How do Uterine Fibroids affect pregnancy?

Fibroids are the unusual growth of the tissues that occur in or outside the uterus. They are benign tumors, non-cancerous in nature. Uterine fibroids are common in women of childbearing age and about 20 percent to 80 percent of women develop these tumors by the age of 50. 

Fibroids vary in size and location and, they can alter the size and shape of the uterus. Though the majority of women are not infertile, depending on their size and location it may cause infertility. Fibroids are hard to detect because sometimes doctors mistake them for the thickness of the uterus. So, according to the doctors, the real number can be higher than expected. 

Symptoms of Uterine Fibroids

Fibroids, in most cases, do not show any symptoms. So, when you get fibroids, symptoms can be negligible but if you do get them these are the common ones:

• Painful periods: You may experience cramps on your stomach and lower back when menstruating.

• Heavy bleeding: If you are bleeding more than normal on your periods then there are chances of you having uterine fibroids.

• Anaemia: Fibroids also cause heavy bleeding which results in heavy blood loss. And this can be the cause of anemia.

• Spotting between periods: Fibroids result in bleeding or spotting when you are between your periods.

• Painful sex: It may result in painful sex as the shape and size of the uterus can be changed from fibroids.

• Prolonged periods: Usually a period cycle is of 2-7 days. With fibroids present in your uterus this duration can be increased.

• Lower back pain: Most common symptom of uterine fibroids is pain and if you experience constant lower back pain then you may have fibroids.

• Bloating of the lower abdomen: Fibroids cause the fulness in the lower stomach. Which causes bloating in the lower abdomen.

• Frequent urination: You may feel the need to urinate constantly and excessively when suffering from uterine fibroids.

• Fibroids also cause complications in pregnancy by:

▪ Infertility

▪ Miscarriage

▪ Pre-term delivery

Causes of the fibroids

Doctors do not know the exact causes of fibrous. But they think it may be related to hormones and genetics.

▪ Hormones like estrogen and progesterone can cause fibroids to grow. These hormones line the wall of the uterus. And during pregnancy, the estrogen level increases which causes the fibroids to grow. 

During menstruation, the estrogen levels go down resulting in the shrinking of fibroids.

▪ Genetics: Fibroid can be passed down from your mother to you. Experts find fibroids to be genetic. They have found a genetic difference between normal cells and fibrous in the uterus.

▪ Extracellular Matrix or ECM: Uterine fibroids have more ECM which causes them to stick together, than the other cells in the uterus. Thus, they are a factor in the increased growth of fibroids.

How do fibroids affect the reproductive process?

The majority of women with fibroids are not infertile. However, it may impact the reproductive process by:

▪ Affects the shape of the uterus that it does not allow the sperm to enter the vagina.

▪ The shape of the uterus is affected in such a way that it impacts the embryo.

▪ Not allowing the sperm and eggs to enter the fallopian tube.

▪ Hinder the blood flow to the baby during pregnancy.

▪ Can cause infertility 

▪ Fibroids can also hinder the growth of the baby

▪ Affecting the uterine lining.

▪ Premature labor

▪ Miscarriage 

Affects of fibroids on pregnancy.

In most cases, fibroids do not have an effect during pregnancy. But 10 to 30 percent of women, with fibroids, have pregnancy complications. Generally in the first trimester, they do not develop any complications. It is mostly seen in the last two trimesters with women having fibroids larger than 5centimetres. And, the most common symptom is pain. 

The risk for babies are:

▪ Abnormal Placenta: Fibroids cause the placenta to break away from the uterus wall. When this happens the important nutrients and oxygen does not reach the fetus in the womb.

▪ Growth restriction: If women have fibroids more than 5 centimeters then it can hinder the full growth of the baby as there is no more space for them to grow. 

▪ Breech delivery: Fibroids can impact the shape of the uterus and with an unusual shape, the baby may not be in the right position during the delivery. 

▪ Preterm labor: As discussed the common symptom of fibroids is pain. This pain sometimes leads to early delivery. 

▪ Caesarian delivery: Most women with fibroids opt for the cesarian section to deliver their baby. In the long term c- section is not good for the mother’s health.

▪ Miscarriage: Fibroids can also lead to miscarriages. Researchers find that miscarriages double with fibroids.

Risks for pregnant women.

