Uterine fibroids are abnormal growths that develop in or on the wall of a woman’s uterus and are usually benign or non-cancerous. Its size can vary anywhere from very small pea to larger than a melon. The size of a fibroid is often described as a pregnancy like a 14 week sized or 4 month sized pregnancy. Many women don’t even know they have fibroids because they don’t have any symptoms and often a pregnant woman first finds out about it when they do her routine ultrasound. Most fibroids don’t need to be removed and just need to be monitored regularly especially if there are no symptoms.
Types of fibroids
There are 4 primary types of fibroids.
- Subserosal fibroids develop on the outside wall of the uterus and they could cause bloating, abdominal pain and frequent urination as they apply pressure on nearby organs.
- Intramural fibroids are the most common and they grow within the uterine walls causing heavy periods and pelvic and lower back pain.
- Submucosal fibroids grow within the endometrial or uterine lining and grow into the uterine cavity causing very heavy periods and severe pain in lower back and pelvis.
- Pedunculated fibroids are attached to the uterine wall on small stalks or stems and can grow outside or inside the uterus. If these fibroids twist on the stem, it can cause pain and pressure.
As mentioned earlier, quite often there are no symptoms with the presence of a fibroid. Pain is the most common symptom when having fibroids. But sometimes there are other symptoms like heavy or painful periods, spotting, becoming anemic from the excessive bleeding, feeling pressure in the lower abdomen, feeling bloated, pelvic pain, painful sex, infertility, miscarriage, and frequent urination. As fibroids increase in size, they can squeeze out space meant for other organs and cause discomfort, pain, and swelling of the abdomen.
What causes them
It is not known exactly why they form. Genetic factors might play a role. Estrogen seems to stimulate the growth of fibroids in many instances. Hence, the size might increase due to rise in estrogen levels during pregnancy. During the first trimester of pregnancy, some fibroids may grow larger but will then shrink after birth. This is also why they often shrink after menopause. It’s hard to predict how quickly or how big they will grow.
How does it affect fertility/pregnancy?
Only certain types of fibroids could affect fertility and this too only 1 to 2% of infertility cases are caused purely by fibroids.(1) Most women who have fibroids still have the ability to become pregnant and it doesn’t cause any issues during their pregnancy. Those affecting fertility could be –
Some fibroids that grow just under the uterine lining are more likely to affect fertility because they could prevent the embryo from attaching to the uterine wall.
Fibroids that grow outside the uterus probably will not affect fertility.
Fibroids which are more than 5 cm in size could have an impact on fertility and may need removal.
Also, fibroids which are situated close to the endometrium or the lining of the uterus, those indenting the endometrium, those situated very close to the tubal opening could be causing issues in fertility.
Some complications during pregnancy and delivery might include:
- Restriction of fetal growth due to large fibroids taking up space in the uterus.
- If the uterine wall is blocked by a fibroid, the placenta might break away from the wall reducing oxygen and nutrients to the fetus.
- Could go into early labor due to the pain from the fibroids causing contractions.
- Cesarean delivery might be needed if the fibroid is located in the lower part of the uterus because the baby’s head might not be able to enter the lower part of the pelvis during birth.
- Baby may be in breech position due to the abnormal shape of the uterus.
- Chances of miscarriage might increase due to the fibroid growing inside the uterine lining.
Treatment depends on the size and location of the fibroids. Prior to pregnancy and especially prior to fertility treatments like IUI and IVF it is recommended to remove the fibroids growing in the cavity. Also fibroids which are compressing the endometrium(uterine lining), large fibroids (>5 cm) are also usually removed prior to fertility treatments. Any fibroid causing a lot of symptoms such as pain and heavy bleeding may also be considered for removal. Treatment is done prior to pregnancy and if fibroids are diagnosed during pregnancy or increase in size during pregnancy, the expectant mothers might have to stay on bed rest, stay hydrated and be prescribed pain relievers to manage the fibroid symptoms. Thus, it is always advisable to get the proper treatment for fibroids before conceiving.
Some of the treatment methods are described below. However, some don’t help very much and complications can occur with treatments such as fibroid embolization and hence if there is an indication to treat the fibroid, surgery is the preferred option.
- Hormonal therapy to shrink fibroids doesn’t cure fibroids but can help manage pain and other symptoms.
- Uterine fibroid embolization (UFE) uses small particles that block the flow of blood to the fibroid causing it to shrink and end any fibroid related symptoms. The uterus is not damaged, there is less pain involved and a faster recovery time. Fibroids that have been embolized also cannot regrow and these are the advantages to this procedure. However there are complications related to this procedure and not very frequently used.
- Magnetic resonance imaging (MRI) guided ultrasound surgery where ultrasound waves are used to destroy fibroids with the help of MRI.
- Myomectomy is a procedure to remove fibroids from the uterus surgically. It can be done through laparoscopy (several small incisions), laparotomy( big abdominal incision) or hysteroscopy (through the vagina).
- Hysterectomy or the surgical removal of the uterus removes the uterus along with the fibroids. This procedure is recommended only after completion of child bearing and in older women.
Speak to your doctor about the size and location of any fibroids you might have, to see if there are any issues with getting pregnant and carrying the baby to term. Also ask your doctor if there are any treatment options for fibroids that might help you get pregnant. Most infertility issues are not due to fibroids although if you suspect fibroids are preventing you from having children, you should get tested and treated. Its best to take treatment before trying to conceive because once you are pregnant, you will most probably have to grin and bear the pain. The start of an IVF journey usually involves preliminary evaluation of your overall health and this includes checking your uterus for any abnormalities like fibroids. If you have any concerns about fibroids, feel free to come talk to the experts at Xenith Advanced Fertility Centre.