Fibroids and Fertility

Uterine fibroids are a common noncancerous tumor that grows in or on your uterus. Fibroids affect women differently and in some, they don’t show symptoms. When they do, symptoms can include heavy menstrual bleeding, back pain, frequent urination, and pain during sex. Fibroids can affect fertility in women differently. 

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?

Uterine fibroids, also called uterine myomas, are non-cancerous tumors that grow in or on the uterus. They also range in size- some being almost undetectable while others can grow into large masses. Some women have a single fibroid, while others present with multiple ones. 

Fibroids can appear in different locations on the uterus. They can directly attach to the uterine wall or connect to the uterus by a stalk. They can also be attached to ligaments or organs around the uterus. Fibroids affect around 20% to 80% of women by the age of 50 and many women only discover they have fibroids during their childbearing years. 

Types of Uterine Fibroids

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

• Intramural fibroids. These develop inside the muscular wall of the uterus. They are the most common fibroids. In extreme cases, they can expand and stretch your uterus.
• Subserosal fibroids. This fibroid is based on the exterior of the uterus also known as the serosa. It can grow large enough to make one side of your uterus appear bigger than the other. They can also grow into the pelvis and expand.  
• Submucosal fibroids. These fibroids are quite rare. They form in the myometrium, the uterus’s middle muscular layer.
• Pedunculated fibroids: A pedunculated fibroid attaches to the wall of the uterus with a stem, giving it a mushroom look. Though it attaches to the outside of the uterus, it can extend to other areas. 
• Cervical fibroids. Though quite rare, cervical fibroids form on the cervix. The cervix is found at the opening of the uterus, right at the top of the vagina.
  

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

What Causes Fibroids?

According to Johns Hopkins University, fibroids develop from abnormal muscle cells in the uterus that multiply rapidly when they are affected by estrogen hormone. Some research has also shown that genetics, negative lifestyle choices, and obesity can be risk factors. 

Symptoms of Fibroids

You can go your whole life without knowing you have a fibroid. Nevertheless, some women do show symptoms like: 

• Heavy and painful periods
• Pain during intercourse
• Bleeding in-between periods
• Longer periods
• Anemia
• Frequent urination or difficulty emptying the bladder
• Constipation 
• Shorter menstrual cycles
• Lower back pain
• Infertility 
• Complications during pregnancy
  

How do Fibroids Affect Fertility?

Some types of fibroids, like those that bulge at the center of the uterus can impact your fertility. In some cases, the only possible treatment is removing the fibroids. Even if the surgery spares the uterus, there could still be scarring that can affect fertility. When this happens, fertility treatments like in vitro fertilization (IVF) will be needed to aid in conception. If you have fibroids and are having trouble getting pregnant, the compassionate healthcare providers at Ivy Fertility will be able to rule out any other causes of infertility and offer assisted reproductive treatment options should you still desire to conceive. 

How Are Fibroids Treated

Since they may be too small to even be detected, most fibroids do not require any treatment. When symptoms show, it may be time to seek medical support. Your treatment options depend on the location, size, and type of fibroid you have. 

According to a 2010 study, untreated fibroids can cause: 

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

Medication

Fibroids can be maintained successfully with medication like:

• Contraceptives: Studies have shown that contraception has an impact on uterine fibroids. 
• Iron supplements: Iron supplements are given to those who bleed heavily because of the fibroids. They help to prevent or correct anemia.
• Gonadotropin-releasing hormone agonists (GnRHa): GnRHa drugs are given to patients to shrink the fibroids. They come in the form of nasal sprays and injections. 
  

Surgery

Surgery is used when the fibroid needs to be removed. There are three main surgeries done to remove fibroids. 

Hysteroscopic myomectomy

A hysteroscopic myomectomy is a surgical procedure 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 for cutting or burning the fibroid. A myomectomy is used to deal with small problematic fibroids. This procedure is a great one because it removes the fibroids but can leave the uterus intact. However, a myomectomy can affect the muscular layer of the uterus depending on the location of the fibroid. This may raise the risk of uterine rupture during pregnancy. Following a myomectomy, some doctors recommend a C-section as a birth plan. 

Radiofrequency ablation (RFA)

RFA is a minimally invasive procedure where heat generated by radiofrequency energy is used to eliminate the fibroids. Small incisions are made in the abdomen, vagina, or cervix, and specialized needles are then used to heat and destroy the fibroid tissue. This treatment preserves the uterus and can be done as an outpatient procedure. It also has a relatively quick recovery time. 

Full Hysterectomy

A full hysterectomy is a great solution for recurring fibroids. The entire uterus is removed which eliminates the potential of fibroids coming back. This procedure is for those who don’t intend to get pregnant. 

Uterine Fibroid Embolization

Uterine Fibroid Embolization is also a minimally invasive medical procedure where a small catheter is inserted close to the fibroid, and tiny particles (embolic agents) are injected that 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. This non-surgical option has a shorter recovery time compared to surgery.

Bottom line

Many women with fibroids still go on and have safe and healthy pregnancies. Nevertheless, some fibroids grow during pregnancy, leading to a higher risk of premature delivery or pregnancy loss. Your doctor will be able to monitor and manage your fibroid symptoms to help reduce the risk of complications for you and your baby.