▪ Weak contractions: Fibroids can disrupt normal uterine tissue, resulting in weak contractions. When in labor this makes it harder to achieve complete cervical dilation, leading to cesarean section. 

▪ Incomplete cervical dilation: Huge fibroids in the lower uterine area can obstruct the birth canal’s opening. Fibroids in this area can cause obstruction, which may necessitate a correction.

▪ Postpartum Haemorrhage: Poor contraction after birth can result in postpartum hemorrhage. It is a medical emergency that happens between 24-48 hours after giving birth. If the uterus is unable to contract, the uterine blood veins may continue to bleed.

What are the effects of pregnancy on fibroids?

Pregnancy in some cases does affect the fibroids. Either it increases their size or shrinks it down. Many women do not face any complications in their pregnancy due to uterine fibroids.

Some of these effects are:

▪ Generally, fibroids’ shapes do not change in size during pregnancy. However, some do change due to an increase in estrogen levels. One-third of uterine fibroids grow in the first trimester with the growth of estrogen level.

▪ Fibroids can decrease in size. Researchers found that 79 percent of fibroids decrease after pregnancy. 

How is uterine fibroid diagnosed?

Your obstetrician can detect the unusual growth in your uterus by physically examining you during your routine pelvic exam. They can feel it with their hands. But to confirm the diagnosis doctor may recommend additional tests like:

▪ Ultrasound

▪ MRI

▪ Cat Scan

▪ X-rays

▪ Laparoscopy

▪ Hysteroscopy

How can uterine fibrosis be treated?

Uterine fibroids have many treatments, but during pregnancy, it is limited as they can be harmful to the fetus. So the treatment is either done before pregnancy or after the pregnancy. 

Treatment that is suitable for your body depends on your situation and certain factors like age, location of fibrosis, and size of fibrosis. 

For expectant mothers

• Bed rest can be recommended for pregnant women

• Keeping yourself hydrated throughout the pregnancy

• Mild doses of pain relief during pregnancy. 

If you want to improve your chances of conceiving then there are several treatments you can try. 

Before Pregnancy

▪ Waiting and observation: Your doctor may suggest you wait and watch if you have only mild symptoms or no symptoms as they are not cancerous. Fibroids grow slowly or not at all. They also shrink and go away after menopause.

▪ Medications: There are many medications for fibroids treatment. Fibroids won’t go away fully but might shrink. They also help with symptoms like pain and excessive bleeding. Some medications that doctors prescribe are:

1. Oral birth control: this reduces bleeding. 

2. Medications such as ibuprofen or acetaminophen can help with pain

3. If you are bleeding heavily vitamin and iron supplements will help with anemia. 

4. Oriahnn for the management of heavy bleeding

5. Gonadotropin releasing-hormone shrinks the fibroids by putting you in temporary menopause

6. A progestin-releasing intrauterine device (IUD): is a contraceptive device to prevent heavy bleeding.

7. Tranexamic acid(Cyklokapron, lysteda)helps to slow down the heavy flow.

▪ Surgery is another treatment method if you want to completely remove the fibroids from your uterus. In this, there are many options like:

1. Myomectomy: a surgery that removes fibroids while attempting to preserve healthy tissue. If you want to become pregnant in the future, this is the best option. There are many ways to do a myomectomy. Either it can be done through major abdominal surgery or through laparoscopy.

2. Hysterectomy: In this surgery, your uterus is removed completely. It is the only sure way to cure fibroids for life. This surgery is not usual and not recommended though. It is a major surgery that can either be done by cutting the abdomen or laparoscopy.

3. Uterine fibroid embolization: This method is also known as uterine artery embolization. The doctor blocks the flow of blood to the uterus by inserting some plastic thing that shrinks your fibroids.

4. Myolysis: In this procedure, the doctor uses electric current, laser, wire loops, or radio frequency to shrink the fibrosis. 

After Delivery: 

After the pregnancy treatment may not be required. As they tend to shrink after the delivery. More than 70 percent of women’s fibroids shrink after 3-6 months of delivery. It shrinks up to 50 percent.

Fibroids do not go away on their own, but if not treated in mild cases it does not possess any harm to the health of women. In some cases, they may cause infertility and complications during pregnancy. But, the majority of women having uterine fibroids do not experience infertility. 

While it is not possible to prevent fibroids but they can be manageable. A healthy lifestyle reduces the risk of fibrosis along with a healthy weight.