Fibroids and Fertility

A number of conditions can affect a woman’s reproductive system and in turn their fertility. One of these conditions is uterine fibroids. In this article, we will look at all you need to know about uterine fibroids, including what they are, symptoms to look out for, and how they can affect fertility.

Key Takeaways

• Fibroids are generally harmless, noncancerous growths that occur in the uterus.
• These growths can vary dramatically in size, with some remaining too small to see with the naked eye and others growing so large they change the shape of the abdomen and are visible from outside the body.
• While most fibroids do not require medical intervention, some may cause complications that require treatment options ranging from surgery to hormone therapy and ultrasound therapy.

What Are Uterine Fibroids?

Uterine fibroids, also known as leiomyomas (or myomas in short) are non-cancerous growths made out of tissue and muscle that form on the wall of your uterus. They are usually harmless and account for the most common uterine tumors in assigned females at birth (AFAB). Fibroids can grow as a single fibroid or in a cluster and can range in size. 

Fibroids often occur in individuals between the ages of 30 and 50, though there are women below this age range who have been diagnosed with fibroids. Approximately 40% to 80% of AFABs have fibroids. They occur most often in people between 30 and 50 years old. People who haven’t had their first period (menstruation) yet typically don’t have fibroids. They’re also less common in people who’ve entered menopause.

Types of Uterine Fibroids

Fibroids are classified based on where they’re located and how they attach to the sides of the uterus. 

• Subserosal fibroids: These fibroids grow under the lining of the outer surface of your uterus and can grow into your pelvis. They also have the potential to become large.  
• Pedunculated fibroids: These fibroids look like mushrooms and attach to your uterus (typically outside) using a stalk or stem. They can also extend to other surrounding areas.
• Intramural fibroids: These are the most commonly seen fibroids and they attach themselves inside the muscular wall of your uterus. 
• Submucosal fibroids: These fibroids grow under the inner lining of your uterus.

Although uterine fibroids are benign or non-cancerous, some fibroids lead to medical complications with the potential for serious side effects. In rare cases, a fibroid can grow too large and suddenly die, causing sudden severe pain in the abdomen.

Symptoms of Fibroids

Fibroids come in different sizes and while some are quite large, others are too small to be seen by the naked eye. In fact, many people can have fibroids without knowing because they can be asymptomatic. 

Common symptoms include:

• Heavy or unusually painful periods
• Longer and more frequent periods
• Urinating too frequently or with difficulty
• Growth or distortion of the stomach region
• Pain during sex or generally in the stomach and lower back region
• Pressure or pain in the pelvic region
• Constipation

Causes of Fibroids

There’s no one root cause of fibroids but certain factors put you at risk. According to Johns Hopkins University, some genetic and lifestyle factors can increase the chances of fibroid development. Additionally, women who are of reproductive age are more at risk of developing fibroids than prepubescent individuals or those who have gone through menopause. 

Other risk factors can be:

• High blood pressure
• A family history of fibroids
• Obesity
• A diet high in red meat

How Are Fibroids Treated

Because they are asymptomatic and can go undetected, most fibroids do not require treatment. When there’s pain, bleeding, or other concerning symptoms, medical intervention may be necessary. But, before choosing an appropriate treatment option, your doctor will conduct a pelvic exam or use an imaging test like an ultrasound, X-ray, MRI, or CT scan to diagnose uterine fibroids. 

Your doctor may decide to do nothing if your fibroids have little to no symptoms, but if there are symptoms, your doctor will explore different treatment options based on the size and locality of the fibroids. Let’s look at these options. 

Medication

Fibroids can be maintained or successfully treated only with medication. Some medications given include:

• Pain relievers: These are given to those with mild symptoms that require managing. 
• Iron supplements: Iron supplements are given to those who experience heavy bleeding during their period. This is given to prevent or correct anemia.
• Birth control: In some cases, your healthcare provider will prescribe birth control pills, injections, or IUDs with progesterone. This can prevent the fibroids from growing and heavy bleeding.
• Gonadotropin-releasing hormone agonists (GnRHa): These drugs are given to shrink the fibroids and offer some relief. These drugs come in the form of nasal sprays and injections. 

Uterine Fibroid Embolization

In recent years, medical advances have uncovered a variety of treatments for fibroids that do not require surgery. One such procedure is uterine fibroid embolization. In this procedure, a small catheter is inserted close to the fibroid and used to block blood flow to the fibroid. This stunts the growth of the fibroid and causes it to shrink by as much as 50 percent.

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.

Can Fibroids Affect My Fertility and Pregnancy?

Yes, fibroids can cause complications when it comes to fertility and pregnancy. but some complications can arise throughout a pregnancy depending on the size and quantity of fibroids within the uterus. 

A 2010 study found evidence that shows an increased likelihood of the following conditions in pregnant women who have untreated fibroids:

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

Nevertheless, the majority of people with fibroids will not experience complications related to these growths during pregnancy and go on to naturally conceive and successfully carry a pregnancy to birth. If you suspect that your fibroids may be causing infertility, the compassionate healthcare providers at Ivy Fertility will perform the necessary tests and walk you through your infertility journey. 

Bottom line

Fibroids are a common condition among 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