Fibroids during pregnancy: danger and consequences

Uterine fibroids during pregnancy, is it dangerous?

Uterine fibroids are non-cancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-oh-my-oh-muses) or fibroids, uterine fibroids are not associated with an increased risk of developing uterine cancer and almost never develop into cancer.

Uterine fibroids during pregnancy, is it dangerous?

Fibroids range in size from seedlings undetectable by the human eye to bulky masses that can distort and enlarge the uterus. You may have one fibrosis or several. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the chest.

Many women have uterine fibroids at some time during their lives. But most women don't know they have uterine fibroids because they often don't cause any symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

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What is fibroid

A tumor that is benign and develops in the muscles of the uterus is called “fibroid.” The cause of this disease is abnormal division of uterine cells. It is assumed that this phenomenon is directly related to increased estrogen production and high hormonal status. In other words, fibroids are formed due to high production of the hormone estrogen against the background of insufficient production of the hormone progesterone.

Myoma can develop even in conditions where examination shows that the concentration of hormones in the blood is within the acceptable range. The reason for this is that there can be a significant difference between the amount of hormones contained in the blood and in the body of the uterus.

Although fibroids are a very common disease, their presence in a pregnant woman is highly undesirable. The fact is that fibroids carry the risk of developing all kinds of complications and unfavorable pathological conditions. Sometimes the solution to these problems is emergency delivery or removal of the uterine body.

Symptoms of Uterine Fibroids

Many women who have fibroids have no symptoms. In those that do, symptoms may be affected by the location, size, and number of fibroids. In symptomatic women, the most common symptoms of uterine fibroids are:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Pain in the back or legs

Rarely, fibrosis can cause severe pain when it outgrows its blood supply and begins to die.

Fibroids are usually classified by their location. The intramuscular walls of the uterus grow intramuscularly. Axillary fibroids protrude into the uterine cavity. Subhair fibroids protrude beyond the uterus.

When to see a doctor

If you have:

• Pelvic pain that doesn't go away
• Excessively heavy, prolonged or painful periods
• Spotting or bleeding between periods
• Difficulty emptying the bladder

Seek prompt medical attention if you have heavy vaginal bleeding or severe pelvic pain that comes on suddenly.

How does fibroid affect conception?

Uterine fibroids are not a death sentence: many women with a similar diagnosis successfully bear and give birth to children. But during pregnancy they are under strict supervision of the attending physician in order to promptly eliminate factors that negatively affect the gestation of the fetus.

Is it even possible to get pregnant with uterine fibroids? The best option was to eliminate the disease before conception, so as not to subsequently experience anxiety throughout the entire pregnancy. Myomatous nodes interfere with the advancement of sperm and egg transplantation. In this case, uterine fibroids play the role of an intrauterine device. The degree of risk increases depending on the type, location of the tumor, its size, and progression.

Myomatous nodes can be single or multiple, but it is the size and location that determine their effect on the developing fetus.

The most common diagnosis is intramural fibroid (interstitial). It is possible that the disease may be asymptomatic, which complicates early diagnosis. The appearance of unusual symptoms is a reason to meet with a gynecologist. Worrying symptoms include:

• feeling of heaviness in the lower abdomen;
• pain of varying intensity, increasing with increasing physical activity;
• menstrual irregularities: heavy, prolonged menstruation;
• the appearance of bloody, bloody, purulent discharge in the middle of the menstrual cycle;
• sudden acute pain due to torsion of the tumor stalk or necrosis of the node;
• anemia;
• signs of intoxication of the body due to fibroid infection;
• dysfunction of the excretory system (impaired urination, defecation), if the tumor is located along the posterior wall of the uterus.

Intramural fibroids (interstitial), like other types, are often diagnosed during a gynecological examination during registration or during the first ultrasound. Hearing a diagnosis is unpleasant news for any woman. “Can fibroids resolve?” is the most common question asked by patients. There is no need to panic in advance, but a responsible approach to treatment is an indispensable condition.

Causes of uterine fibroids

Doctors don't know the cause of uterine fibroids, but research and clinical experience point to the following factors:

• Genetic changes. Many fibroids contain changes in genes that differ from those in normal muscle cells.
• Hormones. Estrogen and progesterone, two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote fibroid growth. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells. Fibroids tend to shrink after menopause due to decreased hormone production.
• Other growth factors. Substances that help the body maintain tissue, such as insulin-like growth factor, can affect fibroid growth.

