Fibroids and Pregnancy

Understanding Uterine Fibroids Uterine fibroids are non-cancerous growths in or around the uterus, affecting up to 40% of women of childbearing age. While fibroids' size, number, and location vary greatly, many women may not experience any symptoms and remain unaware of their presence. However, fibroids can sometimes impact fertility and pregnancy outcomes.

“These benign, largely asymptomatic growths occur on various parts of a woman’s uterine wall. In many cases, fibroids are only discovered during a physical health screening examination or due to heavy menses, pressure, or pain in the bladder, pelvis, or rectum,” Dr. Yeo says.

How Do Fibroids Affect My Ability to Get Pregnant?

Uterine fibroids are quite common and affect about one in three women in Singapore. These benign growths may not always cause symptoms, but they can impact a woman’s fertility and pregnancy, especially if they are large or within the uterine cavity[1].

Large or misplaced fibroids can change the shape of the womb lining, making it harder for a fertilized egg to implant and grow into a baby. Fibroids grow inside the muscular walls of the womb (uterus). Usually, the womb muscles contract in waves during implantation (when a fertilized egg attaches) and early pregnancy. Fibroids may affect normal uterine contractility, which can affect embryo implantation and early pregnancy. They can also increase the chances of expelling an embryo or increase the risk of miscarriage.

Dr. Yeo says in some cases, they can result in abnormally heavy or painful menstruation, frequent urination, lower back pain, or pain during sexual intercourse. Heavy or long-lasting bleeding can make it harder for embryos to implant in the lining of the uterus, especially if the bleeding happens around the time you ovulate.

The relationship between fibroids and pregnancy is complex. Hormonal changes during pregnancy, particularly the higher estrogen and progesterone levels, can cause existing fibroids to grow. The good news is that this growth is not always linear and can vary throughout the pregnancy.

Do I Need to Seek Treatment for Fibroids Before Getting Pregnant?

“The majority of growths do not require treatment beyond observation. If the fibroids begin to develop symptoms, your doctor can recommend various options,” Dr. Yeo explains.

Various medications can be used to control symptoms. However, in some cases, the best course of uterine fibroid treatment will be surgery such as a hysterectomy or myomectomy.

“During a hysterectomy, the entire uterus is removed, but this is obviously not suitable for women trying to conceive. The latter, however, targets only the fibroids, preserving the woman’s ability to reproduce,” she adds.

It is also important to note that there is no evidence to suggest that uterine fibroids are a direct cause of infertility among Singapore women[2]. However, they are often found in women who experience difficulty becoming pregnant, indicating that while they may not be the sole cause, they could be a contributing factor in some cases.

Considering IVF with Fibroids?

Your doctor will guide you in deciding to proceed with in vitro fertilization (IVF) in the presence of fibroids. Small fibroids, especially those not impinging on the uterine cavity, may not significantly impact IVF outcomes. However, if fibroids are causing symptoms such as heavy bleeding or pain, treatment may be recommended before proceeding with IVF.

Submucosal fibroids, which grow into the uterine cavity, have the most significant impact on fertility and IVF success rates and often warrant removal before IVF. Age, overall fertility health, and the number of fibroids all play a role in decision-making.

Can I Go Through the Whole Pregnancy with Fibroids?

The presence of fibroids does not necessarily mean you cannot have an uneventful pregnancy and childbirth. Many women with fibroids have experienced successful deliveries. However, it is essential to monitor closely how fibroids may affect your pregnancy journey.

Regular ultrasounds and prenatal visits are vital to monitoring fibroids’ growth and assessing their impact on the pregnancy. Fibroids may grow during pregnancy due to increased hormone levels, leading to discomfort or pain that needs to be managed with pain relief medications. Other medicines may be used to control bleeding. Your doctor may advise bed rest in cases of significant pain or bleeding.

Depending on the fibroid’s impact, your doctor may recommend a specific birth plan, including the possibility of a cesarean section. Large fibroids may block the birth canal or affect the baby’s position in the womb, leading to breech presentation (feet-first delivery).

After delivery, fibroids often shrink during the postpartum period, but they should still be monitored, especially if you plan to have more children.

Fertility and Future Pregnancies

Fibroids can impact fertility, but many women with fibroids can still conceive naturally or with the help of fertility treatments. Treatment options for fibroids, such as medication, myomectomy, or uterine artery embolization, can improve fertility outcomes.

For future pregnancies, it is essential to have regular follow-ups and discuss any concerns with a healthcare provider. Each pregnancy is unique, and the impact of fibroids can vary widely.

Fibroids are common conditions that can affect pregnancy in various ways. While they can pose challenges, many women with fibroids go on to have healthy pregnancies and deliveries. If you have fibroids and are pregnant or planning to conceive, it is crucial to work closely with your doctor to monitor and manage your condition for the best possible outcomes. By understanding the potential impacts, you can navigate your fertility and pregnancy with fibroids more effectively and ensure the best care for you and your baby.

[1] [1] https://cnalifestyle.channelnewsasia.com/women/uterine-fibroids-signs-symptoms-treatment-pregnancy-infertility-393721

[2] [2] Mettler, L., Deenadayal-Mettler, A., Alkatout, I. (2018). Uterine Fibroids and Effect on Fertility. In: Moawad, N. (eds) Uterine Fibroids. Springer, Cham. https://doi.org/10.1007/978-3-319-58780-6_2