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A uterine fibroid is a benign, firm, usually roundish, swelling (tumour) that develops within the muscular wall of the uterus (womb).
Gynaecologists in the past used to be concerned that a fibroid may grow quickly due to the rising oestrogen levels in pregnancy and cause major problems. A uterine fibroid can cause uncomfortable feelings of discomfort, pressure, heaviness or even pain if they grow larger and press on surrounding organs or pelvic structures. Red degeneration of a fibroid in pregnancy is a rare complication of a fibroid during pregnancy. With regard to falling pregnant, fibroids are thought to account for about two to three per cent of all infertility problems. More rarely a fibroid may obstruct the canal of the cervix or the opening of the fallopian tubes into the womb.
The most frequent problem with fibroids in pregnancy is that they can lead to slightly early labour and delivery of the baby two to three weeks early, which is of very little threat to the baby. When a woman who is having infertility problems is discovered have uterine fibroids, they may be treated and removed they are sufficiently large, to try and increase the likelihood of conception.
If you have been diagnosed with a fibroid that is causing no symptoms and want to fall pregnant, then it is usually safe to continue to try to conceive. If you are having difficulty falling pregnant or if you have had recurrent miscarriages, then investigation is important. If a couple is known to have factors that make infertility more likely, then most doctors will advise that a gynaecology opinion is sought after 6 months of trying to conceive. If you are known to have fibroid or fibroid symptoms then it is advisable to seek investigation after 6 months of trying to conceive. A Fibroid or Fibroids are very often discovered in the womb (uterus) during a pelvic examination or more frequently during a routine ultrasound scan when a woman is pregnant.
Fibroids (leiomyomas) are benign (non-cancerous) tumours or swellings made up of uterine smooth muscle which develop in the muscular wall of the womb. Research has shown that only 42% of fibroid greater than 5cm (labelled as large) and 12% of smaller fibroids (measuring 3-5 cm) can be felt and diagnosed on pelvic examination. There is an increasing trend in the Western world for pregnancy to be delayed until women are older. Even though they are becoming more common, the exact nature and reasons for leiomyomas causing infertility and problems when a woman is pregnant are not fully understood.
Medical evidence from ultrasound studies which monitored the size of fibroids during pregnancy has shown that most fibroids (60-78%) did not change in size significantly throughout pregnancy.
A study investigated the frequency of red degeneration in fibroids during pregnancy using ultrasound scans. There are three medical hypotheses which have been proposed to explain why red degeneration of a fibroid causes severe pain. The first theory is that the rapid speed of growth of the fibroid causes the tissue in the middle of the fibroid to outgrow its blood supply resulting in death of the tissue (known as infarction). The second theory is that the growing uterus disrupts the blood supply to the fibroid by kinking the blood vessels in some way (there is thought to be a change in the architecture of the blood vessels). The third theory is that the pain is due to prostaglandin chemicals produced by damage of the cells in the fibroid. Outcome It has been found that between 10% and 30% of women with fibroids have problems or complications during their pregnancy.
It is known that the frequency of spontaneous miscarriage is increased in pregnant women who have fibroids.
The risk of bleeding during early pregnancy is affected by the location of the fibroid in the womb. Having multiple fibroids and having fibroids that are in direct contact with the placenta have been shown to be independent risk factors for premature onset of labour. It is interesting that fibroids are not an independent risk factor for preterm premature rupture of the membranes (PPROM) of the amniotic sac around the baby.
Data from medical studies suggests that placental abruption is three times as common in those women who have fibroids during pregnancy.
A study which looked retrospectively found that placental abruption occurred in 57% of women who had retroplacental fibroids, in contrast with 2.5% of women who had fibroids in other areas of their womb. Only 2 research papers have been published about the relationship between placenta praevia and fibroids.
Medical research has found that the growth of the baby is not affected by the existence of uterine fibroids. The rate of malpresentation of the foetus in women with fibroids is 13% in contrast with a rate of 4.5% in women with no fibroids. Many medical studies have found that having a uterine fibroid increases the risk of caesarean section. However, obstetricians usually advise that the presence of uterine fibroids is not a contra-indication to a trial of labour.