Doctors believe that uterine fibroids develop from stem cells in the smooth muscle tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a hard, rubbery mass distinct from adjacent tissue.

The growth patterns of uterine fibroids vary—they may grow slowly or quickly, or they may remain the same size. Some fibroids go through growth spurts, and some can shrink on their own. Many fibroids that were present during pregnancy shrink or disappear after pregnancy as the uterus returns to its normal size.

Fibroids and pregnancy: recommendations

No doctor can predict how a tumor will behave during pregnancy. The fibroid nodes can enlarge and harden, which can create problems during childbirth. Then a caesarean section is required. In order for fibroids and pregnancy to proceed well, the expectant mother should:

1. take care of yourself and your condition. This means that a pregnant woman should lead a healthy lifestyle, eat rationally, get enough sleep and eliminate all bad habits. A calm and measured life pattern will help avoid exacerbation of fibroids. If you notice even the slightest change in your condition, you should consult a doctor.
2. exclude sports activities. Fibroids and pregnancy require abstinence from physical activity. This can trigger the growth of the tumor and its pressure on the child.
3. avoid stress. The psychological component of the disease is very important. Uterine fibroids and pregnancy reviews, reading on the Internet, were favorable for those women who lived in harmony.

Risk factors

There are few known risk factors for the development of uterine fibroids other than women of reproductive age. Other factors that may influence the development of fibroids include:

• Heredity. If your mother or sister had fibroids, you are at increased risk of developing them.
• Race. Black women are more likely to have fibroids than women of other racial groups. Additionally, black women have fibroids at a younger age, and they are also likely to have more or more fibroids.
• Environmental factors. Start of menstruation at an early age; use of birth control; obesity; vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruits and dairy products; and drinking alcohol, including beer, appears to increase the risk of developing fibroids.

complications

Although uterine fibroids are usually not dangerous, they can cause discomfort and can lead to complications such as anemia from severe blood loss.

Uterine fibroids during pregnancy, is it dangerous?

Fibroids usually do not interfere with getting pregnant. However, it is possible that fibroids—especially submucosal fibroids—can cause infertility or pregnancy loss. Fibroids may also increase the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction, and preterm birth.

Features of pregnancy with fibroids

This disease is diagnosed, as a rule, by ultrasound examination. Infertility cannot be caused by the presence of fibroids, but its location can significantly complicate the fertilization process. It is best to remove the tumor before conception. However, this is only possible if the tumor size does not exceed 12 weeks. Otherwise, surgery to remove fibroids can lead to heavy bleeding, in which case the organ itself has to be removed.

Typically, pregnancy with the development of fibroids has fetoplacental insufficiency. In addition, the risk of miscarriage is high. The greatest danger is when the fibroid is localized in close proximity to the placenta. In this case, the fibroid node does not allow the placenta to develop fully. As a result, the child does not receive enough oxygen and nutrients. In addition, there is a high risk of placental abruption, which always causes severe bleeding.

As pregnancy progresses, fibroids may begin to break down. As a result of this, the tissues of the fibroid node die, which causes the development of edema and the formation of cysts in the pregnant woman. This process can begin at any time and is accompanied by bleeding.

The presence of fibroids is not an indication that pregnancy should be terminated. But this is, of course, a reason to pay increased attention to a pregnant woman from the attending physician. Many women successfully give birth to healthy babies with such a diagnosis, but only if the size of the tumor is small.

In the first weeks, direct contact between the neoplasm and the placenta may pose a danger to the formation of the fetus. In addition, due to insufficient blood circulation of the uterus, it can contract, which causes miscarriage.

In the future, lack of space in the uterus due to fibroids can lead to premature birth. In this case, the risk increases in direct proportion to the size of the nodes. If there is strong pressure from the tumor on the fetus, deformations of the child’s organs may occur or the child may be born with insufficient birth weight.

During pregnancy, measures are usually taken to slow down the growth of fibroids. To prevent anemia, the pregnant woman is prescribed therapy, prescribed a protein diet and vitamin B. Folic acid and vitamin C are also prescribed.

diagnostics

• Uterine fibroids during pregnancy, is it dangerous?
  

