How Are Uterine Fibroids Managed During Pregnancy?

Fibroids that distort the inner cavity of the uterus may interfere with implantation or embryo development. In some cases, they may affect fertility by blocking the fallopian tubes or altering the uterine lining, making conception more difficult.

Pain is one of the more common symptoms associated with fibroids in pregnancy. As hormonal levels rise, fibroids may increase in size or undergo degeneration, which can lead to localised abdominal pain, tenderness or cramping. This pain can sometimes mimic other pregnancy-related conditions and may require medical evaluation.

Large fibroids or multiple fibroids may irritate the uterus or reduce the available space for the growing baby. In some cases, this may increase the risk of uterine contractions occurring earlier than expected, potentially leading to preterm labour.

Depending on their location, fibroids may obstruct the birth canal or interfere with the baby’s position in the uterus. For example, a fibroid located in the lower uterine segment may make vaginal delivery more challenging and increase the likelihood of a caesarean section.

Certain types of fibroids, particularly those that distort the uterine cavity, may be associated with an increased risk of miscarriage. This may occur if the fibroid affects blood supply to the pregnancy or disrupts normal implantation of an embryo.

In addition to the above, fibroids may occasionally contribute to placental problems, abnormal foetal positioning or postpartum bleeding. Close monitoring throughout pregnancy allows doctors to detect potential issues early and plan appropriate management to support a safe outcome for both mother and baby.

For women with known fibroids, doctors typically adopt a watchful approach. This involves tracking the size of the fibroids and observing how they may affect the position of the placenta or the baby. Many fibroids remain stable throughout pregnancy and do not require active treatment.

Certain types of fibroids may cause pain, resulting in the need for conservative measures and pain management strategies. A doctor may recommend pregnancy-safe pain relief methods that do not involve surgical intervention.

Surgical removal of fibroids, known as a myomectomy, is generally avoided during pregnancy due to the increased risk of heavy bleeding. However, in rare cases during pregnancy, emergency surgery may be required if complications cannot be managed conservatively.

There are several types of myomectomy that can be performed

• Hysteroscopic myomectomy: A procedure that is performed through the cervix without abdominal incisions and is typically used for fibroids within the uterine cavity.
• Laparoscopic myomectomy: This operation involves small abdominal incisions and specialised instruments, suitable for fibroids on the outer surface or within the uterine wall.
• Open abdominal myomectomy: Open surgery may be recommended for large or multiple fibroids that require direct access for safe removal and careful reconstruction of the uterus.

The presence of fibroids may influence delivery decisions. Depending on their size and location, fibroids can sometimes obstruct the birth canal or affect the baby’s position. In such cases, a caesarean section may be recommended for safety.

With appropriate monitoring and individualised care, most women with fibroids can expect a safe pregnancy and delivery. Early assessment and regular follow-up allow potential concerns to be identified and addressed promptly.

Fibroids that are completely removed during a myomectomy usually do not grow back in the exact same location. However, new fibroids may develop from other uterine muscle cells over time. The likelihood of recurrence depends on factors such as age, hormonal profile and the number of fibroids originally present. Women who undergo surgery at a younger age may have a higher chance of developing new fibroids before menopause.

Many fibroids can be safely left alone if they are small, not causing symptoms and not affecting fertility or pregnancy. In such cases, doctors may recommend periodic monitoring with clinical examinations or ultrasound scans. However, if fibroids cause heavy bleeding, persistent pain, fertility difficulties or pregnancy-related complications, removal may be advised.

Fibroids may shrink when hormone levels decline, particularly after menopause. During the reproductive years, however, they are more likely to remain stable or slowly enlarge due to ongoing exposure to oestrogen and progesterone. While spontaneous shrinkage during pregnancy is less common, some fibroids may reduce in size after delivery as hormone levels return to baseline.

No, fibroids are benign tumours, meaning that they are abnormal cell growths that do not spread to other parts of the body. They are distinct from cancerous growths.

Surgery is not always necessary. The decision depends on symptom severity, fertility plans and whether the fibroids are causing complications. Some women manage well with monitoring alone, while others may benefit from surgical removal if symptoms significantly affect quality of life or reproductive outcomes.