A fibroid may distort the architecture of the womb and also interfere with contractions of the uterine muscle (myometrium) leading to loss of muscle strength (atony) of the uterus and postpartum haemorrhage. A medical study has shown that the rate of retained placenta of the uterus is more frequent in those women who had a fibroid, but only if it was located in the lower segment of the womb. It is important to note that medications which are prostaglandin synthetase inhibitors (such as NSAIDs like ibuprofen, diclofenac, naproxen and indomethacin) should be used with care (especially if taken for more than 2 days) in the third trimester.
If pain is very severe then stronger painkillers (such as opiates) may be needed, or other methods of providing analgesia may be utilised such as epidural analgesia.
In those women who have had a fibroid diagnosed before they fall pregnant, gynaecologists may consider surgical treatment such as myomectomy.
Obstetricians advice that acceptable reasons for performing a myomectomy during pregnancy include: a fibroid undergoing red degeneration and causing pain that cannot be controlled (particularly if the fibroid is pedunculated or subserosal), a very large or rapidly growing fibroid or any large (greater than 5cm in size) leiomyoma present in the lower segment of the uterus. With regard to carrying out a myomectomy to remove a fibroid when a caesarean section is performed, most obstetricians agree that this is not advisable. Interventional consultant radiologists have been carrying out bilateral uterine artery embolization for many years.
Uterine fibroids are linked to an increased rate of spontaneous miscarriage, preterm labour, foetal malpresentation, placental abruption, labour dystocia, caesarean section and postpartum haemorrhage.
Those women who have previously had a myomectomy should probably have a caesarean section performed before labour starts, especially if the cavity of the uterus was opened. I remember all too well when Tim and I first decided that we were ready to expand our family and turn 2 into 3. I guarantee you that this is when our little Darah came to be, based on how she measured and when my due date was.
It’s a really tough thing to navigate as you try to NOT STRESS OUT but of course even trying to do that is stressful in and of itself, and if you are doing all that charting stuff, that is also quite stressful! You are using Internet Explorer 6 or older, which is no longer fully supported on this site. This internet site provides information of a general nature and is designed for educational purposes only. I wanted to take the time to properly grieve the loss of my unborn child, as well as to make sure that I was mentally and emotionally strong [again] before trying to conceive another baby.
A woman is forever changed once she suffers a miscarriage, and subsequent pregnancies are often treated with apprehension and anxiety. I spent the months following my second miscarriage mired in self-hatred, berating my body and focusing on all of the ways it had failed me [and killed two of my babies].
When I hear from someone who has recently suffered a miscarriage, or have readers reach out to me, the one thing I won’t tell them is to try again as soon as possible. It’s been three months since my last miscarriage, nine months since beginning medication and talk therapy, and I’m feeling better than I can remember.
I think it was just YESTERDAY that I was wondering how things were going for you, so thank you for the update I’ll keep sending you good thoughts, whether or not you decide to try to get pregnant again!
Recent medical research has shown that most fibroids do not actually become larger during pregnancy, and those that do often return to their pre-pregnancy size afterwards. A fibroid may lead to sharp pain in the lower back (lumbar region) and legs if there is pressure on a nerve. If a fibroid or fibroids develop just under the endometrium (surface lining of the uterus) this may affect the way in which a fertilised egg attaches or implants in the endometrium of the womb.
Sometimes later in pregnancy, fibroids may also disrupt the normal development and growth of the uterus, leading to premature labour and childbirth. Rarely a fibroid can develop and enlarge in the lower part of the uterus and lead to cause partial blockage of the birth canal.
I would advise that you discuss your fibroid with your family doctor or gynaecologist if you are trying to fall pregnant. Gynaecologists recommend that a couple, without risk factors for infertility, that has been trying to conceive for a year or more, should have tests for infertility.
Medical research has shown that the most uterine fibroids do not grow or shrink during pregnancy. Research has shown that the incidence of uterine fibroids in older women who are having medical treatment for infertility is approximately 12-25%. It was found that 9% of fibroids had ultrasound evidence (showed a heterogeneous echogenic pattern or cystic change) of red degeneration.
This theory is supported by the fact that NSAIDS drugs (such as ibuprofen or diclofenac) which work by inhibiting prostaglandin quickly and effectively control the pain.
However, medical specialists have criticised the way that some of these studies have been carried out.
It is hypothesised that mechanical obstruction or impaired distensibility (stretchability) of the uterus may explain some of the problems caused by fibroids. One study found that the rate of miscarriage in women with fibroids was 14% compared with 7% in women without fibroids.
