Uterine Fibroids During Pregnancy

Fibroids are benign tumours that grow out of the cells that make up the uterus. Any woman of reproductive age can develop them, and it is estimated that up between 50% – 80% of women can have one in their lifetime. Although the cause of fibroids is unclear, there are factors such as hormonal levels, genetic factors, race, obesity etc. play a role in their growth. Fibroids in some pregnant women can cause complications such as miscarriage, low birth weight, preterm labour etc. and hence need to be treated before conception. Read further to understand what fibroids are and their effects on pregnancy.

What Are Fibroids?

Also termed as Myomas or leiomyoma of the uterus, uterine fibroids are non-cancerous tumours that range in size from as small as a pea to as large as a grapefruit. Fibroids can grow into the uterine cavity, within the uterine wall, or outside of the uterine wall and women can have them in one or more of these locations. A fibroid or a cluster of fibroids in the uterus that have grown to a large size or are growing on the outside of the uterine wall can displace the uterus to an abnormal position. This could put pressure on internal organs such as the intestine and the urinary bladder leading to symptoms such as fullness, constipation, frequent urination, backache and pelvic pain. Fibroids are also known to cause heavy menstrual bleeding and interfere with fertility. Occasionally they could cause complications during pregnancy. Uterine fibroids are almost always benign tumours of the uterus no matter how large they grow in size, and having fibroids does not increase a woman’s risk of cancer. It is estimated that fibroids usually develop prior to pregnancy. Most women are unaware of it until they get an ultrasound scan or a pelvic exam.

What Are The Types Of Fibroids?

Fibroids are classified based on where they grow in the uterine region.

1. Intramural Fibroids

These fibroids grow within the muscular wall of the uterus and are the most commonly occurring type. They tend to grow large in size and deform the uterus making it full. Their presence can obstruct the egg from being fertilised and cause infertility. Intramural fibroids also cause heavy bleeding during the menstrual periods.

2. Submucosal Fibroids

Submucosal fibroids grow just under the inner lining of the uterus. Even the presence of small lesions in this lining of the uterus can cause infertility and heavy or painful periods.

3. Subserosal Fibroids

These fibroids occur on the outside of the uterus and grow into the pelvic region. They remain attached to the uterus by a small stalk like tissue as the fibroid grows. Subserosal fibroids can put an excess pressure on the internal organs as they grow and cause physical discomfort.

4. Cervical Fibroids

These fibroids although rare, grow in the wall of the cervix and can cause complications during labour.

What Are The Causes of Fibroids When Pregnant?

What leads to the growth of fibroids is not exactly known but there are a few known causes of fibroid during pregnancy Such as hormones, genetic changes and growth factors.

• Hormones such as oestrogen and progesterone seem to promote the growth of fibroids as they stimulate the development of the uterine lining during the menstrual cycles. Research shows that there is a greater presence of receptors for oestrogen and progesterone in fibroids than the normal uterine muscles do. Therefore during pregnancy when oestrogen levels are high, fibroids tend to swell. Birth control pills that contain oestrogen also make it likely to develop fibroids in women who are on the pills.
• Genetic changes can also be one of the causes of fibroids as fibroids contain changes in genes that are different from the normal uterine muscle cells.
• Growth factors are substances that help the body maintain tissues and are suspected to affect the growth of fibroids. New research also found some evidence that caffeine, alcohol and red meats could increase the risk of fibroids.

What Are The Signs & Symptoms Of Uterine Fibroids During Pregnancy?

Fibroids in most women are asymptomatic; a lot of women are unaware of it until they have a scan. In about a third of the women fibroids cause symptoms such as abnormal periods and pain.

The symptoms of fibroids in uterus include:

• Painful periods or prolonged and heavy bleeding which can lead to anaemia
• Frequent urination or pain during urination caused by the fibroid compressing the urinary bladder
• Feeling of fullness in the abdomen which can cause constipation as the fibroid applies pressure on the colon
• Pain in the pelvis, back or belly depending on where the fibroid is located
• Infertility and trouble conceiving
• Pain during sex
• Unexplained miscarriages

Women Who Are At Risk of Getting Fibroids

The risk factors of fibroids are not clearly understood but what is known is that it can affect any woman of reproductive age. Other factors that have an influence include:

• Heredity: There is a high chance that you would develop fibroids if a family member such as your mother or sister has fibroids.
• Race: African women or African-Caribbean women have a high risk of developing fibroids at a younger age than women of any other race. They are also likely to have larger fibroids.
• Obesity: Being overweight causes higher oestrogen levels due to body fat which can lead to fibroid development.
• Age: Fibroids generally occur in women in their 30’s. Fibroids often shrink and show no symptoms in women who have had menopause.
• Hormone levels: Higher oestrogen and progesterone levels are known to trigger fibroid growth.
• Childbirth: The risk of fibroids is lower in women who have already given birth once. The risk drops with more children.
• Lifestyle: Consumption of alcohol, caffeine and red meat has shown to increase the risk of fibroids.

How Are Uterine Fibroids Diagnosed In Pregnancy?

As fibroids are often asymptomatic they are usually discovered incidentally during a pelvic exam. If any irregularities in the uterus are found in an exam, the doctor might suggest a test for positive confirmation.

