I Have a Myoma: Can I Still Get Pregnant? | Filipina M.D.

I Have a Myoma: Can I Still Get Pregnant?

Hi Dr. D.

Tanong po ako ulit, tungkol sa myoma, pag meron po bang myoma bawal bang mag buntis? mga more than 3 ung myoma? ano po bang mangyayari pag nagbuntis n meron kang myoma?

Salamat po

 

Dear B.F.

A myoma is the most common abnormal growth in the uterus.

It occurs in 1 out of every 5 women. Even I have a myoma. My mother and her 5 sisters also had myomas and they all had them surgically removed.

http://drlindagalloway.files.wordpress.com/2009/12/pregnancy_ultrasound.jpg

A myoma or fibroid is due to uncontrolled proliferation or growth of muscle cells within the uterus. This rarely leads to cancer. Half of the cases slowly enlarge, 25% shrink on their own and the other 25% stays the same size all throughout a woman’s life.

It is influenced by the hormone estrogen which is why myomas may disappear altogether once a patient reaches menopause.

Due to estrogen stimulation, fibroids may enlarge during pregnancy but most doctors would choose to leave them alone because removal during pregnancy would cause catastrophic bleeding and they will decrease in size after pregnancy anyway.

Most myomas have no symptoms. Some may present with pain in the “puson” or hypogastric area and a few will have symptoms of strong vaginal bleeding.

Several theories are still undergoing research as to the cause of myomas.

One study relates it to chromosomal or genetic abnormalities which could explain why it is common among female relatives.

Another theory is a diet rich in red meat and fat. This could be supported by the fact that fat and cholesterol convert to estrogen thus increasing the incidence and the size of myomas.

There is no known drug to cure the myoma. Some hormones like Luprolex by Takeda or Zoladex by  AstraZeneca may be injected. These will only shrink or decrease the size of the mass making it easier to operate on but not totally disappear. These hormones may also be used to control the bleeding and the pain temporarily while preparing the patient for surgery.

Surgery is the only way to remove the mass. This is reserved for patients who have severe pain, strong bleeding and those who are trying to get pregnant.

Two types of surgeries are advised.

Total hysterectomy is removal of the entire uterus. This is done for women who have completed their family size and those who have multiple, large myomas.

The other surgery is a myomectomy. This entails removal only of the myoma and leaving behind the uterus so that the woman can still try to get pregnant.

For you, B.F., it is best to do a vaginal ultrasound first and see the sizes and locations of your three myomas. As long as they are not blocking the fallopian tubes and the cervical opening, you can still get pregnant. You can even attempt to undergo a normal delivery.

I had a patient with a 3 cm. myoma. When she got pregnant, it grew to 5 cms. Fortunately, the myoma was high up in the uterus and the baby was lower, closer to the cervical opening. My patient had a normal birth with no complications. Six months after the delivery, on repeat ultrasound, the myoma was only 2 cms and it has remained the same size for the past 5 years.

Do not think of surgery right away.

Diet and exercise should be your first line of management as long as there is no bleeding.

Lessen your intake of fried foods, beef, chicken and dairy. Fat and cholesterol convert to estrogen.

Soy products like tofu, tokwa and soymilk also contain plant estrogens. If you avoid these foods and lose weight too, you will notice a decrease or even disappearance of your myoma.

Good luck!

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22 Comments

  1. filipinamd says:

    Question from Rolynn,

    hi dr., i am 37 weeks pregnant but i have a 9.81 cm. myoma anterio-laterally.shud i just wait for me to labor or go and schedule it wid my ob-gyne? thanx .

    Dear Rolynn,

    Your myoma is big. But this does not mean that you need to have a cesarean section. Discuss it with your OB again. If the myoma is not blocking the passageway for the baby, then just wait for labor to start and you may have a normal delivery.

    Just in case the ultrasound shows that the myoma will get in the way of a vaginal birth then you can already choose a date for a CS after your 38th week.

    Good luck!

    Doc D

  2. filipinamd says:

    Question from Mara:

    Dear Doc, sabi po ng OB ko, may fibroids daw po ako, she asked if i want to do anything with it and i asked her kung ano ba ang pwedeng gawin, sabi niya, if it doesn’t bother you, pabayaan na lang. is this safe? eh paano kung lumaki na ng husto. may history kasi ang lahi namin ng mga malalaking myoma.

    Dear Mara,

    Your doctor is right. If the myoma is not causing any pain, abnormal bleeding or hindering the ability to get pregnant then don’t touch it.

    It very, very rarely cancerous. And it can even shrink on its own if you lose weight and as you get closer to menopause.

