Uterine fibroids are quite common among women in the reproductive age group. Many uterine fibroids are asymptomatic and are only an incidental finding during an ultrasound scan of the uterus. Can these fibroids affect her fertility? How can she manage these fibroids-related fertility issues? Come, let's find out.
Fibroids are harmless tumours that grow in the muscular layer of the uterus. They are also known as Myomas or Leiomyomas. They are a collection of muscle tissue that is usually benign—meaning non-cancerous, although, some fibroids can be cancerous too (<1%).
They can either be present within the myometrial tissue of the uterus or can be connected by a stalk to the uterus. In rare cases, these fibroids can be found outside in the pelvic cavity attached to the nearby ligaments or organs.
The size and number of fibroids can vary from woman to woman. Some women can have just one big-sized fibroid, while some can have many small-sized fibroids. The location of these fibroids also varies. Sometimes, these fibroids can grow big enough to fill up the pelvic cavity causing pressure symptoms on bladder, ureter, rectum and intestines. They can extend even up to the abdominal cavity if neglected.
Fibroids are usually found in different parts of the uterus and sometimes in the cervix. The most common types of uterine fibroids are:
● Subserosal – Growing outside the uterine wall into the pelvis
● Intramural – The most common type of fibroid, growing in the muscle wall of the uterus
● Submucosal - Growing in the muscle layer under the uterus's inner lining and into the uterine cavity
● Pedunculated – The least common type, attached to the uterine wall by a stalk or stem.
The exact cause for fibroids formation is unclear. Some studies show that it could be a combination of imbalance in the estrogen & progesterone hormones in the body, may run in the families suggesting genetic cause or could be because of environmental factors surrounding the woman. It is not possible to predict if or when a woman can develop uterine fibroids. Hence, it is not preventable either. Routine tests can help identify fibroids as soon as possible.
Fibroids commonly present with dysmenorrhea (painful menstrual cycles), heavy menstrual bleeding, painful sexual intercourse. When they cause pressure on the urinary bladder or ureter they can present with pain in the flanks, repeated urinary tract infection, increased frequency or difficult & painful urination depending on the location of the fibroid. If they are causing pressure on the rectum or intestines they can present with constipation. Most of the time it is just an incidental finding when a woman comes for routine checkup to her Gynaecologist or when she visits a fertility consultant for infertility issues.
Fibroid location and size play a major role in its impact on the woman’s fertility. While some small fibroids are harmless and may not impact fertility, some can. Fibroids that are very large or inside the uterine cavity are more likely to affect the woman's fertility.
1. Cervix – Fibroids in the cervix can distort the shape. This, in turn, can affect the sperm's entry into the uterus.
2. Block Fallopian Tubes—Fibroids in the fallopian tubes can block the passage of sperm to the uterus, thus affecting fertilisation. They can prevent the sperm from going up to the egg or prevent the egg from travelling down the fallopian tube. Either way, fertilisation will be affected.
3. Impact Uterine Cavity—Submucosal fibroids can impact the size of the uterine cavity lining. It can distort the shape of the uterus, compromise the blood flow to the embryo, alter the estrogen-progesterone receptors, alter the uterine contractility, decrease the space for growing fetus, can cause premature separation of the placenta leading to miscarriages.
Many women can have a successful pregnancy despite their uterine fibroids. In most cases, the fibroids will not interfere with the pregnancy. In some cases, the fibroids can grow as pregnancy progresses (due to the increase in estrogen). It can result in the following:
● Compromise the blood supply to the fibroid, which may result in miscarriage
● Interfere with the baby's development causing low birth weight or small for gestational age babies
● Impact the baby's position and also lead to a breech position
● Cause difficulties during labour by interfering with the contractions of the uterus
● Block the vagina or cervix and result in a caesarean section
● Increases the incidence of C-section delivery
● Increase the risk of placental abruption
● Increase the chances of a preterm delivery.
Getting pregnant with fibroids is not so complicated for most women. If you have fibroids before you start trying to conceive, you can consult a gynaecologist and identify the best monitoring plan to keep a watch on the fibroids.
If you have large fibroids or fibroids in the uterine cavity, your doctor can help you identify the right treatment option to monitor the fibroid and prevent it from impacting fertility.
Treatment for uterine fibroids depends on multiple factors, such as the size, location, and number of fibroids and symptoms (pain, bleeding, etc.). If there are no symptoms, the doctor will not unnecessarily touch the fibroids. Big or small, some fibroids do not cause any symptoms or complications.
If there are no symptoms, the doctor will wait and watch. They will closely monitor the fibroids through regular tests or scans to ensure they are not growing or causing any issues.
Pregnancy releases hormones (estrogen), which can also cause the fibroids to grow in size. If the fibroids grow in size as pregnancy progresses, it increases the chances of risks and complications.
When uterine fibroids cause severe pain, menorrhagia or infertility, surgery might be the only option. The type of surgery depends on multiple factors, including future pregnancy plans. Certain kinds of Myomectomy (fibroid surgery) can remove the fibroids while preserving the uterus. In some surgeries, damage to or removal of the uterus may be unavoidable. In such cases, you can consult your doctor about freezing your eggs to use at a later date, through surrogacy.
One can choose from the types of fibroid surgeries: hysterectomy, laparotomy or laparoscopic myomectomy. Discuss the pros and cons of each surgery and choose the most suitable option for you. Ensure you let your doctor know about your pregnancy plans and clarify all your doubts before selecting a procedure.
Uterine fibroids are common and may not cause any harm. Some fibroids can resolve on their own after menopause, while some may require treatment. With the right treatment plan and close monitoring, successful pregnancies despite uterine fibroids are possible.
