Fibroids and Fertility

Fibroids are non-cancerous growths, typically found in the uterus. They are often detected during routine pelvic exams and are usually harmless. They vary not only in shape, but can vary dramatically in size. Some can be so small that they cannot be seen with the naked eye, while others can grow so large that they change the appearance of a person’s abdomen, making them look pregnant.

In and of themselves, fibroids do not typically cause infertility, but their presence can affect pregnancy, and occasionally cause medical complications with serious side effects. Let us dig deeper into this and highlight the symptoms to look out for, and more importantly, treatment options available.

What Are Fibroids?

Fibroids, sometimes known as leiomyomas, or myomas are growths that usually do not pose a threat to a person’s health. Some however, may cause complications that require medical intervention, ranging from surgery to hormone therapy, medications and ultrasound therapy.

Fibroids are generally categorized into three types:

• Intramural fibroids, which develop inside the muscle tissue of the uterine wall.
• Submucosal fibroids, which grow extending inward into the uterus.
• Subserosal fibroids, which grow extending outward of the uterus.

The latter, submucosal and subserosal fibroids, are classified as pedunculated, which describes the characteristic of their growth. In this case, they extend by a stalk on which the fibroid itself grows, into the uterus or the area surrounding the uterus.

Signs of Fibroids

Typically, fibroid growths are asymptomatic, and with their common occurrence, many people have fibroids and never know it. However, some fibroids may cause symptoms including: 

Irregularities in Periods

Unusually painful, or heavy periods, longer or more frequent periods could be caused by the presence of fibroids.

Pain

Pain or pressure in the pelvic region during sex, or pain in the abdomen and lower back region can be as a result of fibroids. Although rare, a fibroid can grow very large and then suddenly die, causing sudden and severe pain in the abdomen.

Difficulty with Bowel and Bladder Function

Fibroids can cause someone to have difficulties with bowel movements, due to frequent constipation. Sometimes, they may either urinate too frequently or have general difficulty in passing urine.

Physical Changes

As previously mentioned a fibroid can grow so big that it distorts the appearance of the abdomen.

Causes of Fibroids

It still remains unknown whether one specific factor leads to the development of fibroids, or whether it is a myriad of factors. What is known is that, when small growths in the uterus are exposed to estrogen, they can grow quite quickly, leading to an uncontrolled expansion of abnormal tissues.

This means that females of reproductive age have a higher likelihood of developing fibroids than those who are prepubescent or have gone through menopause. 

Johns Hopkins University suggests that factors related to genetics as well as lifestyle could contribute to the development of fibroids. Higher risks exist for those who have high blood pressure, obesity, consume a diet high in red meat, or whose family medical history includes fibroids.

Of note in this study is that women of colour seem to have a higher rate of fibroid development that more often requires treatment, but no research exists explaining why this is so.

How Fibroids Are Treated

The two main ways in which fibroids are treated is either with prescription medication or through surgical procedures. Most fibroids do not require any treatment, often going undetected for years having caused no issues.

Medical intervention may be required where pain, bleeding, or other concerning symptoms emerge. In a majority of cases this has not resulted in infertility as a side effect.

Nonsurgical Options

Medical advances have led to innovative medicine-based and hormone-based treatments for fibroids that enable patients to avoid surgery.

The development of new non-surgical treatment procedures - particularly for smaller fibroids, and those with milder symptoms - have also shown promise in treating fibroids.

Hormone-based Treatments

Hormone-based treatments using gonadotropin-releasing hormone agonists (GnRHa) medications have had positive results in shrinking fibroids and alleviating their symptoms. 

GnRHa medications reduce the levels of estrogen in the body, which is the hormone that generally ‘feeds’ the fibroids. Reduced estrogen has been observed to slow down and even reverse fibroid growth.

These treatments are intended for the short-term and are usually administered as a pre-surgical protocol, to increase the chances of success. Use in the long-term has serious and undesirable side effects. 

Medication-based Treatments

Medicine-based treatments are designed to address the symptoms of fibroids, the most common form being prescription oral contraceptive pills.

These typically work by reducing the size of the endometrium, which in turn reduces the excessive bleeding that many problematic fibroids cause.

Uterine Fibroid Embolization

In this procedure, the blood flow to the fibroid is blocked using a small catheter that is inserted close to the fibroid itself. This damages the fibroid and makes it shrink, at times as much as by 50 percent.

Ultrasound-based Treatment

In this treatment, the focused, high-energy sound waves of an ultrasound are used to destroy the fibroids without damaging the tissue in the surrounding area. In some cases, the fibroids are eradicated, but no research is currently available showing the long-term impact on fertility.

Surgery

Surgical procedures typically vary based on the size of the fibroids, and the age, health, and future family planning of the patient. Below are some of the surgical options available in the treatment of fibroid:

Hysteroscopic Myomectomy 

This procedure is short and can be performed as a one-day outpatient process. It is typically done when fibroids are small and problematic. 

A small camera, or hysteroscope, inserted into the uterus through the cervix is used to locate the fibroids, and then a small surgical instrument is used to cut or burn away the growth.

Laparoscopic Myomectomy

This procedure is similar to the hysteroscopic procedure, but usually used to treat  fibroids that are larger. It is also a one-day outpatient procedure.

If the fibroids are larger than heterotopic procedure allows,  incisions in the lower abdomen are made for the laparoscopic procedure, allowing for them to be removed easily. 

Full Hysterectomy

This procedure is done under some form of sedation - either general or local anesthesia - to prevent patient discomfort during the procedure. Of all the medical interventions used to treat fibroids, this procedure results in infertility because the full uterus is taken out of an individual’s body.

This means that there is no longer a place for the fibroids to develop. It also means that after a hysterectomy, a person will no longer have menstruation, nor will they ever become pregnant.

This procedure, due to its drastic effects, is usually done under very unique circumstances; where fibroids recur and present a debilitating issue, and at the same time, the individuals do not intend on having children in the future.

Summing It Up

Fibroids are growths in the uterus that are typically harmless, and are of no concern as far as cancer goes. Their presence however can cause other problems requiring medical intervention. 

Often detected during routine pelvic check ups, they can be managed under the guidance of a professional healthcare provider.

If you have any concerns regarding fibroids or require assistance in finding the best course of treatment for fibroid-related issues, Nevada Center For Reproductive Medicine offers a wide range of reproductive health services at our various locations across the country.

Frequently Asked Questions (FAQS)

Can Fibroids Affect My Pregnancy?

A majority of people with fibroids will not experience fibroid-related complications during pregnancy. Some complications may arise in the course of a pregnancy based on the size and number of fibroids in the uterus.

What Complications Can Arise from Fibroids in Pregnancy?

One study found that pregnant women, with untreated fibroids, faced higher risks of spontaneous miscarriage, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery and postpartum hemorrhage.

When Should I See a Doctor?

• When you experience a sudden onset of symptoms related to fibroids. 
• If already existing symptoms become disruptive to your daily life. 
• If you experience a sharp and sudden pain in your abdomen that is unresponsive to pain medication.
• If you experience severe vaginal bleeding accompanied by lightheadedness, fatigue, and weakness

Seek immediate emergency care as it could be indicative of severe complications relating to fibroids.