Finding out you have fibroids during pregnancy is the kind of news that lands heavily, even when the doctor immediately follows it with reassurance. Your mind goes straight to the baby. Is everything going to be alright? Will this cause problems? Should you have known about this sooner?
The honest answer is that it depends, and it depends quite specifically on where the fibroid is sitting, how large it is, and how your body responds to the hormonal shifts of pregnancy. Many women with fibroids go through pregnancy without any significant complications at all. Others need closer monitoring and careful management. Understanding the different types and what each means for pregnancy is the first step toward knowing which category you fall into.
Fibroids are non-cancerous growths of muscle tissue that develop in and around the uterus. They are among the most common gynaecological conditions in Indian women, with prevalence estimates suggesting that up to 40% of women of reproductive age have them, though many remain undetected until a scan is done.
During pregnancy, the hormonal environment changes dramatically. Oestrogen and progesterone, both of which stimulate fibroid growth, rise significantly. This means fibroids that were small before conception can grow during pregnancy, and ones that were causing no symptoms beforehand may start to. Fibroids during pregnancy risks are not uniform across all types. The location of the fibroid within or around the uterus determines far more than the size alone.
The three main types of fibroids are classified based on their location in the uterus. Based on the location, the implications for pregnancy vary.
Fibroids are classified based on where they develop relative to the layers of the uterus. Each location carries different implications for pregnancy.
Submucosal fibroids grow inside the inner uterine lining. It pushes directly into the uterine cavity. This is the space where the embryo implants, the placenta develops, and the baby grows. This location makes them the most concerning type during pregnancy.
Submucosal fibroids pregnancy risk includes a higher rate of first-trimester miscarriage, placental insufficiency, preterm labour, foetal growth restriction, and obstructed delivery requiring caesarean section. The fibroid competes directly with the baby for space and blood supply throughout the pregnancy.
Women who know they have submucosal fibroids before conceiving should discuss hysteroscopic removal with a specialist beforehand. Outcomes consistently improve after treatment.
Submucosal Subtypes: Submucosal fibroids are further classified based on how much of the fibroid protrudes into the uterine cavity.
Type 0 fibroids sit entirely within the cavity on a stalk.
Type 1 fibroids are more than 50% within the cavity.
Type 2 fibroids are less than 50% inside the cavity but still distort it.
Type 0 and Type 1 carry the highest implantation and miscarriage risk because they occupy the most cavity space. Type 2, though less intrusive, still warrants monitoring and often pre-pregnancy treatment.
Intramural fibroids may grow inside the uterus's muscular wall. It is the most common type of fibroid. Intramural fibroids pregnancy complications depend on the size and the position of the fibroids in the uterine cavity. Small fibroids sitting away from the cavity often cause no problems. Larger ones, or those encroaching on the cavity, carry risks closer to those of submucosal fibroids.
The most significant concern is red degeneration, where the fibroid outgrows its blood supply, causing sudden, severe pain, usually in the second trimester, often requiring hospitalisation. Preterm labour, malpresentation, and increased likelihood of caesarean delivery are also associated risks.
Intramural Subtypes: The key distinction within intramural fibroids is whether the fibroid is cavity-distorting or non-cavity-distorting. A fibroid sitting entirely within the uterine muscle without touching the inner lining carries considerably less pregnancy risk than one that has grown large enough to press against or indent the cavity. Fibroids in the lower uterine segment, regardless of size, also carry a higher risk of obstructing labour and requiring caesarean delivery than those sitting in the upper or fundal part of the uterus.
Subserosal fibroids grow on the outside of the uterus. Because they sit away from the space where the baby grows, subserosal fibroids pregnancy impact is generally the least significant of the three types, and most women with these fibroids go through pregnancy without fibroid-related issues.
The one risk worth knowing is torsion. Pedunculated subserosal fibroids, those on a narrow stalk, can twist during pregnancy, cutting off blood supply and causing sudden, severe pain that occasionally needs surgical attention. Very large fibroids can also affect foetal positioning and complicate caesarean delivery.
Pedunculated versus sessile subserosal fibroids: Subserosal fibroids are either sessile, attached broadly to the uterine surface, or pedunculated, growing on a narrow stalk. Sessile subserosal fibroids are generally stable during pregnancy and unlikely to cause acute complications. Pedunculated fibroids carry the specific risk of torsion, as described earlier, and this risk increases as the uterus grows and shifts position through pregnancy. A pedunculated fibroid that was asymptomatic before conception can become a source of acute pain mid-pregnancy as the expanding uterus pulls on the stalk.
Women with fibroids during pregnancy require more careful antenatal monitoring than those without. This typically includes more frequent growth scans to track both the fibroid and the baby, monitoring of foetal position as delivery approaches, and a clear delivery plan that accounts for fibroid location.
The doctor recommends managing pain due to fibroid degeneration with rest and pain relief medications. Surgical removal of fibroids during pregnancy is rare. It is usually done only for exceptional cases where other management has failed.
The most important thing a woman with fibroids can do during pregnancy is attend all scheduled appointments and report new or worsening symptoms promptly.
Surgical removal of fibroids during pregnancy, called myomectomy, carries significant risks including preterm labour, haemorrhage, and pregnancy loss. It is generally avoided unless a fibroid is causing complications that cannot be managed any other way, such as severe, unrelenting pain from degeneration that does not respond to conservative treatment. For the vast majority of women, the approach is to manage symptoms, monitor carefully, and plan the delivery with the fibroid's location in mind, addressing removal only after the pregnancy is complete.
Fibroids during pregnancy are common, and most women with them go on to deliver healthy babies. The type of fibroid matters enormously when assessing risk. Submucosal fibroids are the greatest concern; intramural fibroids require monitoring based on size and position; and subserosal fibroids generally have the least impact. Knowing which type you have and staying in close contact with your obstetric team are the most practical steps you can take.
Fibroids are classified by location. Submucosal fibroids grow into the uterine cavity and carry the highest pregnancy risk. Intramural fibroids are within the uterine muscle wall, and their risk depends on size and location relative to the cavity. Subserosal fibroids grow outside the uterus and generally have the least impact on pregnancy. Still, large ones can complicate positioning and delivery.
Submucosal fibroids carry the greatest risk. Because they grow into the uterine cavity, they can interfere directly with implantation, placental development, and foetal growth. Submucosal fibroids pose higher pregnancy risks, like a higher rate of miscarriage, preterm labour, placental insufficiency, foetal growth restriction, and caesarean delivery. Women with known submucosal fibroids are advised to discuss removal before attempting conception, as results improve after hysteroscopic treatment.
In most cases, subserosal fibroids pose minimal impact because they grow outward from the uterus and do not directly interfere with the uterine cavity or placental function. Still, large subserosal fibroids, particularly pedunculated ones, can undergo torsion, contribute to abnormal foetal positioning, or complicate a caesarean section. Women with large subserosal fibroids should still be monitored through pregnancy, even if active complications are less likely than with other fibroid types.
Size matters, but location is the more important factor. A small submucosal fibroid can cause more significant complications than a much larger subserosal fibroid. That said, fibroids over 5 cm are monitored more closely regardless of type, as they are more likely to grow in the first trimester, undergo degeneration, causing pain, and affect foetal positioning. Intramural fibroids pregnancy complications also increase with size, particularly when the fibroid encroaches on the uterine cavity.
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