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 Pregnancy and Uterine Fibroid Disease     

By:  Hope Waltman

Author's Note:  This article is compiled of facts and figures found through my personal research and an interview with Dr. Robert L. Worthington-Kirsch.

Uterine fibroids are benign tumors of the uterus. They are not cancers, but can cause symptoms such as discomfort during sexual relations, interfere with fertility, cause excessive bleeding during or between periods, and pressure on the bladder or rectum. 

Uterine fibroids can compromise fertility in a variety of ways.  Some can compress the fallopian tubes, preventing eggs from successfully traveling from the ovaries to the uterus.  Some uterine fibroids change the shape of the uterus and act almost like an IUD, causing miscarriages to occur.  Premature labor can happen because of the location and size of the uterine fibroids.  In some cases, uterine fibroids have been known to grow during pregnancy, due to an increase in estrogen levels, and displace the placenta or cause indentation/bulging into the uterine cavity that can impede the growth of the baby.  Fibroids may also have other, less understood, negative effects on conception and pregnancy.  

Most women who have uterine fibroids have no problems during pregnancy.  Unless the woman or her doctor identify something unusual, the standard medical prenatal care is usually followed for a pregnant woman who has uterine fibroids. 

When uterine fibroids cause problems with fertility, a woman should talk with her doctor to see if the fibroids should be treated. 

The current surgical therapy for fibroids in women who want to preserve their fertility is myomectomy (surgical removal of the fibroids).  This is usually a major abdominal surgery, involving several weeks for recovery and a several month wait after surgery before pregnancy can be attempted. Myomectomy has good results as a fertility procedure in women with one or two easily removed fibroids.  However, its outcome is frequently worse for women who have multiple fibroids or whose fibroids are in locations that make them difficult to approach during surgery.  In some of these women the risk of having the myomectomy converted to hysterectomy (removal of the uterus) can be unacceptably high. In addition, fibroids often regrow after myomectomy.  Within five years of myomectomy, as many as 50 percent of women will have return of symptoms from regrowth of fibroids.  In women for whom myomectomy carries a high risk of complication (such as conversion to hysterectomy) or who seek for a more durable treatment for their fibroid symptoms Uterine Artery Embolization (UAE) may be an option. 

UAE is a procedure where an Interventional Radiologist maneuvers a catheter into the main artery supplying the uterus and injects small plastic particles to plug up the blood vessels that supply the fibroids.  The procedure cuts off the blood supply to the fibroids, the fibroids infarct, and the uterus and fibroids reduce in size.  The uterus is supplied with multiple blood vessels and the embolization does not damage the remainder of the uterus. 

The use of embolization to control uterine fibroids and excessive bleeding has been used since at least the late 1970s.  UAE was first used as a treatment for fibroids in France in the late 80’s or early 90’s and the first report was published in Lancet in 1995.