A health professional with more than 20 years of experience as an ob-gyn, Kecia Gaither, MD, MPH, the director of perinatal services at New York Health and Hospitals, Lincoln, in the Bronx, New York, is also an advocate for women’s empowerment and awareness of medical issues that can affect their reproductive health. Here, she discusses the effects of uterine fibroids on pregnancy.
How do uterine fibroids impact on pregnancy?
Some patients who are pregnant and have fibroids can experience a number of issues. One of the main issues that’s of concern is impeding fetal growth. For example, one woman that I just sent home from the hospital has a fibroid the size of a basketball and she’s about 15 weeks pregnant. During pregnancy fibroids grow in response to hormonal influences, so at this time there are a lot of hormones in the body, particularly, estrogen and progesterone, which causes a fibroid to begin growing. At some point, it will outgrow the blood supply feeding it. When this happens, the fibroid undergoes a process known as degeneration, which means that the fibroid has outgrown its blood supply. Next, the middle portion of the fibroid becomes filled with necrotic debris. In other words, it starts rotting on the inside and in doing so it releases a lot of chemicals which can cause pain. That’s why a lot of women have big fibroids that become tender and painful as the pregnancy progresses. As I stated before fibroids can impede fetal growth, but also, depending on their location, they can impede a woman’s ability to have a normal vaginal delivery. This is because if the fibroid is located near the outlet of the uterus, near the cervix, the child won’t be able to pass through the vaginal canal if you’ve got that big fibroid sitting there, which poses a problem.
Are healthy pregnancies possible when a woman has fibroids?
Yes, but this really depends on where the fibroid is. Certainly, if they are near the part of the uterus where the organ meets the Fallopian tube that may be problematic and cause infertility.
Can fibroids create a possible life-threatening problem for pregnant women with fibroids?
I wouldn’t say life-threatening. Sometimes, if the fibroid is on the uterine cavity, it can protrude through the cervix and cause a lot of bleeding, which is problematic. That situation is called a prolapsing of the fibroid. But that, in and of itself, is a relatively rare occurrence. It also should be noted that fibroids can disseminate and show up in other parts of the body. But, again, that’s a rare occurrence.
What kinds of problems do pregnant women with fibroids face if they have obesity issues?
When you’re obese, your body produces excess estrogen, not only from the ovaries but from the fat cells. Fat cells can produce exogenous estrogen, which fibroids like, and the hormone can cause it to grow rapidly, so that’s always something to take into consideration. In general, obesity can create a lot of health problems for women inclusive of fibroid growth, such as diabetes and hypertension, as well as other illnesses. But being obese certainly is a risk factor for fibroids growing very large.
When a pregnant woman has fibroids, what treatment options are considered?
During a pregnancy, we don’t remove fibroids. If a woman has to have a C-section because a fibroid is in the way of delivering her child, we try not to remove it simply because this causes excessive bleeding. However, if a fibroid is in a place where we have to remove it at the time of C-section, certainly we will. But it’s not something that we like to do. The options are for the woman to either have a myomectomy—a surgical procedure to remove uterine fibroids—prior to getting pregnant or after she delivers, then waiting and having the operation at that point in time.
What are your thoughts about the effectiveness of dietary or lifestyle changes to help manage uterine fibroids?
I think that there are benefits to following these behavioral modifications. For example, if you consider the way in which our foods are processed—meats for instance—they have a lot of hormones in them. Do I think there’s a relationship between meat consumption and fibroid growth? Yes, I do. Both anecdotally and scientifically, there is some research that somewhat supports these ideas. Anecdotally, for me, I can say that when I was dealing with fibroids, if I ate a lot of red meat, I had a lot more symptoms. I had to have a myomectomy twice because the fibroids grew back after I took them out the first time, which I think had a lot to do with my diet. I changed my diet and cut out the red meat, but I can’t say I’m a total vegan. But at least three to four days out of the week, I try to eat a vegetarian-based meal as opposed to one that includes any type of meat. Also, when I do eat meat, it’s chicken and fish; no red meat. Have I seen a difference? Yes, I have. Have other women experienced the same thing? Yes, they have. Is there some research around to kind of support that finding? Yes, there is, but there’s a paucity of it. Still, it does exist, so, yes, I do think that cutting out meat products that are hormonally enhanced decreases symptomatology for fibroids. Also, increasing your dietary consumption of fruits and vegetables does make a difference.
Do you have any final thoughts about uterine fibroids and fertility and pregnancy issues?
Well, I think that when we’re talking about fibroids, a woman should be very knowledgeable about what her choices are. Some physicians will jump right away to hysterectomy. I think there are other modalities out there. There’s uterine artery embolization, which is, basically, a procedure where the vasculature, or blood vessels, that feed the fibroids are blocked by medicinal agents, which, ultimately, causes the fibroid to shrink. In addition, there’s myomectomy. (When doctors perform the surgery by making a large incision through the skin and muscle of the abdomen, it’s referred to as an “open” procedure and called a laparotomy.) It can also be done with a small incision that’s just large enough for a laparoscope—a device has a camera attached to the end of it—to be inserted so the surgeon can see the internal structures in the abdomen. But, again, it depends on the size and location of the fibroids.
The important thing is that women with fibroids don’t necessarily have to choose hysterectomy because there are other options, particularly if a woman wants to preserve her fertility.