    Doc D

  3. nhom says:

    dear doc, i have myoma, measuring 9.4 cm.(intramural), although its not cancerous naman daw po but still she advice me na mag undergo ng operation after 3 shots of luprolex..maiiadvice mo po ba n magbuntis muna ako before ako magpaopera o mas safe na magpaopera muna ako bago ako magbuntis..thanks..God Bless

    • filipinamd says:

      I advise you to remove the myoma first to improve your chances of getting pregnant. The luprolex is used to shrink the myoma so that the operation will be less bloody and the myoma will be easier to separate from the uterus. The doctor will try her best to just remove the myoma and leave your uterus intact so that you can still get pregnant.

  4. chelsie says:

    Dear doc, my mom was diagnosed having a myoma na ang size daw ay kasing laki ng melon and my thickening na din daw po un lining ng uterus nya..ang advice po sa knya ng OB nya ay magpa-opera and tatanggalin ang uterus…kung mga ilang months po ba ang lumipas n d xa kgad nakapagpaopera, anu po ang mangyayari? pag po ba ganun ang situation, ASAP po ba dapt mag udergo n xa ng operation..She’s already 50y.o, my symptoms po xa ng heavy bleading during her menstrual period that lasts for a week, my high blood din po xa…thanks po and God Bless.

    • filipinamd says:

      Your mom has 2 problems:
      Myoma – if it is less than 5 cms, I will not operate. i will wait for her to go into menopause because the mass will get smaller after menopause. For the bleeding, if she is not anemic, you can try to take tranexamic acid (Hemanex) 1000mg 3x a day till bleeding stops. If bleeding does not stop, then she will need surgery.
      Thick lining – the normal lining for her age is 0.5 cms. If it is thicker than that then she might need a DNC to make sure the thickening is not due to cancer.

      Considering the 2 problems, maybe the doctor is trying to solve both problems by just removing the entire uterus which might end up happening in the end anyway. She is just saving you some time and more bleeding.

      But, surgery will cost money and risk to any patient. So discuss with your doctor the full expense and make sure a cardiologist clears her before surgery.

      Doc D

  5. Good day po Doc.,binabati ko po kayo ng maligayang araw,meron po akong malaking problema tungkol sa mayoma ko,size 9×8.5cm po sya ayun sa aking ultrasound ng whole abdomen,nag-undergo na rin ako ng transv.ultrasound,papsmear,advice ng gyne ko,magpabuntis nlang daw muna ako bago paopera kung gusto ko rin lang magkababy,35 taong gulang na po ako at wala pang asawa pero my bf,kaso di pa kami settled pareho lalo na ang bf ko,kc daw po pag naoperahan na po ako,matatagalan ako bago mabuntis kc dapat magpapagaling daw muna.Wala naman po akong nararamdaman,no bleeding,basta madalas lang po akong naiihi at sumasakit ang balakang ko pg malapit na ang regla ko,pero normal po ang regla ko.Basta nakakapa ko lang ang bukol sa kanang bahagi ng puson ko.Gusto ko po talaga mgkaanak kc sa aming mgkakapatid ako nlng ang walang asawat anak,pls.po sana po matulungan nyo po ako,God bless!

    • filipinamd says:

      Medyo malaki na nga ang myoma mo. Usually, pag more than 5 cms inaadvise na namin magpa opera dahil maaring hadlang pa ito sa pagbubuntis. pero tama din naman ang iyong doctor. Mag try muna kayo magbaby…siyempre, magpakasal muna, para may blessing from the Lord. If 1 year na kayong nagsisiping at di pa rin kayo nabibiyayaan ng baby, then maaaring naka-bara nga ang myoma. So pwedeng magpa-opera ka na by then.
      Good luck!

      Doc D

  6. alma says:

    magndang araw po doc,meron po aq 2 myoma,isang 9.67cm posterior intramural at isang 4.65 anterior intramural..3 yrs n po kmi mgaswa pro wla pa po kmi baby,sbi po ng ob skin may possibility n tanggalin ang uterus ko kng mgppaopera po ako..ano po kya ang pwede ko gwin,gsto ko sna n mgkababy kht isa lng kya lng ung myoma dn po ang dhilan kya hndi pa po ako mbuntis..ska nttkot dn po ako n mas lumaki p ang myoma ko kng d ko p po ipatanggal..sna po ay mtulungan nyo ako…salamat po.

    • filipinamd says:

      Maaring tanggalin muna ang myoma at hindi ang buong matres. Kung wala na ang myoma, mas mataas ang chance na magka baby kayo.