If the placenta has implanted close to where the fibroid is then the risk of bleeding is increased significantly to 60% from a risk of 9% if there is no contact between the fibroid and the placenta. The risk of preterm labour when fibroids are present is 16% in contrast with a risk of 8% when no fibroids are present. In fact recent research has suggested that fibroids may actually decrease the risk of PPROM. It is thought that one way that fibroids make placental abruption more likely is that there is reduced blood flow to the fibroid and the surrounding uterine tissue. They both indicated that the rate of placenta praevia is doubled even when adjustments were made for previous surgical procedures such as myomectomy and caesarean section.
Studies have suggested that women with fibroids were slightly at greater risk of having a baby whose growth had been slowed, these studies were not adjusted for gestational age of the foetus or the age of the mother, and these studies have been criticised by specialists in this area. Independent risk factors for malpresentation are multiple fibroids, large fibroids and fibroids in the lower uterine segment.
These factors may also explain why fibroids increase the rate of hysterectomy in the weeks following childbirth (during the puerperium). One study looked at 120 women who had a baby at term having had a previous abdominal myomectomy (in which the uterine cavity was not entered) and there were no cases of uterine rupture. This is because these drugs are known to be linked with potential side-effects on the foetus and newborn infant. However, it is not clear whether myomectomy does improve the chances of falling pregnant or whether it affects positively the perinatal outcomes.
Several studies have looked at the safety aspects of carrying out a myomectomy on a woman who is pregnant during the first and second trimesters (i.e in the first 6 months of pregnancy). Researchers have studied the health of the baby and health problems of the mother in women who have had a myomectomy and compared these with women who were looked after and treated without surgery on their fibroid. More recently UAE has become a treatment for large symptomatic fibroids in those women who are not pregnant and who, most importantly, do not wish to become pregnant in the future. Most fibroids do not grow (or become smaller) in pregnancy, but about 30% may enlarge during the first three months of pregnancy. Uterine artery embolization is a reasonable alternative treatment option to surgery in the event of fibroids causing severe problems, but UAE is absolutely contra-indicated during pregnancy and in those women who wish to fall pregnant in the future. So I assumed that taking contraception off the table was like moving the critical Jenga piece…the tower would fall, or in this case, I would just no longer NOT be pregnant, right?I mean, maybe.
Sex Will ChangeThere is a very distinct difference between sex for fun and intimacy and sex with the goal of creating a baby. But I promise you that there was a time when sex was a lot of fun for you and your partner, and you really can tap back into that by opting for spontaneous, comfortable fun together! I know that when we were trying for baby #2, the right mindset would have made the process a lot different. I went into it with a desired birth month in mind (?!?!?!?!) and of course, I realized, no no no, it does NOT work out like that for most couples. He’s starting to form images in his mind, organise categories and arrange things in order. If you have any concerns about your own health or the health of your child, you should always consult a doctor or other healthcare professional. Stevens 6 Comments When I shared publicly, about suffering my first miscarriage, I received an outpouring of support and well-meaning advice. The pregnancy following my miscarriage was filled with anxious thoughts of possible loss, and became a self-fulfilling prophecy when I lost that pregnancy in my tenth week.
After three months, wallowing in grief and sadness, I finally sought the help of a therapist; I had reached such a low that I didn’t know where else to turn. My outlook is bright, I’m at peace with my losses, am able to see all of the wonderful things in my life (and not focus on the negatives), and my husband and myself are beginning to embrace the fact that our son may be our only child. I personally haven’t been through a miscarriage so I have no clue how I personally would have handled it.
I had the same reaction when people told me to try again right away because we’re supposedly more fertile after a miscarriage. I began taking different medical prescription for me to get pregnant and to ensure i produce a healthy baby, but all i do did not work out for me. If red or carneous degeneration occurs there is haemorrhage within the centre of the fibroid. A fibroid therefore, may cause recurrent early miscarriage, which is often so early that a woman is not even aware that she has been pregnant. If this happens, then a caesarean section operation is usually necessary to deliver the baby. Medical research has indicated that if there is cause found for the fertility problem, treating and removing the fibroids increases the chance of falling pregnant by about 40% to 80%. If you want to start a family or try to fall pregnant it is sensible to discuss this with your GP or gynaecologist anyway. If you are pregnant and a fibroid is diagnosed, it is quite likely that it has been present for some time, many months or even many years. Other factors include a woman having irregular periods or a man who has a history of chemotherapy.
