Brigid: [00:19:16] you're trying to get pregnant or you are pregnant and you feel a little bit overwhelmed by all you need to know, then this is the right podcast for you. Welcome to the show. I'm Brigid Moloney
Patrick: [00:19:27] and I'm obstetrician dr. Patrick Moloney. And this is the kick, your expert led podcast that delivers the essentials of growing a baby.
Make sure you head to our website, grow my baby.com.edu to get some awesome freedom. Tools like our pregnancy knowledge checker to help you feel like you got this.
Brigid: [00:19:48] Hello, everyone. This is episode 33, Pat. We're up to, okay. Yeah, it's come a long quickly. Hasn't it? 33
Patrick: [00:19:55] Uterine fibroids today.
Brigid: [00:19:57] Yes. Yes. It's a, interesting topic, [00:20:00] but it actually is a another, request from somebody on our DMs, on our Instagram account.
Patrick: [00:20:05] Easy, done,
Brigid: [00:20:05] Easy done. and I just wanted to ask first pet. Do you reckon in nine months time, there'll be a baby boom.
Patrick: [00:20:12] After the lockdown?
Brigid: [00:20:14] I hope so. I hope so too.
Patrick: [00:20:17] I hope that's what everybody's doing out there. And then, yeah, in nine months time, we'll have a wonderful, you know, boost in, in new babies.
That'd be great.
Brigid: [00:20:27] Yeah. I do know. I mean, because people have told us that there's a few, that if they weren't any mad rush to get pregnant, they've sort of held off.
Patrick: [00:20:35] Yeah, I think that's a general uncertainty. Yeah. And the people who are in a mad rush, just carrying on trying and the people and most of the people I see on a daily basis, of course they were already pregnant when, when the, when the thing started.
Brigid: [00:20:49] Yeah. We've got quite a lot coming in to the practice haven't we?
Patrick: [00:20:51] So we just manage that in the usual way.
Brigid: [00:20:54] They feel a little bit more isolated, you know, in terms of pregnancy information and
Patrick: [00:20:58] yeah, the first [00:21:00] timers it's a bit of a bummer for them. But, you know, if someone having a, a baby newborn first baby in the middle of all of this,
Brigid: [00:21:07] and really we do have a solution for that.
We're building this our growmybaby program, which will be launched by the time you listen to this perfect. Hopefully… I do want to read, a very nice review. We got on our iTunes account, which says, From Ruth Australia, despite this, the fact, this is my third pregnancy and I'm a NICU nurse.
I'm thoroughly enjoying the podcast. I'm surrounded by women and their stories and opinions. What I seek is evidence based information. And this is it. Yes. Good. Isn't it.
Patrick: [00:21:38] That's high I praise. It's not just for experts. In fact, it was supposed to be, you know, what we want to do is talk to too people whose expertise is elsewhere.
about things that, that we know about. So for NICU nurse to be praising our stuff is fantastic.
Brigid: [00:21:52] Those NICU nurses, they're just gems. Aren't they
Patrick: [00:21:55] absolute gems.
Brigid: [00:21:56] not, not a segway at all, but now uterine [00:22:00] fibroids.
Patrick: [00:22:00] Yeah. So fibroids is relevant, to a pregnancy discussion, in a number of ways, the, I guess the most common way a fibroid would turn up is that if somebody was having some sort of problem getting pregnant, or for some other reason had had a pelvic ultrasound and they can see on the ultrasound, in the wall of the uterus, these round swellings of the muscle.
Brigid: [00:22:25] muscle?
Patrick: [00:22:26] Yeah, it's uterine muscle. That's under gone some change, but not cancerous change. Yeah. and it's formed these, mostly spherical, lumps of, of, of hard muscle. And that's what fibroids are.
Brigid: [00:22:37] And I always think of. Just those single lumps. But when you've done a say, let's say you've done a hysterectomy on somebody who's older and, and you say, Oh, wow, a big fibroid, uterus, you mean lots of little fibroids or the whole thing is..?
Patrick: [00:22:50] No, normally lots of, lots of little ones. And sometimes lots of big ones. That's where it, sometimes there's only one, but that's not, [00:23:00] not that common. So, we're talking about little ones of two or three millimeters that would be in everyone's uterus by age 45, versus the really big, significant clinically significant ones that are commonly four or five centimeters.
And, and, you know, no record books might, you know, w might be 20 or 30 centimeters. Right. Yeah.
Brigid: [00:23:23] And do they have the same sort of habit as other things like, do they rupture or do they burst or do they just keep growing
Patrick: [00:23:30] They are usually slow growing so they don't usually rupture or burst and they, and they're solid.
