Uterine Fibroids during Pregnancy: Risks and Management

It is not uncommon for women to discover uterine fibroids for the first time during prenatal check-ups. Statistics show that 1-10% of expectant mothers are diagnosed with fibroids during routine ultrasounds. Understandably, this revelation may raise concerns about the impact on pregnancy: Will the fibroids disappear? Could they harm the baby? Is immediate surgery necessary? and whether fibroids could make it a high-risk pregnancy. This article explores the changes, risks, and management of uterine fibroids during pregnancy, offering reassurance and guidance for expecting mothers.

What Are Uterine Fibroids?

Uterine fibroids (also known as leiomyomas or fibromas) are non-cancerous tumours of the uterus. They are unrelated to uterine cancer and do not increase the risk of developing cancer in the future.

Uterine fibroids can occur individually or in clusters, with sizes ranging from as small as 1mm to as large as 20cm in diameter. They are commonly found within the uterine wall (muscle layer), inside the uterine cavity, or on the outer layer of the uterus.

Changes in Uterine Fibroids During Pregnancy

Hormonal changes during pregnancy can cause fibroids to enlarge. When growth does occur, it typically happens in the first trimester. By the second and third trimesters, fibroid size generally stabilises.

Studies found that during the second trimester (weeks 14-27), smaller fibroids are more likely to grow, while larger fibroids (≥6cm) usually remain unchanged or shrink. By the third trimester (week 28 onwards), fibroids generally begin to shrink.

Common Symptoms of Uterine Fibroids

Many small fibroids do not cause symptoms. However, when symptoms do occur, pain is the most common complaint, especially for fibroids larger than 5cm.

What Are the Potential Risks of Uterine Fibroids During Pregnancy?

Most fibroids do not negatively impact pregnancy. However, complications arise in 10-30% of cases. Potential risks include:

Caesarean delivery (due to large fibroids crowding the lower uterine segment and blocking the birth canal)
Fetal growth restriction
Malpresentation (breech position)
Antepartum haemorrhage (bleeding during pregnancy)
Placental abruption (premature separation of the placenta from the uterine wall)
Abdominal pain
Preterm labour and delivery
Postpartum haemorrhage
Miscarriage

Management of Uterine Fibroids During Pregnancy

Small fibroids typically do not require surgical treatment. Regular monitoring and tracking of fibroid growth during pregnancy are advised.

If uterine fibroids cause pain during pregnancy, conservative management is typically used. This includes rest, hydration and analgesics (e.g. paracetamol). Prostaglandin synthase inhibitors, for example, non-steroidal anti-inflammatory drugs (NSAIDs), require caution when used during the third trimester. Prolonged use of more than 48 hours can lead to adverse effects on the fetus or newborn, such as premature closure of the ductus arteriosus, pulmonary hypertension, necrotising enterocolitis, intracranial haemorrhage, or oligohydramnios. In rare cases, if the pain is severe and unmanageable with conservative management, obstetricians may consider using narcotic analgesics, epidural anaesthesia, or surgical intervention (such as myomectomy).

Surgical removal of uterine fibroids during the pregnancy is not usually recommended due to risk of pregnancy loss or preterm labour. However, some studies have shown that antepartum myomectomy can be safely performed antenatally when necessary. Surgery is applicable for the following situations:

Persistent, significant pain not responsive to conservative management
Large (>10 cm) or rapidly growing fibroids
Fibroids on a pedicle

In most cases, myomectomy should be avoided during caesarean delivery due to the risk of significant bleeding. However, symptomatic subserosal fibroids with a pedicle less than 5cm thick or fibroids deemed safe for removal by an obstetrician may be exceptions and can be removed during caesarean delivery.

FAQs About Uterine Fibroids

1. Do Fibroids Disappear?

The growth of uterine fibroids is influenced by hormones, so they do not disappear on their own. Even after surgery, fibroids may regrow. After menopause, due to decreased hormone levels, fibroids typically shrink, and symptoms may improve. However, it is advisable to undergo regular monitoring before menopause.

2. How Long Is Recovery After Fibroid Surgery?

Uterine fibroid surgeries can generally be categorised into four types: traditional open myomectomy, laparoscopic myomectomy, hysteroscopic myomectomy and high-intensity focused ultrasound (HIFU), each with different recovery times:

Traditional open myomectomy: About 6 to 8 weeks
Laparoscopic myomectomy: About 2 weeks
Hysteroscopic myomectomy: About 2 weeks
HIFU: less than 1 week

3. Can Diet Help Shrink Fibroids?

While diet cannot cure fibroids, balanced nutrition can help manage symptoms and slow fibroid growth.

Food to eat if you have uterine fibroids: Consume adequate fibre, moderate amount of food rich in potassium and antioxidants (green tea & turmeric)
Foods to avoid if you have uterine fibroids: Avoid excessive estrogen-boosting foods , eg, red meats with added hormones, soy bean, soy milk, tofu, and full fat dairy

Stay Calm and Monitor Regularly

Discovering uterine fibroids during pregnancy should not cause excessive worry, as they can coexist safely with the fetus in most cases. The key is to have regular prenatal check-ups, seek detailed evaluations from an obstetrician, and follow their recommendations.

OT&P Healthcare provides comprehensive prenatal care services. If you are diagnosed with uterine fibroids during pregnancy, our professional team will create the most suitable care plan for you to ensure the health of both mother and baby, helping expectant mothers navigate pregnancy smoothly and welcome new life with confidence.