It has been found that about a third of fibroids may enlarge during the first three months (known medically as the first trimester) of pregnancy. By the time they are 35 years of age it is estimated that 40-60% of women will have at least one fibroid, and by the time they reach the age of 50 approximately 70-80% will have fibroids. This is mainly because of the difficulty of distinguishing fibroids from the normal thickening of the lining of the womb (myometrium). Some fibroids did grow (22-32%) and increased in volume and most of this growth took place in the first three months of pregnancy. The women were asked about their symptoms and about 70% of these women had experienced severe abdominal pain compared with about 12% of women whose ultrasound scans showed no sign of red degeneration in their fibroids.
Research has found that the size of a fibroid does not affect the risk of miscarriage, but that the number of fibroids may do. The rate of preterm delivery is 16% in contrast with a risk of 11% when there are no fibroids present.
This then leads to reduced blood flow (partial ischemia) and decidual necrosis in the tissue of the placenta over the underlying leiomyoma. A large fibroid or fibroids can rarely press on and distort the cavity of the uterus and may then lead to a foetal abnormality. More severe pain requires assessment by a doctor and following any necessary investigations is usually managed conservatively with bed rest, hydration and analgesics. These side-effects include: pulmonary hypertension, premature closure of the foetal ductus arteriosus, intracranial bleeding and oligohydramnios.
It is advised that myomectomy should only be carried out at the time of a caesarean section if this is unavoidable to allow the safe delivery of the baby or to allow closure of the hysterotomy (incision in the womb).
A recent medical study found that UAE that was performed straight after a caesarean section in women with leiomyomata may be an effective means of reducing bleeding after childbirth and reducing the need for myomectomy or hysterectomy by causing shrinkage of the leiomyomata. The results from studies are somewhat conflicting, but it is reassuring to note that the majority of women with uterine fibroids will have uncomplicated pregnancies and childbirth.
A caesarean section may be advisable for those women who have previously had a myomectomy, especially if the cavity of the womb was opened. I hope that some advice I can offer on this side of the journey can help those of you out there who are thinking about trying to conceive or already on that path, and maybe even getting a little stressed out! But let me tell you from personal experience that there’s something to be said for practicing some old habits and being spontaneous with your rendezvous, rather than simply focusing on doing what the chart says.
Now, a year is still not THAT long, but, when you go in thinking it’s going to be instantaneous? Share your experiences (good and not so good) with other parents-to-be and let us know if you have any helpful tips.
Overwhelmingly, people responded by telling me to try again as soon as possible; they meant well, but somehow I felt that this was bad advice [for me]. In retrospect, I had tried again too soon, and my fragile mental and emotional state quickly deteriorated after suffering a second loss [in six months].
Indeed, I have had many women tell me that they regret getting pregnant so soon after miscarrying, because it caused them to bury their loss[es] with the prospect of a new baby; in fact, many woman, who conceived immediately after miscarrying, have told me that they ended-up having their loss[es] resurface later (as a result of not properly grieving). So many women are skilled caretakers and nurturers, but rarely treat themselves with such care; this is a time when self-care is of the utmost importance.
I no longer feel rushed in trying to have another pregnancy overshadow any grief, as I have [finally] taken the time to grieve my losses properly. After a bad experience with a high risk doctor, I decided to go back to my OB to start bloodwork. It didn’t seem right to me so we waited, but like you, 4 months after my first I was pregnant again and miscarried that pregnancy as well.
When she's not chasing her precocious preschooler, Lauren pens hilarious and heartwarming stories about her life as a mother, ghostwrites blogs for businesses, and sometimes even finds the time to write a bit of creative non-fiction.
The figures quoted vary, but it is estimated that between 25 per cent and 80 per cent of women have a fibroid or fibroids if you look very carefully. This usually happens in the middle trimester (three months) of pregnancy and is thought to result from the leiomyoma (fibroid tumour) growing rapidly and outgrowing its blood supply. This is because pre-conception counselling can improve the chances of having a healthy baby.
