Fibroids and fertility

Up to 80% of women and people with female reproductive health systems have fibroids by the time they turn 50, with 20-30% of those occurring during pregnancy. While many fibroids never cause problems, some can impact your chances of getting — and staying — pregnant. 

Mason Hui, DO, a minimally invasive gynecologic surgeon and obstetrician-gynecologist (OB/GYN) with Atlantic Health System, shares how fibroids can affect fertility and pregnancy.

What are fibroids?

Fibroids are benign (noncancerous) tumors that develop in or on the uterus, or womb. Made up of muscle and tissue, these abnormal growths can appear either individually or in clusters. 

While the exact cause of fibroids is unknown, you might be at a higher risk for developing fibroids if you:

• Have a family history of fibroids
• Are an African American woman
• Are between the age of 30 and 50 years old

Although fibroids can affect the cervix and ovaries, they most commonly grow in the uterus. The three main types of uterine fibroids include subserosal fibroids (located in the outer wall of the uterus), intramural fibroids (located in the muscles of the uterine wall) and submucosal fibroids (located inside the uterus).

Can fibroids affect fertility and pregnancy?

Because they’re in or near the uterine cavity (the space inside the uterus where the fetus develops), submucosal fibroids can make it more difficult to conceive. They can disrupt fertility by:

• Changing the shape of the uterine cavity, which can disrupt implantation and placentation of a pregnancy.
• Blocking the fallopian tubes, which keeps the eggs from traveling to the uterus.
• Restricting blood flow to the uterine lining, which damages the lining and prevents the fertilized egg from implanting.
  

While subserosal and intramural fibroids don’t usually affect your ability to get pregnant, they can lead to problems during pregnancy. Fibroids can increase your risk of:  

• Miscarriage
• Preterm labor
• Premature rupture of membranes (water breaking too soon)
• Placental abnormalities
• Breech position during birth
• Hemorrhaging during delivery
• Cesarean section
  

Signs and symptoms of fibroids

Some fibroids may be so harmless that you don’t even notice them. 

“Up to 50% of women have fibroids and don’t even know it,” says Dr. Hui. 

In other cases, they can cause severe discomfort. Common fibroids symptoms include:

• Heavy or painful bleeding during your period
• Bleeding between periods (spotting)
• Abdominal fullness or bloating
• Constipation
• Frequent urination
• Difficulty emptying your bladder
• Reproductive health issues, including infertility and miscarriages

How are fibroids diagnosed?

Doctors commonly use physical exams and ultrasounds to diagnose fibroids. In some cases, they will use an MRI scan to detect them. 

How to treat fibroids during pregnancy

During pregnancy, doctors will prescribe medications to help you manage pain and cramping. 

“Fibroids often degenerate in pregnancy,” explains Dr. Hui. “The baby and the fibroid share the blood supply. As the uterus and baby grow during pregnancy, it demands more of the blood supply and the fibroid slowly dies off.” When the fibroid dies off, or degenerates, this can cause significant pain in pregnancy. 

Fibroids are generally treated with anti-inflammatory medications, pelvic rest, and hydration during pregnancy. If this does not help, the use of stronger pain medications can be used in a hospital setting. The surgery to remove fibroids, or a myomectomy, is only used as a last resort during pregnancy because of the high risk to the fetus.

Don’t let fibroids keep you from growing your family. Talk with your doctor to learn about safe and effective treatments that will help you manage the risks and achieve a happy, healthy pregnancy.