Fibroids, Pregnancy and Fertility: What to Do if You’re TTC
Uterine fibroids are a condition that affect many women at some time during their reproductive years. While not fully understood, the cause is believed to be related to a combination of genetic, hormonal, and environmental factors.
So what do you need to know and do if you are in the 20% of women of reproductive age suffering from uterine fibroids?
This post will look at the uterine fibroid symptoms and treatments as well as how they can impact your pregnancy journey.
What are uterine fibroids?
Also called leiomyomas or myomas, uterine fibroids are noncancerous growths of the uterus. These abnormal growths or tumors can range from quite small to very large and develop in or on a woman’s uterus. Although typically benign, they can cause severe abdominal pain as well as a range of other symptoms, though many go unnoticed entirely.
Fibroids are classified by where they develop on the uterus and there are four basic classifications.
- Intramural fibroids, the most common type, grow within the uterine wall.
- Subserosal fibroids form on the outside of the uterus.
- Pedunculated fibroids are subserosal tumors that have developed a slender base to support the tumor.
- Submucosal fibroids are tumors that have developed in the middle muscle layer of the uterus.
Fibroids can vary in size from undetectable to the human eye to large masses that affect the size of the uterus. You could have one single fibroid or multiple fibroids that join together and cause a large mass.
Depending on how severe your case you could be asymptomatic and not even realize you have them. In these instances they are either never discovered or can be caught during another exam such as a pelvic exam or ultrasound.
Some women do experience symptoms such as:
- Pelvic pressure or pain
- Increased need to urinate
- Difficulty emptying the bladder
- Heavy periods
- Periods that last longer than a week
It is important to seek medical help if you experience any of these symptoms for an extended period of time.
Can you get pregnant with uterine fibroids?
Getting pregnant with fibroids is rarely an issue, although fibroids may themselves cause issues throughout your pregnancy. Since fibroid growth may be related to an influx of estrogen and progesterone, fibroids tend to grow during pregnancy and can cause problems. While most women go on to have normal pregnancies, sometimes being pregnant with uterine fibroids can cause challenges.
Fibroids and pregnancy
Most women will experience no challenges from fibroids during pregnancy, but as many as 30% of women diagnosed may experience some form of complication. The most common fibroid pregnancy symptom is pain, but fibroids also increase your risk of other complications like fetal growth restrictions, placental abruption, delivery complications, and breech position.
How uterine fibroids affect fertility
If you do suffer from fibroids and are trying to conceive you might be worried about your ability to become pregnant naturally. Usually the fibroids themselves don’t cause any issues when it comes to fertility, but it does occur in some cases.
If you are having problems getting pregnant and know that you suffer from fibroids you should discuss your condition with your doctor. Some studies have shown that 5-10% of women suffering from infertility have fibroids.
Some fibroids, especially submucosal fibroids, can cause miscarriages and infertility depending on location, size, and number of masses. It is important to have a full fertility work up to verify that the fibroids are causing the infertility before treating.
Some treatments of fibroids can drastically affect your ability to get pregnant. Many women see their fibroid symptoms subside with the use of oral contraceptives or IUDs, but these types of measures prevent pregnancy while using them.
Hysterectomy and endometrial ablation are two possible treatments for extreme or recurring cases of fibroids and would mean you could never get pregnant. Therefore it is important to take into consideration your family planning when deciding treatment options.
How uterine fibroids can affect trying to conceive
Your ability to conceive will depend on the severity of your fibroids. Talking to your doctor about the size and position of your fibroids will give the best information about your chances of conception. Your doctor will be able to assess whether your fibroids could cause problems in either getting pregnant or carrying a pregnancy.
How uterine fibroids affect pregnancy
Many women successfully become pregnant while suffering from fibroids and see no effect on their pregnancy or on the fibroids. However, there are several pregnancy complications that could be exacerbated by fibroids.
The biggest concerns include:
- Preterm delivery
- Pain that requires hospitalization
- Fetal growth restriction
- Placental abruption
- Fibroid growth that affects the baby’s position in the uterus
- Need for C-section
If you suffer from fibroids during pregnancy your OB should keep a close eye on your condition. In about one-third of the pregnancies involving fibroids there is some growth of the masses in the first trimester. This could be related to changes in estrogen, but more study needs to be done in this area.
If your doctor is concerned about your fibroids during your pregnancy they may recommend treatment. Rarely is a surgical treatment performed during pregnancy, but your doctor may recommend bed rest, extra hydration, and the use of mild pain relievers to manage the fibroids.
Understanding more about fibroids
It’s important to understand that uterine fibroids are extremely common. In fact, as many as 20 to 80 percent of women will develop fibroids by the time they reach 50. The cause of uterine fibroids is unknown, but millions of women worldwide have successfully treated these non-cancerous growths.
Most women with uterine fibroids have no symptoms because they are small enough to go without notice. In those that develop symptoms, the most common are:
- Pelvic pain and pressure
- Bloating/fullness in the lower abdomen
- Frequent urination
- Weight gain
- Heavy or prolonged bleeding
- Pain during sex
- Lower back pain
The good news is that you may not need treatment if you are not experiencing symptoms and the fibroids are not interfering with your life. If you are experiencing consistent symptoms and your doctor recommends treatment, you can expect one or more of the following:
- Pain relief medication
- Hormonal birth control
- Hormone agonist medication
- Focused ultrasound surgery
- Uterine artery embolization
Uterine fibroids are usually diagnosed during a regular pelvic exam. Your doctor may feel the fibroid with their fingers as a mass on the uterus. Further imaging tests can confirm the diagnosis.
Your doctor may order an ultrasound, MRI, X-ray, CT scan, or hysterosalpingogram (HSG) to get a picture of fibroids. Surgical tests such as laparoscopy or hysteroscopy are also used to definitively confirm the presence of uterine fibroids.
If you suffer from uterine fibroids and are actively trying to get pregnant or considering having a child, it is important to have an honest conversation with your doctor about treatment. There are options available to treat the symptoms of your fibroids and potentially shrink or remove them and still maintain your fertility.