids and get adequate rest.

• Fibroid degeneration: While rare in the first trimester, be aware of sharp pain accompanied by a fever, which could indicate degeneration (when a fibroid outgrows its blood supply and starts to break down).

Second Trimester – Managing Growth and Pain

The second trimester is often the peak time for fibroid growth. This is also when red degeneration is more likely to occur. Your doctor will consider the following factors:

• Increased pressure: As fibroids grow and your uterus expands, you might feel more pressure on your bladder, bowel, or other organs.

• Round ligament pain: This can become more pronounced as the uterus shifts and grows.

• Red degeneration: This is a hallmark of fibroid pain in the second trimester. It's characterized by sudden, intense localized pain, tenderness over the fibroid, and a low-grade fever.

Treatment tips:

• Bed rest: Your doctor might recommend modified bed rest.

• Increased monitoring or hospitalization: In rare and severe cases of red degeneration, hospitalization might be needed for pain management and observation.

• Since fibroid-related bleeding can sometimes cause iron-deficiency anemia, it's crucial to take high-quality prenatal vitamins with iron.

How to Prevent Fibroids From Growing During Pregnancy

While you can't entirely prevent fibroid growth during pregnancy due to hormonal changes, you can support your overall health:

• Avoid excess heat: Some sources suggest avoiding very hot baths or saunas.

• Get adequate sleep: Prioritize rest to support your body.

• Eat anti-inflammatory foods: A diet rich in fruits, vegetables, and whole grains can support overall health.

• Stay well-hydrated: Drink plenty of water throughout the day.

• Reduce stress: Practice stress-reducing techniques like meditation or gentle yoga.

Third Trimester – Planning for Labor

As you approach your due date, birth planning becomes crucial. The presence of fibroids can significantly influence your delivery plan, and your healthcare provider will monitor them closely to determine the safest birth method. Your doctor will consider the following:

• Fibroids near the cervix: These can block the birth canal, making a vaginal delivery impossible and necessitating a C-section.

• Fetal malposition: Fibroids can distort the uterus's shape, causing the baby to be in a breech (feet or bottom first) or transverse (sideways) position.

• Increased risk of preterm labor and placental abruption: While rare, fibroids and pregnancy can increase these risks. Your provider will monitor for any signs.

• Planned early delivery or C-section: In high-risk cases, your doctor may schedule an early delivery or a planned C-section to ensure the safest outcome for you and your baby.

During Delivery – What to Expect

Even with fibroids during pregnancy, many women still deliver safely. However, some complications can occur. 

• C-sections are more common: Women with fibroids are approximately six times more likely to need a C-section. This can be due to fibroids blocking the birth canal, causing malposition, or affecting uterine contractions.

• Longer labor: If fibroids interfere with effective uterine contractions, labor may be prolonged.

• Monitoring: Continuous monitoring of the fetal heart rate and placental function is standard in fibroid pregnancies.

• Postpartum hemorrhage: There's a slightly increased risk of heavy bleeding after delivery if fibroids interfere with the uterus' ability to contract effectively.

Tips on Successful Pregnancy With Fibroids

Many women with uterine fibroids have healthy, full-term pregnancies, which should leave you feeling empowered and hopeful. Here are some realistic, medically-backed strategies:

• Keeping prenatal appointments: Regular check-ups are vital for monitoring fibroids and your baby's health.

• Nutrition and rest: A balanced diet and adequate rest support your body through the demands of pregnancy.

• Knowing when to call the doctor: Pay attention to your body and don't hesitate to contact your healthcare provider if you have any concerns.

• Consider the Hormone Health Clinic for Fertility: For women with fibroids planning future pregnancies or seeking personalized care, a clinic specializing in integrative hormonal support can be beneficial. They can help manage symptoms and explore options for optimizing fertility.

When to Seek Help

Always be cautious. Contact your doctor immediately if you experience any of the following warning signs:

• Severe pain, especially if sudden, intense, or not relieved by rest or approved pain medication.

• Any amount of bleeding during pregnancy should be reported.

• Reduced fetal movement, fever, or chills.

• Regular contractions, pelvic pressure, or fluid leaking.

Bottom Line

Uterine fibroids are a common condition that affects many women during their reproductive years. While the exact cause isn't fully understood, a combination of genetic, hormonal, and environmental factors is believed to be at play. If you're one of the 20-80% of women who develop fibroids by age 50, it's essential to know that getting pregnant with fibroids is rarely an issue. Many women with fibroids have normal, healthy pregnancies, but understanding the potential impact and being proactive with your prenatal care is key to a positive outcome. You've got this, and your healthcare team is here to support you every step of the way.

Frequently Asked Questions

What are the chances of getting pregnant with multiple uterine fibroids?

Having multiple fibroids can affect fertility and pregnancy. However, only 2–3% of women are infertile solely because of fibroids.

Can a pregnant woman also have fibroids?

A pregnant woman can have fibroids while having a normal pregnancy and delivery.

How to handle fibroids if you're 5 months pregnant?

The best way to handle fibroids is to listen to your doctor’s advice, which will usually include bed rest, hydration, and mild pain relievers if prescribed by your doctor.

Can fibroids cause complications during pregnancy?

Yes, fibroids can potentially cause complications during pregnancy, with pain being the most common issue seen in women with large fibroids. 

Is giving birth difficult when you have fibroids?

Many women with fibroids have uneventful pregnancies, and your doctor will let you know if there might be complications and solutions to address them.