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Women's Health

Intramural fibroids and pregnancy

04/26/2007

Question:

I am 36 years old and have a single intramural fibroid measuring 12.7 x 10.1 cm. MY MRI report says "the endometrial canal is located anterior to the fibroid." It grew during my pregnancy (although it topped at about 9-10 cm then) and then shrunk the whole time after birth when I was breastfeeding. After stopping breastfeeding and resuming birth control (Ortho Evra), it grew again and here I am 2 .5 years later. Now I want another baby, but also want to be rid of the fibroid. Anyway, now I`m planning on a second child and my questions are as follows: 1- Does the prior behavior of the fibroid during and after pregnancy mean anything in terms of what I can expect to happen in a second pregnancy? 2- Is it riskier to try to have the second child first and then think about a myomectomy, or to have a myomectomy now (has to be open, with a veritcal incision becasue of size/location, according to my doc) and then try to conceive? I have had no trouble conceiving during the 1st time around and haven`t tried yet for the second one, but I`m more concerned about the miscarriage risks than the fertilitiy issue. Thanks for your help.

Answer:

This is a complicated issue with no easy answer.  Although fibroids can increase the risk of several pregnancy complications including:

many pregnancies in the presence of fibroids have no complications at all. 

To some extent, a woman would be more at risk for a complication if there were complications with a previous pregnancy, or if she has symptoms from the fibroid when not pregnant such as heavy or frequent bleeding.  12 cm, however, is a pretty big fibroid, and by size alone would confer significant risk.

Surgery to remove the fibroid also has risks.  It can cause significant bleeding, scar tissue in the abdomen and a weakness in the wall of the uterus that can open (rupture) in a subsequent pregnancy. 

I recommend that you speak with your doctor about all of these risks and make your decision based on which risks you, personally, are willing or able to tolerate.

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Response by:

Jonathan  A Schaffir, MD Jonathan A Schaffir, MD
Clnical Associate Professor of Obstetrics & Gynecology
College of Medicine
The Ohio State University