Fibroids and Fertility

Key Takeaways

• Fibroids are common, non-cancerous growths of muscle that form in the uterus.
• These growths can vary dramatically in size
• Most women with fibroids have normal fertility and pregnancy outcomes
• Fibroids occur in up to 70% of women by the time they are 50 years old.
• Fibroids don’t always show symptoms or need treatment.

What Are Fibroids?

Fibroids, also known as myomas or leiomyomas are benign (noncancerous) tumors that grow in or on the uterus. They can directly attach to the uterine wall or be connected to the uterus by a stalk. They can also be attached to ligaments or organs around the uterus. Fibroids affect around 70% of women of reproductive age mostly women between the ages of 30 and 50. 

Types of Uterine Fibroids

There are four main types of fibroids, categorized based on where they are located and how they attach themselves.

• Intramural fibroids- Most common fibroids, usually found inside the muscular wall of your uterus. 
• Subserosal fibroids-Fibroids that grow under the lining of the outer surface of the uterus. They can also grow into the pelvis and can grow really large.  
• Submucosal fibroids- They grow under the inner lining of the uterus.
• Pedunculated fibroids- Look like mushrooms and attach to the outside of the uterus and can extend to other areas. They attach with a stalk or stem. 

Though they can be harmless, some fibroids can lead to medical complications with the potential for serious side effects. 

What Causes Fibroids?

According to Johns Hopkins University, fibroids develop from abnormal muscle cells in the uterus and multiply rapidly when they are affected by estrogen hormone. Genetics, obesity, and negative lifestyle choices can increase the chances of fibroid development. 

Symptoms of Fibroids

While some women can have fibroids without showing any symptoms, some women with uterine fibroids can experience symptoms like the following:

• Heavy and painful periods
• Bleeding in-between periods
• Longer periods
• Pain during intercourse
• Shorter cycles
• Anemia
• Lower back pain
• Frequent urination
• Infertility or recurrent pregnancy loss

Many women go through their entire lives without knowing they have fibroids due to the fact that some fibroids are too small to be seen.

How Are Fibroids Treated

Most fibroids do not require any treatment because they are too small or don’t show any symptoms. However, when symptoms show, it may be time to seek medical support. Doctors determine your treatment options based on the type of fibroid you have. Different options are available to those who need help dealing with fibroids. 

Drug Protocols

Fibroids can be maintained successfully with medication. Medications given are again determined by the location ad extent to which the fibroid is affecting one’s day to day life. 

Some medications given include:

• Contraceptives: Studies have shown that contraception has an impact on uterine fibroids. Fibroids rely on hormones to grow and as such, contraceptives like birth control pills, injections, or IUDs with progesterone can be given to regulate bleeding.
• Iron supplements: Iron supplements are given to complement other treatment options, particularly for those who bleed heavily as a result of the fibroids. Iron supplements are given to prevent or correct anemia.
• Gonadotropin-releasing hormone agonists (GnRHa): Fibroids can be shrunk, and this is what GnRHa drugs are for. They come in the form of nasal sprays and injections. 

Surgery

Surgery becomes an option when the fibroids are problematic. 

• Hysteroscopic myomectomy: This surgical procedure is usually for small problematic fibroids. It’s done using a hysteroscope, or small camera, that’s inserted into the uterus through the cervix and used to locate the fibroids. A small surgical instrument is then inserted to be used to cut or burn away the growth. This procedure removes the fibroids but leaves the uterus intact. 
• Radiofrequency ablation: In this procedure, small incisions are made in the abdomen, vagina, or cervix. After, specialized needles are then used to heat and destroy the fibroid tissue.
• Uterine artery embolization (UAE): UAE involves using tiny particles injected into the blood vessels leading to the uterus. This cuts off blood flow, causing the fibroids to shrink.
• Full Hysterectomy: This procedure is for those who don’t intend to have children or who have recurring fibroids. Here, the entire uterus is removed, preventing future uterine fibroids and pregnancies.

Uterine Fibroid Embolization

Medical interventions have evolved, resulting in better options like uterine fibroid embolization. With UFE, a small catheter is inserted close to the fibroid and used to block blood flow to the fibroid. This not only shrinks up the fibroid to almost half its size but also ensures the fibroid doesn’t continue to grow.

How do Fibroids Affect Fertility?

Fibroids can affect your fertility. As fibroids grow, they can cause complications in fertility and pregnancy. In severe cases, only surgical interventions can treat the fibroids, and this can cause scarring which can affect fertility.

According to a 2010 study, when fibroids go untreated fibroids they can result in: 

• Fallopian tube blockage
• Spontaneous miscarriage
• Preterm labor
• Placenta abruption
• Malpresentation
• Labor dystocia
• Increased chances of cesarean delivery
• Postpartum hemorrhage

Many people with fibroids rarely experience any complications, and even more so when trying to conceive and go on to conceive naturally and carry a pregnancy to birth. For women struggling to conceive, the compassionate healthcare providers at Ivy Fertility will be able to determine if fibroids are the issue by doing the necessary tests and walking you through your infertility journey. 

Bottom line

Fibroids are a common condition that affects many women and can become a significant problem to the point of affecting fertility and pregnancy. When you experience any symptoms of fibroids or if symptoms become disruptive to your everyday life, talk to a doctor. They will be able to assess, test, and prescribe the appropriate next steps for treatment.

Uterine fibroids are common and can affect fertility in many ways. They can affect whether sperm and egg meet, whether an embryo can implant in the uterus, whether a pregnancy can continue, and can also affect the growth and positioning of the baby.

Treatment is decided on a case-by-case basis. It is based on the symptoms of fibroids and may improve overall fertility. How and whether you treat your fibroids depends on the severity of your symptoms and your doctor’s recommendations.