Uterine Fibroids and Pregnancy: Key Concerns and Next Steps

Uterine fibroids and pregnancy?

Recently, I was diagnosed with pregnancy while checking for uterine fibroids.
On June 15, I took RU486, followed by uterine contraction medication (2+1 pills) on June 17, and again on June 18 (2+1 pills).
On June 22, during my follow-up appointment, the gynecologist mentioned that the embryo had been expelled, but the ultrasound indicated that there were still some remnants.
During the two days of contractions, I took painkillers, so I didn't experience much pain, but after the third day, I had significant abdominal pain, which I initially thought was caused by the fibroids.
Today, I consulted a gynecologist who patiently explained my situation and prescribed some pain relief and antispasmodic medications.
He advised that if I want to monitor my condition, I should see an obstetrician.
My questions are as follows:
1.
How can I determine if everything has been expelled completely? Currently, I still have a flow similar to the end of a menstrual period, with a dark color.
2.
Under what circumstances should I see an obstetrician again? Should I wait until next week, or if my next menstrual period arrives smoothly, can I avoid seeing an obstetrician?
3.
The fibroids measured 6 cm and 14 cm (compared to 4 cm and 8 cm six months ago).
Did the pregnancy cause the fibroids to grow rapidly? Can taking RU486 or uterine contraction medications cause inflammation and abdominal pain in the fibroids? Now that the pregnancy has ended, will the fibroids shrink?
4.
Given the size of the fibroids, is traditional surgery necessary, and considering there are some adenomas, can the uterus be removed directly? (I do not plan to become pregnant again.) How long after terminating the pregnancy should I wait before addressing the fibroid issue?
Thank you, doctor, for taking the time to respond.

Mrs. Chen, 40~49 year old female. Ask Date: 2016/06/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, after taking RU486, the criteria for confirming complete evacuation are that there is no continued bleeding and a negative pregnancy test.
Therefore, you should follow up with your original hospital according to the scheduled appointment.
Regarding the fibroids and adenomas, after the termination of pregnancy, the fibroids may decrease slightly in size, but not significantly.
Surgical intervention should consider traditional surgery as the more appropriate option.
Wishing you good health.

Reply Date: 2016/06/22

More Info

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the uterus and can affect pregnancy and reproductive health. Your situation involves several critical aspects regarding the management of fibroids during and after pregnancy, especially after a recent termination of pregnancy. Here’s a comprehensive overview addressing your concerns:
1. Determining if the Uterus is Cleared Post-Termination: After a medical termination of pregnancy, it’s essential to ensure that the uterus is clear of any remaining tissue. This is typically assessed through follow-up ultrasound examinations. If you are experiencing bleeding similar to a menstrual period, it may indicate that the uterus is still expelling tissue. However, if the bleeding is heavy or accompanied by severe pain, you should seek immediate medical attention. A follow-up appointment with your healthcare provider is crucial to confirm that the uterus has returned to its normal state.

2. When to Consult an Obstetrician: If you continue to experience abnormal bleeding, severe pain, or any other concerning symptoms, it is advisable to consult an obstetrician. Generally, if your next menstrual cycle does not occur as expected, or if you have ongoing symptoms, you should reach out to a specialist. It’s also wise to schedule a follow-up appointment within a week or two after the termination to ensure everything is progressing well.

3. Fibroid Growth During Pregnancy: It is common for fibroids to grow during pregnancy due to increased estrogen levels. The rapid growth you’ve observed (from 4 cm and 8 cm to 6 cm and 14 cm) could indeed be attributed to hormonal changes associated with pregnancy. Medications like RU486 (mifepristone) and uterotonics can cause uterine contractions, which may lead to discomfort, but they are not typically known to cause inflammation of fibroids. Post-termination, fibroids may decrease in size, especially if they were stimulated by pregnancy hormones.

4. Surgical Considerations for Large Fibroids: Given the size of your fibroids and your decision not to pursue future pregnancies, surgical options may be considered. Myomectomy (removal of fibroids) or hysterectomy (removal of the uterus) are potential procedures. The choice between these options depends on various factors, including your overall health, the size and location of the fibroids, and your personal preferences. It is generally recommended to wait for a few months after a termination before undergoing elective surgery to allow your body to heal.

5. Post-Termination Care: After a termination, it’s essential to monitor your physical and emotional health. Follow your healthcare provider's advice regarding pain management and any medications prescribed. Ensure you attend all follow-up appointments to monitor your recovery and the status of your fibroids.

In summary, your health care provider is your best resource for navigating these concerns. Regular follow-ups, monitoring symptoms, and open communication with your healthcare team will help ensure that you receive the appropriate care and support during this time. If you have further questions or concerns, don’t hesitate to reach out to your healthcare provider for personalized advice.

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