  Pelvic exam

Uterine fibroids are often encountered incidentally during a routine pelvic examination. Your doctor may feel irregularities in the shape of your uterus, indicating the presence of fibroids. If you have symptoms of uterine fibroids, your doctor may order these tests:

• Ultrasound. If confirmation is needed, your doctor may order an ultrasound. It uses sound waves to take an image of your uterus to confirm the diagnosis and to outline and measure fibroids. The doctor or technician moves an ultrasound device (transducer) through your abdomen (transabdominal) or places it into your vagina (transvaginal) to take images of your uterus.
• Laboratory tests. If you have abnormal menstrual bleeding, your doctor may order other tests to investigate potential causes. These may include a complete blood count (CBC) to determine if you have anemia due to chronic blood loss and other blood tests to rule out bleeding or thyroid problems.

Other Image Tests

• Uterine fibroids during pregnancy, is it dangerous?
  

  Sonohysterography

• Uterine fibroids during pregnancy, is it dangerous?
  

  hysterosalpingography

• Uterine fibroids during pregnancy, is it dangerous?
  

  hysteroscopy

If a traditional ultrasound doesn't provide enough information, your doctor may order other imaging tests, such as:

• Magnetic resonance imaging (MRI). This imaging test can show the size and location of fibroids, identify different types of tumors, and help determine appropriate treatment options.
• Hysterosonography. Hysterosonography (his-tur-o-suh-NOG-ruh-fee), also called saline infusion sonography, uses a sterile saline solution to dilate the uterine cavity, making it easier to obtain images of the submucosal fibroids and endometrium.
• Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) uses dye to highlight the uterine cavity and fallopian tubes on x-rays. Your doctor may recommend it if infertility is a concern. In addition to identifying fibroids, this can help your doctor determine whether your fallopian tubes are open.
• Hysteroscopy. To do this, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix and into your uterus. Your doctor then injects a saline solution into your uterus, widening the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.

Childbirth with fibroids

We have already found out that fibroids can cause many complications. In this case, throughout the entire pregnancy there is a high probability of miscarriage or premature birth. Fibroids also increase the risk of ectopic pregnancy.

If the tumor is on the cervix, the cervix can open painlessly even before labor begins. This provokes miscarriage or premature birth, depending on the period. Large fibroids also lead to the same result. Due to the presence of fibroids, the baby may take an incorrect position in the uterus. This leads to the need for delivery by caesarean section.

The tumor interferes with the normal supply of oxygen and nutrition to the baby, which leads to a delay in its development. This affects the condition of the child even after his birth.

Another danger that occurs with fibroids is that the placenta is attached very tightly. This makes it impossible for it to come out naturally and provokes severe bleeding. In this case, the uterus is removed.

Many women with fibroids give birth on their own and without complications. But in any case, the woman is hospitalized in the maternity hospital at an earlier stage. The possibility of natural childbirth is assessed by the size of the tumor nodes and the condition of the child. Possible early rupture of amniotic fluid, premature or prolonged labor.

Caesarean section is prescribed in the case of:

• Incorrect position of the fetus.
• The presence of scars on the body of the uterus.
• Necrosis of tumor tissue.
• Transition of a neoplasm to cancer.
• Presence of other complications.
• The child is in serious condition.

Under certain circumstances, the tumor is removed during a caesarean section. This usually happens when the incision goes through the fibroid or if the tumor interferes with suturing.

treatment

There is no single best approach to treating uterine fibroids—there are many treatment options. If you have symptoms, talk to your doctor about options for symptom relief.

Watchful waiting

Many women with uterine fibroids have no signs or symptoms or only mildly annoying signs and symptoms that they can live with. If so, then watchful waiting may be the best option.

