Have you ever wondered about problems with pregnancy and fibroids? When you learn that you have fibroids, it means that you have a non-cancerous tumor in your uterus. And, since your uterus is a large, layered organ, we classify and name fibroids based on where in your uterus they develop.
In case you need a review: your uterus has three layers: the outer serosa; the middle, muscular myometrium; and the inner lining—the endometrium. This endometrium is the lining that you shed each month during your period.
Now that you’ve got the anatomy down, we’ll get to classifying fibroids. There are three different types of fibroids.
1. Uterine fibroids that develop beneath the outside covering of the womb are called sub-serosal.
2. If they form in your uterine muscle, they are intramural.
3. And if fibroids pop up in your uterine cavity, inside the endometrium, they are submucosal.
Many women find it difficult to become pregnant while they have untreated fibroids. That's because your growths could block the fallopian tubes, or change the shape of your uterus, interfering with conception. But, if you do become pregnant, the location of your fibroids can make a major difference in your ability to carry your child to term. And that's a big problem for all women. But it's especially concerning for black women, who are three times more likely to develop fibroids and, according to the CDC, three times more likely to die from pregnancy-related complications.
When it comes to pregnancy and fibroids, tumors that develop in your womb can have the greatest impact on your pregnancy. If the fibroid is large enough to change the shape of your womb, you may experience pregnancy complications. Common side effects include, spotting and pain. Your fetal growth could be limited, because fibroids take up too much space in your uterus. With pregnancy and fibroids, your risk for premature delivery and miscarriage also increases. And during your pregnancy, you're also at risk for placental abruption (when your placenta detaches from your uterus.)
Furthermore, a new scientific study in the Annals of Epidemiology revealed that having fibroids during pregnancy led to a slight increase in the baby's head, arm and thigh circumference. Having fibroids also led to a slight increase in pre-term births. Also, in some cases, your fibroid may require you to have a C-section. That’s because its growth can alter your baby’s position, or block off your delivery pathway.
Sometimes, the location of your fibroid can make it difficult to become pregnant. In fact, we find fibroids in between 5% – 10% of women with infertility. The most common culprits? Fibroids that are inside your uterine cavity (submucosal). You may also have trouble getting pregnant with very large intramural fibroids (the ones within the wall of your uterus.) And that could be becausefibroids reduce the presence of certain cytokines that are important to the conception process.
Luckily, most women with fibroids can still become pregnant. But if you have fibroids and plan to get pregnant, you should receive a thorough medical evaluation. After all, fibroids can impact your fertility in several ways.
They can change your cervix shape, limiting the number of sperm that enter your uterus. Depending on location, fibroids can also change your uterine shape, getting in the way of sperm or fertilized embryos. Some fibroids may block your fallopian tubes, which keeps your egg from traveling to your uterus for fertilization. Also, fibroids can impact your endometrial lining, making it harder for embryos to implant. This problem is further complicated if fibroid affect blood flow to your uterine cavity. Why? Limited blood makes it even tougher for embryos to implant in your uterus.
Now you know what you need to watch out for when you’re trying to conceive. But here are some concerns to understand when you're dealing with pregnancy and fibroids.
Luckily, the news keeps getting better. A 2023 study from India followed 110 pregnant women with fibroids. Among their numbers, 80% of the expectant mothers carried their babies to term. Now, 61% of the women delivered their babies by c-section. But complications during and after pregnancy were relatively rare, with just 21% experiencing pre-term labor; 20% needing blood transfusions; and only 9% experiencing bleeding after delivery. Of course, this was a small study, but it does suggest that fibroids and pregnancy don't have to mean major adverse outcomes. Even so, if you get a diagnosis of fibroids before trying to conceive, you may want to seek treatment to make the conception and pregnancy process easier.
Now, we know these are all scary ideas. But here’s some good news for you. First of all, these complications occur in between 10 to 30% of pregnant women with fibroids. So, your pregnancy could be unaffected. And, most fibroids don’t grow during pregnancy. In fact, with your changing hormone levels, some fibroids may even shrink while you're pregnant.
Still, given the potential risks to you and your growing baby, you should talk to your healthcare provider about your fibroids if you want to become or already are pregnant. Most experts recommend treating fibroids before trying to conceive. Because, once you're pregnant, your treatment options are very limited.
Are you thinking of starting your family, and you've been diagnosed with fibroids? Click here to request an appointment with our Houston fibroid specialists. We can review treatment options, to help you conceive and safely carry your baby to term.
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