They're not full of water or anything. but, they can certainly cause problems by pushing on other things. So if there are ones that poke out ways from the uterus, like Mickey mouse ears, and ultrasound, then they might push against the bladder or the bowel causing those, those organs to, to not function properly.
And, if they push in ways into the uterine [00:24:00] cavity, then they commonly cause menstrual problems.
Brigid: [00:24:03] Like painful periods, heavy,
Patrick: [00:24:05] heavy, heavy, usually, usually not painful, but, but heavy. Yeah.
Brigid: [00:24:09] So would that be the thing that would get somebody a diagnosis of having a fibroid?
Patrick: [00:24:15] Yeah. So in the pre pregnancy years that woman might have an ultrasound is pretty common.
Isn't it? For pelvic pain, heavy menstrual bleeding. Yeah.
Brigid: [00:24:24] so many different causes, you know, of that, isn't it like endometriosis?
Patrick: [00:24:28] Absolutely. So, so, you know, it's very, very common situation where someone would have had a pelvic ultrasound for some reason prior to the, first pregnancy. And so that woman might come into that pregnancy, aware that those fibroids are there and sometimes those fibroids might be addressed as part of a subfertility situation
Brigid: [00:24:50] and how common are fibroids?
Patrick: [00:24:52] Well, they're practically universal by the time you get to your mid forties. but, clinically significant ones in the pre [00:25:00] pregnancy years is pretty rare.
Brigid: [00:25:02] Yeah. And, some people more susceptible to developing fibroids.
Patrick: [00:25:06] yeah, the family history.
Right. And some, racial groups.
Brigid: [00:25:11] Yeah. And it's hard with family history because this is the same with endo, isn't it? That sometimes your mother or your grandmother, or whoever has had heavy periods. And that just becomes part of your family's culture. You know, women in our family, we have heavy periods and that investigation isn't.
Isn't done to say, okay, well it's fibroids, but
Patrick: [00:25:29] yeah. And this was why it's good to have an actual diagnosis. Yeah. Yeah. So, if we look at, at, women in the pre pregnancy years, having having significant fibroids, that's, it's not that common we might know about them, but they're small. And we might, we would probably say to that woman looks, you've got some small fibroids it's unlikely to affect your fertility and go for it and see how you go.
Brigid: [00:25:52] And how does it affect the fertility?
Patrick: [00:25:54] Well, if they're really big, they might be up near where the tubes come in. So it might [00:26:00] literally, it might literally block it. if they poke in ways towards the uterine cavity, then it might really affect how much good lining there is for a fertilized egg to implant.
Brigid: [00:26:12] So the lining of, of an aid can't implant on that on a fibroid
Patrick: [00:26:17] it's harder. Yeah. It's harder for them to implant over the top of a fibroid. Yeah. Yep. So, we, we might wind up addressing fibroids in a infertility or recurrent miscarriage setting.
Brigid: [00:26:31] And when you say we might address it, what are you doing?
Patrick: [00:26:34] We have to make a careful assessment about how much we really think it's the problem.
Then if we think, if we really think it is, then, then there's an operation to take the fibroids out, but keep the rest of the uterus in.
Brigid: [00:26:46] Is that super tricky?
Patrick: [00:26:48] It is super tricky. the, those, the ones that poke inwards towards the uterine cavity, you can approach those through the vagina. With an instrument that goes in through the [00:27:00] cervix and sort of shaves the fibroid back into
Brigid: [00:27:02] one.
So you're not actually removing the fibroid in its entirety, just taking
Patrick: [00:27:07] just the bit of it, that pokes into the uterus. Yeah. and, that has its own complexities. And then there's operations down from above, an open operation to cut fibroids out of the uterus or, these days our laparoscopic operation to cut fibroids out of the uterus and thats
complex surgery. Cause you have to make sure that you keep enough of the good part of the uterus to sustain a, a pregnancy.
Brigid: [00:27:32] and just to, I dunno, people mightn't know laparoscopic that's the keyhole surgery,
Patrick: [00:27:37] yeah, yeah. So we've got to look carefully at who, who really needs their fibroids removed, but by no means, does everybody need them removed?
and then. and then carefully assess that where the fibroids are located in the best way to take them out.
Brigid: [00:27:52] And you're seeing a specialist gynecologist by now aren't you?.
Patrick: [00:27:55] Yeah. Yeah. So, that's how, that's how the fibroids can affect things [00:28:00] beforehand. And once the pregnancy is up and up in a way, usually things will go very well, even with a fairly large fibroid.
