Fibroids and pregnancy
Q: I’m 24, single and looking forward to having a family one day. I was recently diagnosed with fibroids. What treatment options would allow me to have a baby in the future? A: Fibroids are noncancerous masses made of muscle that grow within the uterus.
While fibroids are common — they are present in over 75% of women — most people don’t have symptoms or pregnancy problems due to fibroids, and not everyone needs treatment.
Fibroids are classified into three main categories: Subserosal fibroids:
The fibroids grow on the surface of the uterus. They are the least likely to affect pregnancy since they are outside the womb, or endometrial cavity. Intramural fibroids: These fibroids grow within the wall of the uterus. They can make it more difficult to get pregnant but only if they get large and start to push into or distort the endometrial cavity. Submucosal fibroids: These grow within the endometrial cavity, which is where a developing baby would grow. Studies show these fibroids can make it more difficult to get pregnant and might be a risk factor for miscarriage.
For some, large fibroids can cause heavy or prolonged periods or bulk symptoms. Bulk symptoms include pelvic pressure or heaviness, frequent urination, difficulty passing bowel movements or feeling full constantly. Fibroids can make it harder to become pregnant or stay pregnant, and sometimes fibroids can cause problems during pregnancy or delivery of the baby.
A greater number of fibroids, larger fibroids, and submucosal fibroids have been shown to have the biggest effect on women trying to get pregnant.
Options for treating fibroids include:
■ Medications can be used to treat heavy periods due to fibroids, and a couple of medications can temporarily shrink fibroids. Most of these medications will prevent pregnancy while you take them, so they are not meant for people trying to conceive. Medications are good if you have bothersome symptoms and you don’t want to get pregnant right away.
Myomectomy is a surgery where the fibroids are removed from the uterus. A myomectomy can be performed through the vagina or abdomen, either through small incisions or a “bikini” or C-section type of incision. Having the surgery performed vaginally or laparoscopically is safer and less invasive than having it done through a large incision, but the surgery depends on the size, location and number of fibroids. A myomectomy has been shown to be safe and effective for women who want to get pregnant in the future.
■ Uterine fibroid embolization, aka uterine artery embolization, blocks the blood supply to the fibroids. This makes the fibroids smaller and decreases menstrual bleeding. Studies show more pregnancy complications for women after this procedure.
■ Radiofrequency fibroid ablation is a surgery where a device is inserted into the fibroid to destroy the tissue with heat. It can be performed through the vagina or laparoscopically. Like embolization, this procedure may affect future pregnancy.
■ Endometrial ablation decreases heavy period bleeding using a device inserted through the vagina that destroys the lining of the uterus. Pregnancy is not recommended afterward.
None of the treatments above remove the uterus, so new fibroids may occur. For patients with significant fibroids, a hysterectomy is the best option. In this surgery, both the uterus and fibroids are removed to prevent fibroids from coming back, and eliminating menstrual bleeding forever.
Fibroid specialists can guide you through your treatment options and help you achieve a healthy pregnancy. — Michelle Louie, M.D., Surgery, Mayo Clinic, Phoenix