Some of the several uterine fibroids test available are:

• Ultrasound scans: These scans use sound waves to generate a picture of the uterus and any fibroid growth on it to confirm its presence. The procedure involves the doctor using an ultrasound transducer which is placed on the abdomen (transabdominal) or placed inside the vagina (transvaginal) to get images of the uterus.
• Magnetic resonance imaging (MRI): MRI scans generate three-dimensional images of the uterus and the fibroids and can accurately determine its structure, location and size. It can also help identify the type of fibroid and determine the best treatment options.
• Hysteroscopy: This procedure involves the examination of the uterine cavity and the openings of the fallopian tubes through the use of a small probe called a hysteroscope.
• Hysterosalpingography: An X-Ray imaging procedure, uses a dye to highlight the uterine cavity and the fallopian tubes. Hysterosalpingography is recommended if there is a concern about infertility. Along with revealing the fibroids, it can also be used to determine if the fallopian tubes are open.
• Hysterosonography: Hysterosonography is also termed as a saline infusion sonogram, which uses a saline solution to expand the uterine cavity. The expansion allows better examination and imaging of the submucosal fibroids.

Complications of Fibroids

Most women who have fibroids go on to have normal pregnancies and vaginal delivery. In some cases, the risk of a fibroid during pregnancy is higher and can cause complications depending on where the fibroids are located and how big they are.

• Complications arising during pregnancy

It’s important to know that the location of the fibroid largely determines the complications, if, they arise. Depending on their type, fibroids sometimes increase the risk of a miscarriage during the first and second trimester. Fibroids in the uterine cavity are the ones most likely to cause a miscarriage.

• Complications arising during delivery

Fibroids don’t prevent women from having a vaginal delivery. However, fibroids located in the lower part of the uterus could block the baby’s descent. In that case, a C-section will have to be performed. The same applies to when there are multiple fibroids which could prevent the uterus from contracting normally and stall the labour.

• Risk to baby

It is highly unlikely that fibroids with harm the baby. In rare cases, complications may occur if the placenta grows over the surface of a fibroid inside the uterus. This could lead to the improper supply of nutrients to the baby resulting in a low birth weight or cause the amniotic sac to rupture prematurely.

Treatment

Most fibroids don’t need any treatment if the symptoms are not causing too many problems. Since there is no single best approach to the treatment, the doctor determines the best course of action involving medicine for fibroids or fibroids surgery based on the type of fibroid and the symptoms.

• Treating with medication

Medication is the simplest method of fibroid treatment without surgery and is effective in treatment. Gonadotrophin-releasing hormone analogues (GnRHas) shrink or halt the growth of fibroids temporarily and are administered as a nasal spray, a monthly injection or as a skin implant. The GnRHas reduce the oestrogen levels in the body and the course of treatment normally lasts between three to six months. They are usually prescribed a few months before the woman plans to conceive.

• Treating with surgery

Myomectomy is the only method of surgical removal of uterine fibroids that leaves the uterus intact and is an option for women who still want to retain their ability to conceive. Myomectomy can involve procedures to remove the fibroids through laparoscopic or hysteroscopic surgery. Open surgeries are for larger fibroids that cannot be operated laparoscopically. Although the fibroid is removed, the women have a 25% probability of a new one growing in the next 10 years.

Advanced treatment

• Focused ultrasound: This method uses an MRI scanning machine to pinpoint the exact location of the fibroid. High energy ultrasound is focused on the fibroid to heat and destroying the cells and causing it to shrink.
• Thermal techniques: This relatively new technique called myolysis uses laparoscopically inserted equipment that is directly probed into the fibroid. It uses laser or electric current to destroy the fibroid cells. A similar procedure called cryomyolysis destroys the fibroid cells by using extreme cold to freeze the blood supply to the fibroid.

What Are The Home Remedies To Cure Fibroids In Pregnant Women?

There are plenty of home remedies available that can be used to shrink uterine fibroids naturally without surgery. These remedies and treatments can be included as part of a healthy lifestyle for fibroid uterus treatment naturally.

Some of the home remedies include:

• Castor Oil Pack: Applying a castor oil pack on the abdomen helps in pain relief as it contains ricinoleic acid that has anti-inflammatory properties. Castor oil also stimulates the lymphatic system to fight against toxins in the body that contribute in fibroid development.
• Green Tea: Adding green tea to your natural fibroid treatment diet has plenty of benefits. The compound epigallocatechin gallate (EGCG) present in green tea inhibits growth of fibroid cells and eventually leads to their shrinking.
• Apple Cider Vinegar: Apple cider vinegar is used extensively in detoxing the body and shrinking fibroids. It helps in reducing the fibroid symptoms.
• Burdock Root Tea: Burdock root is known to improve the liver’s ability to metabolise oestrogen which in turn shrinks fibroids. As a treatment, drinking its tea is effective in fibroid and new tumour growth inhibition.
• Garlic: Garlic has powerful anti-inflammatory and anti-oxidant properties that discourage the growth of fibroids and other tumours. Eating three to five cloves a day can reduce fibroids and its symptoms.
• Indian Gooseberry: Indian Gooseberry is rich in antioxidants and is an immunomodulator which is good for reducing fibroid symptoms.

What Happens To Your Fibroids After Delivering The Baby?

Immediately after giving birth, fibroids could trigger excessive bleeding which might require blood transfusion in rare cases. In most cases the woman is put on supplements for fibroids to recover. In the months after the delivery as the uterus shrinks in size, fibroids could shrink in size as well and sometimes to a size smaller than it previously was.

Is It Possible to Prevent Uterine Fibroids?

There is no way to prevent fibroids unless a woman undergoes a hysterectomy. Hysterectomy which involves the complete removal of the uterus is the only way to ensure that fibroids can never grow again. The downside is that since the uterus is removed, the woman will never be able to conceive.

Conclusion

Although there is no way to prevent fibroids, having them doesn’t mean that you cannot have a healthy pregnancy. With the treatments available, it is possible to keep the troubles of fibroids at bay during the pregnancy.