Fibroids are not cancerous. They rarely interfere with pregnancy. They usually grow slowly—or not at all—and tend to shrink after menopause, when levels of reproductive hormones drop.

medications

Medicines for fibroids that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They do not eliminate fibroids, but they can shrink them. Medicines include:

• Gonadotropin-releasing hormone (Gn-RH) agonists. Medicines called Gn-RH agonists (Lupron, Synarel, etc.) treat fibroids by blocking the production of estrogen and progesterone, putting you in a temporary postmenopausal state.
  As a result, menstruation stops, fibroids shrink, and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before your scheduled surgery. Many women experience significant hot flashes when using Gn-RH agonists. Gn-RH agonists are usually used for no more than three to six months because symptoms return when the medication is stopped, and long-term use can cause bone loss.
• Protein-releasing intrauterine device (IUD). A protein-releasing IUD can relieve heavy bleeding caused by fibroids. The protein-releasing IUD only provides symptomatic relief and does not shrink fibroids or go away. It also prevents pregnancy.
• Tranexamic acid (Lysteda). This non-hormonal medicine is taken to relieve heavy menstrual periods. This only occurs during heavy bleeding.
• Other medications. Your doctor may recommend other medications.
  For example, oral contraceptives or progestins may help control menstrual bleeding, but they do not reduce the size of fibroids. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain associated with fibroids, but they do not reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.

Non-invasive procedure

• Uterine fibroids during pregnancy, is it dangerous?
  

  Focused Ultrasound Surgery

MRI-guided Focused Ultrasound Surgery (FUS):

• A non-invasive treatment for uterine fibroids that preserves your uterus, requires no incision and is done in an outpatient setting.
• Performed while you are inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The images give your doctor the exact location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses sound waves (ultrasound) onto the fibroid to heat and destroy small areas of fibrous tissue.
• New technologies so researchers are learning more about long-term safety and effectiveness. But so far, the data collected shows that FUS for uterine fibroids is safe and effective.

Minimally invasive procedures

• Uterine fibroids during pregnancy, is it dangerous?
  

  Uterine artery embolization

Some procedures can destroy uterine fibroids without actually removing them through surgery. These include:

• Uterine artery embolization. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to the fibroids, causing them to shrink and die. This method can be effective in shrinking fibroids and relieving the symptoms they cause. Complications can occur if the blood supply to your ovaries or other organs is disrupted.
• Myolysis. In this laparoscopic procedure, radiofrequency energy, electric current, or laser destroys fibroids and constricts the blood vessels that feed them. A similar procedure, called cryomyolysis, freezes the fibroids.
• Laparoscopic or robotic myomectomy. In a myomectomy, your surgeon removes the fibroids while leaving the uterus in place.
  If the number of fibroids is low, you and your doctor may choose a laparoscopic or robotic procedure, which uses thin instruments inserted through small incisions in your abdomen to remove fibroids from your uterus. Fibroids can be removed through the same small incisions, breaking them into smaller pieces, a process called morcellation, or one incision can be widened to remove entire fibroids. Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. A robotic myomectomy gives your surgeon an enlarged, three-dimensional view of your uterus, offering greater precision, flexibility, and dexterity than is possible with some other techniques.
• Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained within the uterus (submucosa). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
• Endometrial ablation. This treatment, performed with a special instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of the uterus, either stopping menstruation or shortening the menstrual cycle.
  Generally, endometrial ablation is effective in stopping abnormal bleeding. Axillary fibroids can be removed during hysteroscopy to ablate the endometrium, but fibroids outside the lining of the uterus are not affected.

Traditional surgical procedures

Options for traditional surgical procedures include:

• Abdominal myomectomy. If you have multiple fibroids, very large fibroids, or very deep fibroids, your doctor may use open abdominal surgery to remove the fibroids. Many women who are told that a hysterectomy is their only option may have an abdominal myomectomy. However, scarring from surgery may affect future fertility.
• Hysterectomies. This surgery, hysterectomy, remains the only proven permanent solution for uterine fibroids. But a hysterectomy is a serious operation.
  A hysterectomy ends your ability to bear children. If you also decide to have your ovaries removed, the surgery will lead to menopause and the question of whether you will take hormone replacement therapy. Most women with uterine fibroids may be able to keep their ovaries.

  You may also face an increased long-term risk of cardiovascular disease (CVD) and some metabolic conditions after a hysterectomy, especially if you have surgery before age 35, according to recent research. Talk to your doctor about treatment options for your condition to see if there are any alternatives you might consider.

