Do Uterine Fibroids affect pregnancy?

During the childbearing years, many women suffer from this unusual pattern of menstruation where they may bleed excessively or have other severe discomforts during menstruation. If you are also suffering similarly, don’t hesitate to get in touch with a gynaecologist.

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Let us now know a bit more about Uterine Fibroids.

What are Uterine Fibroids?

Uterine fibroids are usually non-cancerous growths inside or outside the uterus attached to the wall. They are also called leiomyomas or Myomas.

These fibroids can be as small as a seed or much larger. It can be just a single fibroid or many in number.

If the fibroid is small or single, it may go unnoticed for a long time as there will be no symptoms.

However, if the size of the fibroid is big or they are many in number, it will show symptoms.

What are the symptoms of Uterine Fibroids?

Uterine fibroids will show either of the following signs:

• Heavy menstrual flow.
• Menstrual flow extending beyond seven days.
• Severe backache and pain in the legs.
• Difficulty in passing urine.
• Constipation.
• Pelvic pain or pressure.
• Frequent urination.

In some cases, if the fibroids grow too much, it is short of blood supply. In such cases, the fibroid begins to die, causing acute pain.

Seek immediate medical consultation with a gynaecologist if you experience sudden vaginal bleeding or sharp shooting pain in your pelvic region.

Classification of Fibroids

• Intramural fibroids – fibroids inside the muscular uterine wall.
• Submucosal fibroids -fibroids inside the uterine cavity.
• Subserosal fibroids – fibroids project outside the uterus.

What causes uterine fibroids?

According to research, some of the causes of uterine fibroids are:

Changes in Gene structure: Many fibroids display a different gene structure than the normal uterine muscles.

Hormones: When estrogen and progesterone are in the process of preparing the uterine lining for the menstrual cycle, they also result in the growth of the fibroid. Fibroid has more receptors of estrogen and progesterone.

After menopause, the fibroids shrink on their own due to a lack of hormones.

Other growth factors: Fibroids might respond to insulins also, which is responsible for tissue growth.

Extra Cellular Matrix: The cell structure of the fibroids change due to the Extracellular matrix. It is a binding agent which binds the tissues and cells. Due to its higher density in the fibroids, the fibroids become fibrous and keep growing. That is why the cell structure changes in the fibroids, making them grow.

Doctors believe they start growing from a stem cell in the myometrium (a smooth muscular lining of the uterus). A single cell multiplies many times. It forms a firm, rubbery mass that is different from the surrounding tissue. This is the fibroid.

The growth pattern of uterine fibroids is unpredictable. Sometimes they may grow slowly, rapidly, or not grow at all. Sometimes shrink on their own.

Often, if the fibroid is present during your pregnancy stages, it will shrink by itself or completely disappear post-pregnancy.

Who is at risk of developing uterine fibroids?

Apart from being in the reproductive age, there are certain factors putting you at risk of developing fibroids, such as:

• Race: Women from certain communities have a higher chance of growing fibroids, and that too from an early age.
• Hereditary: If your mother had fibroids, you might get them.
• Lifestyle: Not eating fibres, obesity, lack of Vitamin D, alcohol consumption are all factors that may cause fibroids.

Complication:

Usually, fibroids are not complicating. However, there can be a drop in red blood cells (anaemia), causing fatigue due to heavy blood flow. At times blood transfusion is required.

Pregnancy and fibroids:

Fibroids don’t affect your chances of getting pregnant. However, it is possible submucosal fibroids could cause-

• infertility or pregnancy loss.
• Placental abruption,
• fetal growth restriction
• preterm delivery.

Treatment for removing uterine fibroids:

The doctor will usually take a wait and watch approach to the fibroid if the woman has manageable symptoms and is not affecting her health poorly.

However, if the symptoms aggravate, various treatment options are available. Your doctor will decide your treatment plan based on the severity of the condition.

• Medication: Hormone regulation to regulate your periods is the aim of this treatment.
• Gonadotropin hormones: These hormones block the production of estrogen and progesterone, thereby inducing menopause. This stops the bleeding and shrinks the fibroid.
• IUD that releases progestin: It manages only the symptoms and prevents pregnancy. Fibroids do not shrink with this.
• Lysteda: This medicine does not alter hormones. It is only to control heavy bleeding.

• Non-Invasive procedure:

Ultrasound surgery using MRI machine: This procedure is carried out in the MRI machine. The images show the location of the fibroid, and the targeted soundwaves from the transducer generate heat to destroy the fibroid.

• Minimally invasive procedures:
• Embolizing the uterine artery: Embolic agents are injected into the arteries supplying blood to the uterus. Lack of blood flow shrinks the fibroid, and it dies.
• Ablation using radiofrequency: The doctor uses radiofrequency energies to shrink the blood vessels supplying blood to the fibroid.
• Robotic or laparoscopic myomectomy: In this process, the surgeon removes the fibroids without touching the uterus. If the fibroids are small or less in number, laparoscopy is ideal since they can be taken out from a small incision.

If the fibroid is big, it can be broken down and removed using laparoscopy.

• Hysteroscopic myomectomy: This process is used if the fibroid is sub-mucosal, meaning inside the uterus. The laparoscope is inserted via the cervix, and the fibroids are taken out.
• Ablation of the endometrial lining: The surgeon inserts a special instrument into the uterus and provides heat using microwave energy, electric current, or hot water to burn the endometrial lining.

This reduces the bleeding. During this procedure, the sub-mucosal fibroid also can be removed. But the fibroid inside the uterus remains unaffected.

After this procedure, you may not get pregnant, but you will still be administered birth control pills to avoid pregnancy in the fallopian tubes.

• Surgical Procedures: The surgeon may opt for traditional surgery if the situation demands.
• Myomectomy of the abdomen: If there are multiple or very large fibroids in your uterus, the surgeon will do the open abdomen surgery and remove the fibroids.

This procedure endangers your chances of conceiving.

• Hysterectomy: In this procedure, the surgeon will remove your uterus.

As a result, if you are trying to get pregnant, then a myomectomy might be the only option. Speak to your doctor and clear your doubts.

Conclusion:

You are responsible for your well-being. Be proactive and get regular checkups if you have a family history or have had menstrual problems in the past.