Myoma causes problems with pregnancy

Fibroids in pregnancy

What are fibroids?

Fibroids are benign, usually harmless, muscle tumors that originate from the muscle tissue of the uterus. They can lie in the uterine cavity and cause pain and bleeding disorders there and prevent pregnancy. But they can also lie on the outside of the uterus and then usually only cause discomfort if they are very large.

Are fibroids age-dependent?

Yes. Fibroids are very rare before the age of 20. Up to the age of 40, around 25 to 30% of all women have fibroids.
Most fibroids are found in women between the ages of 45 and 54.

Which fibroids do you differentiate?

In principle, a distinction is made between fast-growing and slow-growing myomas. There are fibroids that lie in the uterine cavity (intracavitary), under the lining of the uterus (submucous), in the uterine wall (intramural), on the outside of the uterus (subserous) and fibroids can lie on the side of the uterus, then they are called intraligamentary.
Depending on their location and size, fibroids cause different complaints and symptoms.

How common are fibroids in pregnancy?

The number of fibroids in pregnancies varies greatly depending on the intensity of the observation. One reckons between 1-20% pregnancies in which fibroids are observed. However, only 10% of all fibroids in pregnancy cause problems.

What is the cause of fibroid growth during pregnancy?

Fibroids can sometimes grow very quickly and strongly during pregnancy, but other fibroids can also shrink. That depends on the dependency of the
Myoma growth depends on the level of hormones in the blood. During pregnancy, a large number of female hormones are released that can stimulate fibroid growth.

What problems can fibroids cause during pregnancy?

First of all, fibroids can prevent pregnancy from occurring at all by disrupting the implantation of the egg in the uterus. Fibroids can also disrupt the early growth of the embryo so badly that it can lead to a miscarriage. Has a pregnancy been through 12-14 years of age despite a fibroid? Developed at the 1st week of pregnancy, the growth of the fetus usually continues undisturbed during pregnancy. Damage to the child from fibroids is not to be expected and is extremely rare. However, premature births can occur.

Large fibroids can obstruct the birth canal so that a caesarean section must be performed. Fibroids can get very large in size during pregnancy, sometimes causing pain and pressure.

When should fibroids be operated on during pregnancy?

Fibroids should not be operated on during pregnancy unless it is vital for the mother. A fibroid operation during pregnancy is always a very high risk because of the high blood flow to the uterus and the fibroids. Such an operation can also induce premature labor.

Is it possible to remove a fibroid with a caesarean section?

In principle, a myoma can be removed during a caesarean section. But I strongly advise against it, unless the fibroid is where you have to open the uterus for the caesarean section anyway. An additional operation should be avoided if possible because of the considerable risk of bleeding. It is also the case that fibroids that have grown very quickly during pregnancy usually die after pregnancy and no longer continue to grow anyway. They then usually get smaller on their own and no longer cause any complaints. So wait and see what is left of the fibroids ½ to 1 year after the pregnancy!

Should fibroids be removed before pregnancy?

This depends very much on the location of the fibroids and the symptoms or whether the woman has previously become more difficult to conceive or has had more frequent miscarriages. This must be decided by a specialist on a very individual basis and after a precise ultrasound examination.

What time should elapse between myoma surgery and pregnancy?

Unfortunately, there are no scientific studies on this, only expert recommendations. In the case of a fibroid that was located on the outer wall of the uterus, there is no need to adhere to the pregnancy waiting period. After a uterine operation, which also took place in the depth of the uterus, you should take a break of about ¼ year. In the past one spoke of one, sometimes even 1.5 years. This is certainly way too long.

Which surgical method is preferred today?

First and foremost, the surgeon should use the method he knows best. Different methods are always mastered in myoma centers and are very individually adapted to the given circumstances. There are operations from the vagina, most operations nowadays are performed by laparoscopy, but abdominal incision operations are also recommended in many cases.

What is fibroid embolization?

Myoma embolization is a procedure in which a thin probe is inserted from the leg into the uterine artery under local anesthesia and plastic particles are injected into the uterus, which then become lodged in the blood vessel system of the myomas and clog the blood vessels. This causes the fibroids to die and shrink. As a rule, fibroid embolizations are only recommended for women who no longer want to become pregnant. Myoma embolization before pregnancy is only recommended in rare exceptional cases. Myoma embolizations are carried out in special centers in which gynecologists work closely with x-ray specialists.

What is focused ultrasound?

This is a special procedure that is only offered in a few centers in Germany, as it involves a high level of technical effort. In this method, fibroids are heated by ultrasound waves. In order to control the ultrasound waves in a targeted manner, this is carried out under the control of magnetic resonance therapy (MRT). This is why the procedure is also called MRgFUS (MR-controlled focused ultrasound). This procedure has also not yet been tested in women who want to become pregnant. Clinical studies on this are ongoing. So far, only a few health insurance companies have adopted this very expensive procedure. Not every myoma is suitable for this, but the procedure makes sense in individual cases.

Can hormones or diets prevent fibroids from growing?

There are hormones that put women into menopause. These hormones cause fibroids to sometimes shrink. As soon as the hormone therapy is ended, however, the hormones grow again just as strongly, so that such hormone therapy, which is rich in side effects, only makes sense for a limited period of time. Other hormones such as progestins or z. B. the pill do not have a positive effect on hormone growth. There is no such thing as a fibroid diet. There are no effective therapies for fibroids in traditional Chinese medicine either.

Can you prevent fibroids?

No. Myomas are hereditary. A preventive measure is not yet known.

PD Dr. Enikö Berkes
Head of the Clinic for Gynecology and Obstetrics