Are you currently pregnant or planning to get pregnant? If so, you should know that Uterine Fibroids can not only influence fertility when you’re trying to conceive but can also affect the pregnancy itself. This isn’t something that should scare you though. 70-90% of women who have uterine fibroids will not have any pregnancy complications related to their condition[1]. Even if you are one of the unlucky few who will face a few fibroid-related obstacles in your pregnancy journey, if you have the right care, your dream of having a healthy bundle of joy can still be a reality.
On talkingfibroids.com, we believe that knowledge is power. So today we’re unpacking some of the potential complications pregnant women with fibroids may face, as well as tips for managing and monitoring symptoms during your pregnancy.
The potential impact of fibroids on pregnancy: understanding complications
Before getting stuck in, remember that not all fibroids are made equal. On this blog we always emphasize the importance of working closely with your gynaecologist or OB-GYN because every woman and her fibroids are completely different. For all the potential complications we will discuss below, the percentage risk of actually experiencing them can vary widely depending on factors such as the size, number, and location of the fibroids, as well as your overall health[2]. A lot of this can be managed proactively with your doctor, which we unpack later in the article (so don’t get so overwhelmed by the potential issues that you forget to read the silver linings!).
Miscarriage :
Miscarriage refers to the loss of a pregnancy before 20 weeks. Women with fibroids, particularly those that distort the uterine cavity, are at an increased risk of miscarriage[3]. The reasons for this are not well understood, but it’s thought that fibroids can interfere with the implantation of the embryo or disrupt blood flow to the placenta, leading to miscarriage. Submucosal fibroids, which grow into the uterine cavity, are particularly associated with a higher risk of miscarriage[4].
Preterm labour:
As November is Prematurity Awareness Month, let’s start with a complication you may have already heard about; the risk of going into preterm labour before your actual due date. The medical community considers a pregnant woman to be “full term” when she has been carrying her child for between 37 to 42 weeks. This is the period during which the baby has fully developed and is ready to face the outside world. Conversely, preterm birth occurs when a baby is born before 37 weeks of gestation[5]. These babies that are often affectionately referred to as “preemies” can experience a range of issues due to underdevelopment in organs like the lungs, brain and heart depending on how premature they may be.
Studies suggest that women with fibroids have a higher risk of delivering preterm than women without fibroids. Why? It’s thought that fibroids can decrease the space available for the growing foetus, putting pressure on the uterus and potentially triggering early labour. Additionally, fibroids can increase uterine irritability, leading to contractions that could initiate preterm labour[6].
Other things to bear in mind: Pain and bleeding and caesarean sections
There are some ways that having fibroids may impact your pregnancy that can be uncomfortable for you to think of or deal with, even if they don’t pose a direct risk to the health of your baby.
The first is pain and bleeding during your pregnancy, which is unfortunately quite common for women with fibroids. Again, this may not harm the baby directly but can obviously cause you quite a lot of discomfort and anxiety as the mom-to-be! The location of fibroids tends to determine the risk for bleeding. Bleeding in early pregnancy is significantly more common if the placenta implants close to the fibroid. During pregnancy, fibroids may also increase in size due to the elevated levels of oestrogen, which can lead to pain, particularly if the fibroid outgrows its blood supply and undergoes degeneration. This degeneration can cause intense pain, fever, and inflammation[7]. Fibroids can also cause vaginal bleeding if they affect the uterine lining.
Another thing to bear in mind (or perhaps to make peace with depending on what your doctor says), is the heightened chance of having a Caesarean Section (C-section). Fibroids may block the birth canal, making vaginal delivery difficult or impossible. Large or poorly positioned fibroids can interfere with uterine contractions during labour. Fibroids can also increase the risk of complications during labour, such as abnormal foetal positioning (breech presentation). The rate of C-sections in women with fibroids is significantly higher, compared to the general population[8].
Managing and monitoring fibroids during pregnancy for optimal outcomes
So now that we’ve covered many of the things that can go wrong, we can at least start on what you can do about preventing or managing these things. The simple truth is that it’s all about being proactive with your OB-GYN.
As we stated upfront, a lot of the risk in any of these complications is dependent on factors like the size, location and number of fibroids you have. If you’re not pregnant yet, but planning to conceive, it’s a great idea to work with your gynaecologist or OB-GYN ahead of time to evaluate the size and location of your fibroids to see what your likelihood of potential obstacles would be. In some cases, they may recommend interventions like fibroid removal (called a myomectomy) or hormonal therapies to shrink fibroids if they are larger, numerous or distorting your uterus.
If you’re already pregnant then no-sweat! Even with careful pre-planning, not all complications can be predicted with a high degree of reliability. The good news is that women with fibroids will often undergo more frequent ultrasounds to monitor their growth and assess their impact on the baby’s development, uterine environment, and placental function.
If the worst comes to pass, and you do experience complications, modern medicine presents numerous options for safe delivery.
It’s also important to note that your doctor may give you specific instructions to take it easy, even to the point of getting bedrest. Even if full bedrest is not necessary, you yourself can lower your risks by simply avoiding heavy physical activity, getting adequate hydration, and taking proactive measures to manage your stress levels, like meditation, yoga, breathing properly and getting adequate sleep.
If you are suffering from severe pain and bleeding during pregnancy, you also don’t need to suffer in silence! By consulting with your doctor, you can be prescribed various medications to help with these unpleasant side effects that will be safe for you and your baby. In any case, you should consult your doctor immediately if you’re experiencing any of these symptoms. It might just be fibroid growth, but could indicate something more serious, so never ignore them!
Conclusion
As we said in the beginning – we believe that knowledge is power. Having fibroids doesn’t necessarily mean you will experience complications in your pregnancy, but being aware of how your fibroids could potentially affect you and your baby’s health could be the nudge you need to consult your OB-GYN earlier, and to prepare yourself both mentally and physically for any eventuality. With the proper care, you too can join the ranks of many happy mothers with fibroids.
References:
[1] Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7. PMID: 20508779; PMCID: PMC2876319. https://pmc.ncbi.nlm.nih.gov/articles/PMC2876319/
[2] https://www.nhs.uk/conditions/fibroids/complications/
[3] Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7. PMID: 20508779; PMCID: PMC2876319.
[4] Li, H., Hu, Z., Fan, Y. et al. The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis. BMC Pregnancy Childbirth 24, 345 (2024). https://doi.org/10.1186/s12884-024-06545-5
[5] https://www.efcni.org/health-topics/key-facts-preterm-birth/
[6] Li, H., Hu, Z., Fan, Y. et al. The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis. BMC Pregnancy Childbirth 24, 345 (2024). https://doi.org/10.1186/s12884-024-06545-5
[7] Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7. PMID: 20508779; PMCID: PMC2876319. https://pmc.ncbi.nlm.nih.gov/articles/PMC2876319/#B2
[8] Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7. PMID: 20508779; PMCID: PMC2876319. https://pmc.ncbi.nlm.nih.gov/articles/PMC2876319/#B2