Morcellation for fibroid removal

Morcellation, the process of breaking fibroids into smaller pieces, may increase the risk of cancer spreading if a previously undiagnosed cancerous mass is morcellated during a myomectomy. There are several ways to reduce this risk, such as assessing risk factors before surgery, deforming the fibrosis in the bursa, or widening the incision to avoid morcellation.

All myomectomies carry the risk of cutting through undiagnosed cancer, but premenopausal women generally have a lower risk of developing undiagnosed cancer than older women. Additionally, complications during open surgery are more common than the chance of undiagnosed fibroid cancer spreading during a minimally invasive procedure. If your doctor plans to use morcellation, discuss your individual risks before treatment.

The Food and Drug Administration (FDA) recommends that most women take morcellation. In particular, the FDA recommends that women who are undergoing peri- or postmenopause avoid morcellation. Women who are older or entering menopause may have a higher risk of developing cancer, and women who are no longer concerned about preserving their fertility have additional fibroid treatment options.

If you can still have children

Hysterectomy and endometrial ablation are the only two treatment options that cannot be used by women who want to maintain their ability to become pregnant. Before deciding on a treatment plan for fibroids, it is recommended to have a complete fertility assessment.

If fibroid treatment is required, myomectomy is usually the choice. However, all treatments have risks and benefits. Discuss this with your doctor.

Risk of developing new fibroids

For all procedures except hysterectomy, seedlings—tiny tumors that your doctor doesn't detect during surgery—can eventually grow and cause symptoms that require treatment. This is often called the relapse rate. New fibroids may also develop, which may or may not require treatment.

Small node - few problems

Uterine fibroids are a benign tumor consisting of muscle and connective tissue cells.
It consists of one, or more often several nodes that can grow both inside the uterus (as happens in 90% of cases), and in its cervix, and even in the abdominal cavity (subserous form). Often, uterine fibroids first appear during pregnancy - increased levels of female sex hormones stimulate its growth. Fibroids can be detected during a routine gynecological examination, and the diagnosis can be confirmed using ultrasound.

Pregnancy that occurs against the background of small myomatous nodes located far from the placenta insertion site, as a rule, does not threaten either the woman or the baby with anything bad. And, although the nodes can grow as the pregnancy progresses, this growth is imaginary - it is associated only with the enlargement of the uterus itself and does not pose a danger. And in some expectant mothers, fibroids not only do not grow, but even decrease in size.

So the expectant mother should not panic. You just need to see a gynecologist regularly, follow a routine, get plenty of rest, and closely monitor your iron levels, since during pregnancy, fibroids are often accompanied by iron deficiency anemia. To reduce this risk, you should take B vitamins, ascorbic acid and folic acid, which improve iron absorption. Well, after childbirth and completion of breastfeeding, it is necessary to begin treatment for fibroids, which begins with a course of hormonal medications containing progesterone.

Women's diseases: how uterine fibroids are treated today

More details

Preparing for your appointment

Your first appointment will likely be with either your primary care provider or your gynecologist. Because meetings may be brief, it is advisable to prepare in advance for the meeting.

What can you do

• Make a list of any symptoms you are experiencing. Include all of your symptoms, even if you don't think they are related.
• List any medications, herbs, and vitamin supplements you take. Include the doses and how often you take them.
• If possible, accompany a family member or close friend. You may be given a lot of information during your visit, and it may be difficult to remember everything.
• Bring a laptop or electronic device with you. Use it to note important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first in case time runs out.

For uterine fibroids, some basic questions to ask include:

• How many fibroids do I have? How big are they?
• Are fibroids located inside or outside my uterus?
• What tests do I need?
• What medications are available to treat uterine fibroids or my symptoms?
• What side effects can I expect from using the medications?
• Under what circumstances do you recommend surgery?
• Do I need medication before or after surgery?
• Can my uterine fibroids affect my ability to get pregnant?
• Can treating uterine fibroids improve my fertility?

Make sure you understand everything your doctor says. Feel free to have your doctor repeat information or ask follow-up questions.

What to expect from your doctor

Some questions your doctor may ask include:

• How often do you have these symptoms?
• How long have you been experiencing symptoms?
• How severe are your symptoms?
• Do your symptoms seem to be related to your menstrual cycle?
• Does anything improve your symptoms?
• Is anything making your symptoms worse?
• Do you have a family history of uterine fibroids?

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