I have uterine fibroids. Can I still get pregnant?

With the development of medicine, the tragedy of having uterine fibroids and then having the uterus removed, thus completely losing the fertility function, is becoming less and less common. However, since uterine fibroids are an estrogen-dependent tumor that accompanies women of childbearing age, the relationship between them and pregnancy and childbearing is complex and entangled.

In early pregnancy, the presence of fibroids is not conducive to the implantation and growth of the fertilized egg, and the incidence of miscarriage is 2 to 3 times that of normal women without fibroids. Large intramural fibroids or submucosal fibroids can hinder the movement of the fetus in the uterine cavity and cause malposition of the fetus. Fibroids can affect the normal contraction of the uterus and prolong the labor process. Large fibroids incarcerated in the pelvic cavity can block the birth canal and cause dystocia. Fibroids can also affect the contraction of the uterus after delivery and cause postpartum hemorrhage.

On the other hand, after pregnancy, the smooth muscle cells of the uterus increase in size, and the fibroids also increase in size, which is most obvious in the first four months of pregnancy. Rapidly growing fibroids are prone to insufficient blood supply and degenerative changes, among which red changes are the most common. Patients experience fever, abdominal pain, vomiting, local tenderness, and even miscarriage and premature birth.

It can be seen that the relationship between uterine fibroids and pregnancy and childbirth is really complicated. However, we can still try to sort it out from the following aspects.

What should I do if I was planning to get pregnant but found uterine fibroids? Generally speaking, if the relationship with pregnancy and childbearing is not considered, only those fibroids with special locations, heavy menstrual flow, continuous menstrual bleeding, anemia, or a diameter of more than 5 cm require surgery. For women who are planning to get pregnant, the treatment indications should be appropriately broader.

Submucosal fibroids located in the uterine cavity may hinder the implantation of future embryos, thus leading to miscarriage. Therefore, regardless of whether there are symptoms or not, it is recommended to treat them before pregnancy. It is currently believed that submucosal fibroids are best treated with hysteroscopy. Hysteroscopy is also a type of minimally invasive surgery, which involves inserting a special camera through the vagina and cervical canal and performing the surgery with special instruments.

So, how big does a uterine fibroid have to be before pregnancy to require surgery? There is no clear standard at present. Some medical institutions, such as Peking Union Medical College Hospital, believe that if the diameter of the uterine fibroid is no more than 4 cm, the patient can consider pregnancy. However, the patient needs to be informed that the fibroid may grow rapidly during pregnancy, causing red degeneration due to ischemia, or the subserosal fibroid may twist when the uterus changes position, thus causing miscarriage or premature birth.

If the fibroids are located at the lower end of the uterus, i.e. the cervix, or if the fibroids in other parts of the uterus are less than 4 cm in diameter, but the patient has a history of infertility or multiple miscarriages and no other clear reasons can be found, the fibroids can be removed first and then pregnancy can be achieved.

Assuming that a uterine fibroid removal surgery is performed before pregnancy, how long do you need to use contraception after the surgery before you can get pregnant? This is a question that cannot be answered before the operation and needs to be judged based on the intraoperative situation. Generally speaking, if the fibroids are located between the myometrium or under the serosa, the number is small, the integrity of the uterine wall is not significantly damaged during the removal process, and the uterine cavity has not been entered, you can get pregnant after 6 months of contraception after the surgery; if the number of fibroids is large, many incisions are made on the uterus, the removal process is particularly difficult, or the uterine cavity has been entered, it is recommended to use contraception for at least one year or even two years. Of course, for subserosal fibroids with a slender pedicle connected to the uterus, if the operation goes smoothly and there is almost no damage to the integrity of the uterine wall, you can get pregnant 3 months after the operation.

(The author is the chief physician of the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, professor, doctoral supervisor, and the third "National Famous Doctor")