Uterine fibroids and fertility
Uterine fibroids are benign tumors that form in the muscular wall of the uterus. They are also referred to by other names such as leiomyoma, leiomyomatoma, myoma and fibromyoma. They can grow in various positions: on the inner side (submucosa), on the outer side (subserous), and inside the wall of the uterus (intramural).
They can be adhered to the uterus or grow on a kind of stem called a peduncle. It can also happen that they grow on the cervix or on nearby organs such as the ovaries, intestines or bladder but they are rare situations.
Responsible for their growth are the female hormones, estrogen and progesterone, which is why they usually regress or stop growing once they reach menopause.
Their sizes may be different. They can be as small as a pea, as big as a lemon or even more grains and depending on their location and size they can pose a problem and/or affect fertility.
When do fibroids prevent pregnancy?
In uterine fibroids they prevent the establishment or continuation of a pregnancy when:
- They prevent sperm from reaching the fallopian tubes and thus prevent sperm from meeting the egg cell.
- Block the path of the fertilized egg from the fallopian tubes to the uterus or prevent embryo implantation
- They prevent good blood circulation in the uterus and therefore prevent the endometrium from developing properly
Does the presence of fibroids give particular symptoms?
Fibroids are rarely cancerous and are usually benign. They may be asymptomatic for some women, or they may have symptoms similar to PMS, endometriosis, or pelvic inflammatory disease.
Symptoms may include:
- Abdominal pain, especially if fibroids are pressing on other organs
- Excessive menstrual bleeding
- Bleeding at other times of the menstrual cycle
- Feeling bloated
- Swollen abdomen if fibroids are very large
- Need to urinate frequently
- Constipation
- Painful sexual intercourse
- Back pain.
There are risk factors that are represented by overweight and the presence of family members with fibroids.
If you have any of these symptoms or risk factors and have difficulty getting pregnant, it’s important to talk to your doctor.
How are they diagnosed?
Fibroids can be diagnosed in several ways:
- through a pelvic exam
- with an ultrasound
- with MRI, CT scans, or X-rays
What is the treatment for uterine fibroids?
Treatment varies based on how much they affect the woman’s overall health.
The best procedure for removing fibroids that are affecting fertility is a surgery called myomectomy. They can also be removed through a laparoscopy.
Another removal procedure is uterine artery embolization, with which the arterial supply to the fibroid is blocked, inducing its reduction. It is a minimally invasive procedure performed by an Interventional Radiologist, a doctor who has been specially trained to perform this and other minimally invasive procedures.
After these procedures and before more fibroids can grow, the woman has a better chance of conceiving naturally or through IVF.
Women who have heavy bleeding before surgery may also need to be treated for anemia before trying to become pregnant, to replenish their iron stores.
Sometimes a doctor may suggest that you have hormone treatment before surgery in order to control hormone production so the fibroids stop growing and are easier to remove. However, these hormones can cause menopause-like side effects, such as hot flashes, mood swings, lack of libido, weakening of bones and joints and headaches, but by inhibiting menstruation women can increase their iron stores and thus avoid the anemia.
Fibroids during pregnancy
Fibroids can grow more easily in pregnancy due to increased hormone levels, mainly in the first trimester when estrogen and progesterone are at very high levels. In most cases they do not cause any problems.
Occasionally fibroids may also shrink during pregnancy.
Fibroids can interfere with the normal course of pregnancy if:
- restrict blood flow to the uterus (in which case it can cause Natural Miscarriage )
- force the placenta to sit over the cervix (placenta previa) or force the placenta to leave too soon (placental abruption)
- prevent the uterus from contracting (stopping labor)
- force the baby into the breech position
If a baby is breech or there are problems with the placenta, a premature birth or caesarean section may be necessary.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.