      • alma says:

        magandang araw po uli doc,bkt sbi po nung ob skn masyado n daw po kasi malaki ang myoma ko tpos 2 pa kya may possibility po n tanggalin n rin po ang buo matres?ibig po sbhn may mga cases n rin po n kasing laki ng myoma ko n hndi nmn po tinanggal ang matres kundi yung myoma lng po?maraming salamat po tlga,ngkaron p po ako ng pagasa kht konti…maipapayo nyo po b n gwin ko n po agad ang operasyon?salamat po uli doc..

        • filipinamd says:

          Palagi namang pwedeng subukan mag myomectomy, merong mga successful. Meron din namang hindi. Pero sayang naman kung hindi susubukan di ba?

  7. Ice says:

    doc, im 25 yrs old single i had 13cm intramural anterior fibroid.. would you help me to decide if i proceed as much as possible for myomectomy or treat first with lupron injection..im planning to have baby soon also what do you think the best thing that i need to do? thnak you..

    • filipinamd says:

      13 cms is very big. Di na kayang paliitin yan ng Lupron. You can use Lupron for 1-2 months para lumiit lang ng konti para hindi masyadong bloody ang surgery, pero no choice ka kung hindi magpa myomectomy kung gusto mo talaga mag baby.

  8. ana says:

    hi po…im 30 yrs old n at my myoma po aq…sbi po ng ob q maliit pdaw un myoma q parang buto lng ng munggo…problema q din po pagmalapit nq magkaron at during my mentrual period sobra skit po puson q. so my ob recomended me to tke pills…gusto q po mgkababy..100percent po b n sure di aq mgka2ron ng problema f i take pills f ever mn n dumating n un plan nmin n mgkaron n ng baby?hope matulungan nyo po…tnx and more power….

    • filipinamd says:

      Walang effect and pills sa abilidad magka baby. Nakakatulong pa nga ito kung may polycyctic ovaries or endometriosis ka.

  9. Jay says:

    Hi Doc. I am 21 years old and I had my first check up almost a year ago. The first ultrasound confirmed that I have myoma of size 8cm. Pero sabi ng OB ko it’s better if we have another ultrasound just to be sure. A month later, the ultrasound showed that it grew to almost 10cm. I haven’t been back to my OB since then. Cause according to her, there’s no drug to cure it (which is said in this post as well). I don’t experience vaginal bleeding but I always have severe dysmenorrhea. But lately, even if I don’t have my period I’ve been having abdominal pain. My OB suggested surgery in my last check up but she said it wasn’t an emergency operation so I didn’t have it right away. Tama po ba yung decision ko? And what else can you recommend for my case? Thanks a lot!

    • filipinamd says:

      A myoma is not cancer so, YES, it is not an emergency but the longer you wait, the bigger it will become. Large myomas might be harder to remove and it might lead to total removal of the uterus which means no more babies for you.
      I suggest i-pa-opera mo na. Actually 10 cms is already big. Make sure your doctor will try her best to remove only the myoma and not the whole uterus.

  10. hilda galvez says:

    Good day po Doc, pls help me po,2 weeks ago po nagpunta ako OB to ask why di po kami nagkakababy ng bf ko 4 years na po kami.then my OB find out na may roon raw po ako small myoma..sa pangalawang punta ko pa sa OB ko may nireseta sya na POlynerve E, Folic Acid and Poloycresulin.gusto ko po mawala ang myoma ko kahit maliit pa at gusto ko na rin mag kababy

    • filipinamd says:

      Hi Hilda,

      Kung maliit lang ang myoma mo, hindi ito hadlang sa pagbubuntis. Yung mga gamot na binagay ng doctor mo ay mga viatmins lamang para paghandaan ang pagbubuntis. Kung 4 years na kayong di magka-baby, marahil may ibang problema. I suggest magpa-sperm count si Mister at ikaw naman subukan mo bumili nung Ovulation Testing Kit, Ovatel. Araw araw maglalagay ka ng 1 drop of your saliva dun sa kit and ma-che-check kung nagoovulate ka. Kung nag-oovulate ka nga pero di ka nabubuntis, baka naman ang fallopian tubes mo ay barado. The next step is a hysterosalpingogram. The best solution is to consult an infertility specialist. Marami akong recommendation sa blog ko na “List of Recommended Doctors”.

  11. Mae says:

    2 years n kami ng asawa ko pero until now wala parin kaming baby. doc give me some advises… thanks ng marami

    • filipinamd says:

      Please do a vaginal ultrasound and let your hubby do a sperm count…then see an infertility specialist.