Uterine Fibroids: Surgery vs. Pregnancy Risks

Uterine fibroids

Hello Dr.
Tsao,
I have been experiencing occasional abdominal pain after my menstrual period, and upon examination, it was discovered that I have a uterine fibroid measuring approximately 8x6x6 cm.
However, three years ago, when I was checked at another clinic due to heavy menstrual bleeding and dysmenorrhea, there were no abnormalities found.
Since then, I have not had regular ultrasound examinations, and currently, aside from occasional abdominal pain, there are no other effects.
The doctor believes that the fibroid is growing too quickly.
While it may not affect my ability to conceive, it could pose other risks during pregnancy (such as pain, preterm labor, etc.), and has recommended surgery.
I happen to have the opportunity to undergo surgery soon, but I also have plans to get married and conceive in the coming years.
Therefore, I would like to ask for your opinion on the following:
1) Is the risk of pregnancy after laparoscopic surgery greater than the risk of not having the surgery? Should I wait for three months of monitoring before making a decision?
2) Is the recommended time to wait before trying to conceive after surgery six months, or will a longer recovery period be necessary?
Thank you for your assistance!

Yang, 30~39 year old female. Ask Date: 2023/10/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you may consider surgery.
The general risks are low, and you can start trying to conceive 6 months after the procedure.
Wishing you good health.

Reply Date: 2023/10/07

More Info

When it comes to understanding the implications of uterine fibroids on pregnancy and the potential need for surgery, it's essential to weigh the risks and benefits carefully. Uterine fibroids, which are benign tumors of the uterus, can vary significantly in size, location, and number. In your case, you have an 8x6x6 cm fibroid that has been growing rapidly, which raises some concerns regarding its impact on future pregnancies.

1. Surgery vs. No Surgery Risks: The decision to undergo surgery versus waiting to see how the fibroid affects your pregnancy is a nuanced one. If the fibroid is causing significant symptoms, such as pain or heavy menstrual bleeding, surgery may provide relief and improve your overall reproductive health. However, surgery, especially laparoscopic myomectomy, can carry its own risks, including potential complications such as infection, bleeding, or damage to surrounding organs.
On the other hand, if you choose not to have surgery, the fibroid could potentially lead to complications during pregnancy, such as increased pain, risk of preterm labor, or even obstructing the birth canal if it grows significantly. Studies suggest that while many women with fibroids can have successful pregnancies, there is a higher risk of complications compared to those without fibroids. Therefore, if your doctor believes the fibroid poses a significant risk to a future pregnancy, it may be prudent to consider surgery.

2. Timing for Pregnancy After Surgery: After a laparoscopic myomectomy, the general recommendation is to wait at least 3 to 6 months before attempting to conceive. This waiting period allows your body to heal properly and reduces the risk of complications in a future pregnancy. The exact duration may depend on individual factors, including how well you recover from the surgery and your doctor's specific recommendations based on your health status and the nature of the surgery performed.

In conclusion, the decision to proceed with surgery or to wait should involve a thorough discussion with your healthcare provider, considering your symptoms, the growth of the fibroid, and your future pregnancy plans. If surgery is performed, adhering to the recommended waiting period before trying to conceive is crucial for ensuring a healthy pregnancy. Always keep an open line of communication with your healthcare team, as they can provide tailored advice based on your unique situation.

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