Most women with fibroids don’t have problems during pregnancy—in fact, a lot of women with fibroids go through pregnancy, labor, and delivery without being aware they even have them. That said, fibroids do raise the risk of delivering early or needing a cesarean section, among other complications. So right now is a good time to check in with an obstetrician to see if treating your fibroids would give you the best chance at a healthy pregnancy.
When I examine a woman with fibroids who’s contemplating pregnancy, I’m focused mainly on their size and location. Fibroids are growths that develop on or in a woman’s uterus. They can be smaller than a pea or as big as a grapefruit. Small or medium-sized fibroids that aren’t causing pain or excessive menstrual bleeding usually don’t need treatment and can just be monitored. (That is, unless you’re planning in vitro fertilization—before IVF, it’s best to remove even small fibroids from the lining of the uterus to make sure nothing interferes with the embryo’s ability to implant.)
On the other hand, a large fibroid can take up space in your uterus, leaving less room for a baby to develop. You’re almost guaranteed to deliver early, so it’s safer to have the fibroid removed before you conceive. If you have numerous fibroids, you should have those removed too, because large or multiple fibroids can outgrow their blood supply during pregnancy, which can cause cramps and severe pain.
There are lots of ways to remove fibroids, but if you want to protect your ability to have a baby, you’ll need a myomectomy. That’s a procedure in which the surgeon cuts out the fibroids and then stitches up the uterus. Myomectomy can be done laparoscopically; instruments are inserted through small incisions in your abdomen, sometimes with robotic assistance, or through an old-fashioned abdominal incision. If your fibroid is in the uterine cavity or just under the surface of the intrauterine wall, the myomectomy can also be done hysteroscopically, in which instruments are passed through the vagina and cervix into the uterus in order to remove the fibroids without an abdominal incision.
After a myomectomy, you should wait at least three months before getting pregnant. Your obstetrician will treat your pregnancy as high-risk and will keep a lookout for complications. You may need to schedule an elective C-section, especially if the myomectomy involved a deep incision in the uterine wall, since that can weaken the uterus and make it more likely to rupture during labor. That’s a rare complication, but it’s serious when it occurs, so it’s better to play it safe and deliver via C-section.