Myomas: Hidden Enemies of Motherhood?

Myomas, also known as uterine fibroids, are common benign tumors that develop from the uterine muscle. It is estimated that up to 80% of women of African descent are affected during their reproductive years. When a woman is planning to conceive, the presence of myomas often raises questions and concerns: Should I worry? Can I still get pregnant? Do they need to be removed? This article outlines what needs to be monitored when living with myomas and trying to conceive.

1. Not all myomas have the same impact

It's important to understand that the majority of myomas do not prevent pregnancy or cause complications. Their impact mainly depends on:

• Location:

  • Submucosal myomas (those that distort the uterine cavity) are the most likely to affect fertility.

  • Intramural myomas (located within the uterine wall) can impact fertility if they are large or close to the cavity.

  • Subserosal myomas (on the outer surface of the uterus) usually do not affect fertility.

• Size: Myomas larger than 4–5 cm, especially if multiple or poorly located, may hinder embryo implantation or cause uterine contractions.

• Number: A uterus with many fibroids (a “fibromatous” uterus) requires careful evaluation.

  
  

2. When is treatment before pregnancy necessary?

Treatment may be recommended before pregnancy if:

• The myoma(s) distort the uterine cavity (confirmed via ultrasound or hysteroscopy).

• They cause heavy menstrual bleeding leading to anemia.

• They result in severe pain or repeated miscarriages.

• They measure more than 5 cm and are located in critical areas (e.g., the uterine isthmus or cervix).

In such cases, a myomectomy (surgical removal of fibroids) may be considered, keeping in mind the surgical risks (adhesions, healing time, etc.).

3. Can I get pregnant with myomas?

Yes. Many women become pregnant naturally despite having myomas. If fertility testing shows open fallopian tubes, good ovulation, and an undistorted uterine cavity, conception is very possible without prior treatment.

A fertility evaluation is recommended if pregnancy does not occur after 12 months of trying (or 6 months if over 35 years old).

4. What happens if I get pregnant with myomas?

When pregnancy occurs in the presence of fibroids, some precautions are necessary:

• Regular ultrasound monitoring to track myoma growth.

• Monitoring for contractions, placental abruption, or preterm birth, depending on the myoma's location.

• Pain may occur if a myoma undergoes degeneration due to poor blood supply. This usually resolves with pain management.

Most women carry their pregnancies to term without major complications, but personalized medical follow-up is essential.

5. Key takeaways

• Not all myomas are harmful to fertility.

• Assessment by ultrasound or MRI helps determine their type, size, and position.

• Surgery is only needed in certain situations.

• Careful medical follow-up before and during pregnancy helps maximize the chances of success.

If you're trying to conceive and have been diagnosed with fibroids, speak with your gynecologist to develop the right plan for your situation.

Kind regards,

Dr. Sandra Yene Amougui