Fibroids and PregnancyRebecca Klein
They can be microscopic, the size of a grapefruit, and even grow to volleyball proportion or beyond. These unwelcome guests call a woman’s uterus home. We are talking about tumors of the muscle of the uterus, commonly known as fibroids.
The good news is that with the monitoring modern technology enables, the great majority of pregnant women who have fibroids give birth to healthy babies, says Dr. Pedro Arrabal, MD, a Baltimore OB-GYN and maternal fetal medicine specialist.
According to Dr. Bobbie Gostout, MD, an associate professor of obstetrics and gynecology with the Mayo Clinic in Rochester, Minnesota, fibroids infrequently cause difficulty with conception. Yet once a woman is pregnant, fibroids can enlarge rapidly—especially during early pregnancy—cause severe pain, and even necessitate hospitalization, Dr. Gostout explains. Still, she says most fibroids do not cause any difficulties with pregnancy.
Nevadra Johnson, of the Washington DC area, was about to undergo surgery to remove her fibroids when she learned she was pregnant with her second child. “It was kind of bittersweet. You’re excited about it. You’re also worried,” she says of the news. “You’re saying, ‘Will the baby make it?’ There’s a lot of worry in the beginning stages of pregnancy. It’s even more so when you know you have a condition.”
Fibroids and the Growing Fetus
Johnson, who was referred to Dr. Arrabal, learned that for the safety of her unborn child, her surgery needed to be postponed until after delivery.
“During pregnancy, fibroids are not treated,” explains Dr. Gostout. “We simply try to manage the symptoms in a woman who wishes to preserve fertility.” After pregnancy, she says fibroids can be surgically removed through a myomectomy and adds while there are newer treatments which appear promising, so far they have only been applied in large numbers to women who are done having children, “mainly since the unknown effects on the strength of the uterus and the ability of the uterus to carry a healthy pregnancy.”
When Johnson’s fibroids were first discovered in 2000, she had a five-year-old son, but in early 2006, pregnant with her second child, her three fibroids ballooned from the size of a quarter to grapefruit size. At three-months pregnant, Johnson says her protruding stomach made her look twice as far along.
Johnson admits wondering if the fibroids were cancer. The answer was no. Dr. Arrabal says that the odds of developing cancer as a result of fibroids during pregnancy are less than one percent.
“Whenever we tell anybody things are out of the ordinary, people tend to assume the worst. The way I look at it, it’s my job to assume the worst and to try to prevent the worst,” says Dr. Arrabal, who asks patients to leave the worrying to him and to stay as positive as possible.
He explains as a woman’s estrogen levels significantly rise during early pregnancy, fibroids can grow tenfold or more. The traditional method of measuring a mother’s abdomen to determine a baby’s approximate size can give a false sense of security, as the fibroids can throw off the numbers. Thanks to major medical advances in the last 30 years, Dr. Arrabal says the baby and the fibroids can be monitored in ways never before possible. Ultrasounds and other tests are used to track the baby’s size and the location of the fibroids.
While Dr. Arrabal emphasizes the favorable odds, he also prepares patients for potential complications, such as an obstructed birth canal necessitating a Cesarean section, preterm contractions, and preterm labor. In a minority of cases, the fibroid settles under the placenta, forcing it to separate from the uterus, which Dr. Arrabal says can cause a woman to hemorrhage or have a stillbirth.
Dr. Gostout says there are also potential complications in the first trimester, including the chance of miscarriage.
Signs and Risk Factors
When fibroids are detected during pregnancy, an ultrasound often reveals their presence, says Dr. Arrabal, who lists such symptoms as a larger uterus than expected, pelvic pressure, and premature labor pain. If a woman is not pregnant, signs include a lump or a mass in the lower abdomen, pelvic pressure, and a higher incidence of heavy periods.
Dr. Arrabal reports fibroids are seen more often in African American women, risks increase with age, and once a woman has one fibroid, there is a predisposition for more.
Dr. Gostout adds about 20 percent of women in their twenties and about 30 percent of women in their thirties have fibroids. In a majority of cases, she explains, the fibroids are small and asymptomatic. “The actual odds of fibroid-related problems in pregnancy are unknown,” she explains.
Near Forgotten Fibroids
Heather Scott, of Boston, Massachusetts, learned on the day of her daughter’s birth in 2003 she had fibroids. At her 37 week exam, her doctor detected fetal stress, high blood pressure, and fibroids. Hours later, she had a Cesarean section.
After the pregnancy, Scott’s fibroids shrunk to about five centimeters, and she was told not to worry about them. She nearly forgot about them until her next pregnancy when her fibroids more than doubled in size. Eventually, the fibroids created uterine distress and caused low level daily contractions, resulting in orders for bed rest. “Just taking it easy really helps,” Scott says about the uncomfortable sensation of heaviness.
Scott met with a fetal maternal specialist every two weeks to access the size of the fibroids and of the baby; she also received a fetal fibronectin test to check her risk for preterm labor. By 30 weeks, her fibroids were bigger than the baby but fortunately hadn’t stunted the baby’s growth.
Despite the discomfort, Scott maintained her humor. She says after giving “lots of love” to what she assumed was her baby’s back or bottom, a nurse pointed to the same area and said, “‘Look at that fibroid.’ Surprised, Scott replied, ‘No, are you kidding me? I thought [it] was the baby.'”
Moving Beyond Worry
Like Scott, Johnson also was put on bed rest. After a rocky first trimester with several emergency room trips following episodes of intense pain, Johnson says her fibroids became more manageable, but far from pain-free.
At 29 weeks, she spent a night at the hospital after experiencing minor contractions and was given medication to calm the fibroids, which when agitated can cause the uterus to contract.
“I was a little concerned… when the pains were coming,” says Johnson, who found herself able to manage the pain once knowing the baby was okay.
Johnson says six weeks later she was confident that the baby was a good size and that she shouldn’t have any problems if the baby made an early debut. She focused on trying to enjoy the pregnancy and getting the baby’s room ready.
Last April, Johnson, her husband, and their 10-year-old son, welcomed a healthy baby boy.
Johnson advises those facing a similar situation to “Do the best that you can. Eat right, take care of yourself, and just have faith.” She adds seeing a high-risk doctor and having the additional ultrasounds eased a lot of stress. Johnson had her fibroids surgically removed three months after giving birth. “It’s a relief overall to know they’re gone,” says Johnson.
Scott, who gave birth to a son in August 2006, marvels at the power of modern medicine. “Several years ago, I think [the fibroids] would have been a huge deterrent and potentially a cause of premature fetal delivery or even death, but today thank goodness for modern technology and great doctors. It definitely bumps you into a high-risk group, but as far as high risks go you are on the low end, because it’s manageable.”