Studies have shown that the vast majority of women with fibroids have an uncomplicated pregnancy and childbirth. It is therefore thought likely by specialists that the frequency of fibroids during pregnancy is actually underestimated. In particular most growth occurred during the first 10 weeks of pregnancy and it is interesting to note that very little growth took place during the last 6 months of pregnancy (i.e. Multiple fibroids increase the risk of miscarriage (miscarriage rate found to be 23%) compared with a single fibroid (miscarriage rate was 8%).
The congenital abnormalities that have been shown to occur with large submucosal fibroids include: torticollis ( an abnormal twisting of the neck), dolichocephaly (lateral compression of the baby’s skull) and limb reduction defects.
Predisposing factors for caesarean section are: multiple fibroids, foetal malpresentation, large fibroids, submucosal fibroids and leiomyomas in the lower uterine segment. Researchers report that there are many case reports of uterine rupture occurring during childbirth in women who had previously had a laparoscopic myomectomy. Sometimes doctors will prescribe prostaglandin synthetase inhibitors like non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac.
However, those women who had had a myomectomy in pregnancy were more likely to have a lower segment caesarean section because the doctors were concerned about the risk of rupture of the uterus.
Obstetric consultants agree that it is generally safe to remove pedunculated subserosal fibroids during a caesarean section without there being an increased risk of bleeding.
There are several reports of successful and uncomplicated pregnancies following UAE for fibroids, but generally pregnancy is not advisable following a uterine artery embolization. But for healthy couples with no obvious obstacles in their way (such as advanced maternal age, PCOS, low sperm count, etc.), it is perfectly normal for it to take 6 months or longer to get pregnant. With that said, one of the things I wish I had known about that would have made the process feel better (yup, I mean that literally) is a sperm-friendly lubrication. I charted like it was MY JOB when we were trying for our first child, and distinctly remember leaving town for a few days for a business conference, at least 4 days past when all of my charts said it was even possible for me to conceive.
Don’t get me wrong, my first thought, after discovering I had suffered a missed miscarriage, was about trying again as soon as possible. I was broken, and my days would get darker before I was able to see the forest for the trees. I know that there are no ‘do-overs’ in life, but I’m extremely grateful to have taken time after miscarrying to find peace and acceptance. After that we waited for 7 months to try again and it was only after we were at that place of contentment with our family of 3.
In a typical case a woman will have several fibroids present within her uterus and these will usually be of varying sizes. It is easy to diagnose fibroids with ultrasound scanning, and most pregnant women have one or more ultrasound examinations.
However it has been found that some women do unfortunately have some problems due to their fibroids. Fibroids can also cause pain simply due to their size and larger fibroids (those greater than 5cm) are those that most often cause pain, usually during the second and third trimesters of pregnancy. Recent research has shown that uterine ruptures take place before the start of labour at the site of the previous myomectomy carried out by laparoscope. I was totally clueless about that fact, and I wish I had realized and accepted it sooner and not spent those months being very frustrated. I remember learning about the fact that many lubricants can interfere with sperm doing their jobs, and so it got the boot. Our third is a total gift and just what our family needed – but I do NOT enjoy pregnancy, so after his birth I had my tubes tied. Fibroid tumours are benign (they are not cancerous and do not spread to other parts of the body). Before the advent of ultrasound scanning many women who were pregnant did not know that they had fibroids. It is known that uterine fibroids are linked to a greater rate of spontaneous miscarriage, placental abruption, early onset of childbirth (preterm labour), malpresentation of the baby (abnormal position of the baby e.g. Early spontaneous miscarriage happens more often when the fibroids are in the main body of the uterus when compared with fibroids being in the lower segment of the uterus or those fibroids which are intramural or submucosal. Fortunately the risk of uterine rupture following laparoscopic myomectomy is reported to be low at 0.5% to 1%. Astroglide Trying to Conceive TTC is a fantastic option to consider, as it has been specially formulate to provide an environment where sperm has a good chance of survival. While it is true that most of your memories fade away about the pain of pregnancy and of labor, I remember it all enough to know that I’m done, thankyouverymuch!
They usually cause no symptoms at all and are often present without a woman knowing that she has them. If they become larger then they are more likely to result in symptoms or problems such as pain or discomfort.
If fibroids enlarge and distort the endometrium (lining of the womb) then they cause heavy periods.
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