But there are some important considerations to look at. One is that, you know, when you're pregnant and you go to see the obstetrician, we measure tummy, you know, with a tape measure from the pubic bone up to the top of the, of the pregnancy. And that should be about a centimeter per week of pregnancy.
If you've got a 10 centimeter fibroid sitting on the top of the uterus, that's exactly. You'll just be measuring the fibroid. So we're more likely to resort to more ultrasounds in a woman whose uterus has fibroids. And we're not going to be able to as accurately follow the fetal growth by just the hands on.
Yeah. Yeah. So we'll go to ultrasound and then over at the ultrasound place, they're going to need their best purpose synography because it can be hard to say.
Brigid: [00:28:52] so the fibroids actually blocking their view.
Patrick: [00:28:55] So what if the fibroids are at the front and they have to look through the fibroids at the baby.
[00:29:00] So that's, that's hard to. Yeah. And then, of course, if the woman's got something called lower segment fibroids where they're right down the bottom near that near the cervix, or right, right on the bit where you would do a Caesar, then that all has to be taken into consideration in some careful pregnancy planning, to, to make sure that that isn't a big surprise on the day.
How many times have you Googled something about your pregnancy?
Brigid: [00:29:26] When I was pregnant all the time, dr. Pat,
Patrick: [00:29:29] we get it. You may be confused or overwhelmed. It's normal to want information, but where's the reliable stuff from experts.
Brigid: [00:29:37] Now, if you like our podcast, dr. Pat and I have developed an online program to help guide you through whatever stage of pregnancy you're at,
Patrick: [00:29:45] it's taken us literally two years to put it together
Brigid: [00:29:47] two long, hard years.
Patrick: [00:29:50] But, you know, it is a game changer in how pregnancy information is given
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And you get lots of information around that. And then you also get to join our closed Facebook group. So we'll have some Q and A's and some lives happening in there. So we really get to interact with you.
Patrick: [00:30:15] We've called in all our contacts too. So we've got a dietician and anaethetist physiotherapists and sonographer.
Yeah. Who else? A pediatric nurse obstetrician mother, or for
Brigid: [00:30:26] just all the people you need to hear from.
Patrick: [00:30:28] So if that's you come and join us at www dot, grow my baby.com today, you
Brigid: [00:30:33] see you in the course. Oh, I don't even know whether this is a question I should ask, but like, say if somebody does have a fibroid over where you would do the C section cut, but it's lower segment. It might also cover the opening of the cervix. Yep. How's that baby coming out?
Patrick: [00:30:51] Well, you can do a Caesar. You would probably do a caesarean section in that situation. Yeah. But make the cut somewhere else. So you can make an [00:31:00] up and down cut. That's not where that fibroid is.
Brigid: [00:31:04] There's ways and ways.
Patrick: [00:31:04] There's ways in where it's complicated, but it can be, it can all be done. Yeah.
Brigid: [00:31:09] All right. So somebody, do they have like more pain during the pregnancy? Or is there any other considerations during the pregnancy?
Yeah, it's possible
Patrick: [00:31:16] sometimes fibroids undergo something called acute degeneration where they just suddenly, pack up and, and the, and the tissue disintegrates.
And it's not, you know, there's some different theories about exactly why that happens, but it might be that they get a call inside their blood supply. And, if they do pack up and disintegrate like that, they'll undergo something called acute degeneration where that to the tissue in the fibroid actually dies and that's painful, right?
Brigid: [00:31:43] Yeah. but doesn't impact the pregnancy?
Patrick: [00:31:45] Not necessarily. but certainly something, it would certainly be one of the things we would look for, if a woman with known big fibroids who was pregnant suddenly had a lot of pain,
Brigid: [00:31:55] and the pregnancy hormones could create anything other or their action of the fibroids.
[00:32:00] Like, do they grow bigger or shrink?
Patrick: [00:32:02] Yeah. They, they, they don't tend to sort of grow bigger in, you know, quickly accelerating or anything like that. That's more an effective the passage of time. So, that brings us to that sort of post-pregnancy phase where we say, well, okay, well, we've got, we got away with it. That babies are out and well, what are we doing now?
And of course the answer to that depends on what that woman. What her, what her plans are for the rest of her family. If that was only baby number one, and we've got more to go, then we keep a close eye on those fibroids over the next year or two to reassess, whether she would be better off just going for another pregnancy when she's ready or whether she would be better off having a myomectomy, which is the fibroids removed, and then had the other pregnancy.
Brigid: [00:32:47] And if you do have a myomectomy, what's the sort of recovery time.
Patrick: [00:32:51] Yeah. There's various different views on that. but, it certainly takes many months for the uterus to recover. and [00:33:00] then you have to have a think about. about whether it has it recovered just towards normal state or is it actually ready for a pregnancy?
