uterine fibroids

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Can A Myomectomy Prevent a Second Miscarriage?

Monday, February 18th, 2013

A miscarriage is a horrible experience for any woman. When the excitement of pregnancy is suddenly cut short by the unexpected news of loss, the grief is difficult to manage. Many women who go through this feel they need many months to heal after the ordeal, but some move on and feel ready to try again right away. Luckily, recurrent miscarriages are rare, but that’s not to say it’s easy to trust that the second pregnancy won’t go the same as the first.

Before we continue, let’s define some terms.  Miscarriage is a lay term for a “spontaneous” abortion, occurring before 20 weeks of gestation.  When most people hear the term “abortion”, they quickly recoil because they believe it to be an “induced” abortion, which is the loss of a pregnancy before 20 weeks by artificial methods.  Fibroid is a lay term for myoma, which is the appropriate term for a benign tumor of the smooth muscle of the uterus. This growth is not fibrous.

Studies show that women who had a miscarriage (spontaneous abortion) as a result of uterine fibroids (myomas) are more likely to have one in their second attempt. However, those same studies show that the surgical removal of said myoma can greatly increase a woman’s chances of having a live birth despite a previous miscarriage.

Fibroids (Myomas) are benign tumors that grow on the walls of the uterus, and they actually affect a significant number of adult women. Twenty-five percent of all women have myomata, with the percentage rising  to 50% in Black women.  When myomas grow into the uterine cavity and thus distorting the inner contour of the womb , they can cause miscarriages (spontaneous abortions). In other locations, such as growing on the outside of the uterus like Mickey Mouse ears (subserosal), they are absolutely harmless and women don’t even know they have them.

Once a doctor diagnoses myomas (myomata) as the cause of a spontaneous abortion (usually in the second trimester), he or she might recommend surgical removal before a second attempt at pregnancy. This surgery is technically called a myomectomy (not fibroidectomy), and it is a relatively safe procedure. Unfortunately, there is a 25% chance the myoma could come back over time, but in many cases, they don’t reappear until years later.   For further information about myomas and myomectomy, you are referred to my book, INSIDE INFORMATION FOR WOMEN on the topic.

If you have had one or more spontaneous abortions, your gynecologist should perform a comprehensive evaluation of your uterus to determine whether or not myoma played a role. This may include a sonohysterogram, and/or a hysterosalpingogram. Most often, spontaneous abortions are totally random, but in some cases, they are caused by an abnormality in the reproductive system. Should your doctor find intramural or submucosal myomata (myoma in the wall of your uterus), you should consider surgery before trying again. While a second attempt at pregnancy won’t make up for the disappointment of the first loss, addressing the problem and correcting it will go a long way in achieving a successful outcome.

 – Yvonne S. Thornton, M. D., M. P. H.