Uterine Fibroids in Pregnancy: Risks and Management

There is a genetic predisposition, but no definitive targeted gene therapy exists yet, largely because the exact cause is still not fully known beyond the working assumption that estrogen and progesterone drive growth, based on the fact that fibroids shrink after menopause. On blocking hormones, this is already happening in a milder form: oral contraceptive pills, which many women take from their late teens into their mid-thirties, work by suppressing internal hormone production, and are safe as long as the patient does not smoke and has no family history of stroke or hypertension.

No, Mirena is an intrauterine contraceptive device that releases a small daily dose of progesterone, and it does not treat the fibroid itself. It helps control the symptoms, mainly heavy bleeding, but the only definitive treatments remain removal by myomectomy or hysterectomy, or one of the minimally invasive procedures.

Primolut-N is a progesterone, similar in principle to Mirena, and can be given when a patient cannot tolerate a combined estrogen-progesterone pill. It can be taken twice daily from day five to day 25 of the cycle if the patient wants a withdrawal bleed, which will be much lighter and pain-free than a normal period, or continuously if she prefers not to have periods at all.

Recurrence cannot be prevented while a woman is still in her childbearing years, because myomectomy only removes the fibroids that can be seen; the same hormonal environment remains, and small seedling fibroids too tiny to detect at surgery can go on to grow. If a woman has not conceived for a long time after myomectomy, there is no reason to keep waiting: IVF is a reasonable next step rather than continuing to hope for natural conception.

Fibroids have a typical whorled appearance on ultrasound, round and well encapsulated. A molar pregnancy shows an erratic collection of cells rather than a defined mass, and hormonal testing helps too: hCG levels rise well beyond what is normal in pregnancy. An ultrasound or MRI clearly distinguishes the two, since fibroids have a characteristic encapsulated, whorled appearance that a molar pregnancy does not.

Yes. They can interfere with conception, cause early miscarriage, malpresentation, preterm labour, an uncoordinated labour pattern, and a higher chance of caesarean delivery and postpartum haemorrhage, so a pregnancy with fibroids should be monitored as high risk.

They can grow larger in the first trimester because of increased blood flow to the uterus, but they generally stabilise afterward and shrink back toward their original size after delivery.