Yeah, so, it's common to wait at least six months and if not significantly longer. And sometimes knowing exactly how much of the uterus of how much. How many fibroids were cutaway and how deep into the uterine muscle you had to go to get those fibroids out.
Brigid: [00:33:25] So whether you've weakened the wall.
Patrick: [00:33:27] Exactly. And that can give you a real idea about whether that, whether, the subsequent pregnancy, whether that woman should be delivered vaginally or by caesarean sections. Yeah. Yeah. Cause the forces of labor might be different to the forces of every day.
Brigid: [00:33:40] I was hoping, I think I know the answer to this.
I was going to say after birth, like, do they miraculously go away or anything like that? Like, but you're saying most people by 45, have got some fibroids,
Patrick: [00:33:50] some little ones, some little ones. And, so I think knowing that helps people to know that they're not cancer and they are not. They are, they are [00:34:00] very, very commonly experienced thing.
When do they become a disease when they're causing you a problem?
Brigid: [00:34:05] Yeah.
Patrick: [00:34:05] Pain
Brigid: [00:34:06] Or,
Patrick: [00:34:07] or, or heavy menstrual bleeding or a fertility issue. Yeah. So if we look at this woman further down the track and she's had all the babies, then again, whether or not she needs. Further surgery in the form of say hysterectomy, it depends whether they're causing trouble or not.
Yeah. Yeah. So they'll cause trouble. If they're huge
Brigid: [00:34:26] and you've got a massive uterus
Patrick: [00:34:28] and you can see it or feel it, or it's pushing against bladder or bowel causing problems with bladder or bowel function, or maybe they're not huge, but they're just in a place that causes very heavy menstrual bleeding.
Well, by the time the woman's finished her family, different surgical options are on the table. Okay. And by that point, it's actually much easier to make those
Brigid: [00:34:49] decisions.
Patrick: [00:34:50] Absolutely. But also to carry them out because a hysterectomy taking out the whole uterus is technically much easier than myomectomy taking out the [00:35:00] fibroids one by one.
Brigid: [00:35:00] Yeah. Yeah. I could imagine. Well, and I'm, I mean, I'm just a little bit fascinated cause I've, I've actually seen, well, you've talked about some very big fibroid uteruses. How big is the biggest fibroid uterus that you've removed through doing a hysta,
Patrick: [00:35:14] at open hysterectomy probably sort of, volleyball size.
Wow. Yeah. So, and because they grow so slowly, sometimes woman hasn't even really noticed.
Brigid: [00:35:25] She just thinks she's putting on weight
Patrick: [00:35:27] maybe. Yep. Yep. And then, it, it just creeps up incrementally year by year until they can be very big.
Brigid: [00:35:33] That is phenomenal,
Patrick: [00:35:35] much more commonly the patient I see with heavy menstrual bleeding in her forties.
Who's and the, and the culprit is fibroids. They will be three, four, five centimeters.
Brigid: [00:35:44] Yeah. Okay. So I just really want to recap because, the original question was for somebody that was pre pregnant and, fibroids is isn't a common.
Patrick: [00:35:56] Not in that prepregnancy age group. Yeah. But it's definitely a [00:36:00] problem that needs specialist analysis if they're there and the woman hasn't any babies yet, because the decision about whether just to go for it and try for a pregnancy or to have the fibroids removed first is a nuanced.
A complex decision. Yeah.
Brigid: [00:36:18] And for a woman trying to find the right practitioner to help her, what are some of the questions that she should ask?
Patrick: [00:36:25] I think that, you know, it starts with the local doctor with the GP. And then the question about, about. where to go. we need to, interrogate our GP about, about sending us to someone, who is, you know, experienced in that area
Brigid: [00:36:41] and who has laparoscopic skill and
Patrick: [00:36:43] potentially, although we might not know at that point, that's a laproscope is needed.
Yeah. But, this isn't the domain. I think the point you're making is that this isn't the domain of every single gynecologist. And so we need to make sure that we're in, we're in the right place.
Brigid: [00:36:57] So for all those women that, pre pregnant, [00:37:00] trying for pregnancy and have been diagnosed with fibroids, we hope that that's been helpful, and wish you all the luck in the world in your pregnancy quest.
Patrick: [00:37:08] Absolutely. Thanks for asking to, from our listener about asking about fibroids, that's something that we hadn't really fully. thought of, to include in the program, but absolutely we want to hear from people about special things like that, that are of interest to them. And, we hope of interest to everybody else.
Brigid: [00:37:25] Yeah. Excellent. Well, everyone until next week. Thanks for listening.