Fibroids, Tumors in the Uterus Fertility and Infertility

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Andrea Fernando

By Andrea Fernando

What are fibroids?

Fibroids are non-cancerous growths of the muscle wall of your uterus. They can sometimes grow large enough that they alter the shape or size of your uterus or cervix. They are often ball shaped and usually develop in multiple tumors rather than a single fibroid. They are also known as leiomyomas, meaning 'smooth muscle tumor'.

Who gets them?

Studies have shown up to 80% of women in their reproductive years have uterine fibroids, so they are completely normal to have. There is a higher risk of having fibroids if you are overweight, in your 40s or of African-American descent. There is a strong genetic component to fibroid development; if a family member has fibroids you are more likely to have them too.

Can fibroids turn into cancer?

Fibroids are tumors, however they are non-cancerous tumors (benign). Only 0.1% of uterine fibroids become cancerous (malignant).

How do I know if I have fibroids?

Most fibroids are found after a routine pap smear showing an enlarged uterus. Some women have increasingly heavy periods, or can feel a lump in their abdomen, but most cases of fibroids are completely asymptomatic. If you notice a heavier period than usual or any sort of mass in your stomach, see your doctor. An ultrasound will then confirm the presence of fibroids and determine the course of action.

Fibroids Impact Fertility

How do fibroids affect my chances of getting pregnant?

Most fibroids do not have any effect on fertility. Less than 5% of all infertility cases are due to fibroids, and most types of fibroids do not affect uterine structure at all. Submucosal fibroids (directly under the inner most layer of uterine wall) are the most likely to cause infertility and miscarriage. This is mostly due to obstruction of the flow of sperm by the fibroid narrowing the uterine canal or fallopian tube.

How do fibroids affect pregnancy?

Firstly, around 10% of all pregnant women have fibroids, so they are very common and often have no affect on your baby's health. Some fibroids can grow in size during pregnancy due to altered hormone levels, and this may affect the baby's position, causing miscarriage or preterm birth.

How are they usually treated?

As most fibroids are completely asymptomatic they are often left untreated. If symptoms such as excessive menstrual bleeding or severe abdominal pain develop, medications that reduce the amount of hormones that cause bleeding and cramps can be prescribed by your doctor. These medications are, however, only for symptomatic relief and lower your chances of getting pregnant.

The only permanent treatment for fibroids is a hysterectomy (removal of the uterus). This is usually only undertaken by women who no longer wish to have children and who suffer from severe symptoms.

Myomectomy (myoma - muscle tumour, ectomy - removal), involves the removal of fibroids from the uterus. It is the preferred surgical treatment for women with symptomatic fibroids who don't want their uterus removed.

I have been diagnosed with fibroids, will I need a myomectomy?

Most fibroids are harmless and other than some slightly heavier periods will not affect your health at all. The symptoms of these fibroids can be treated with hormones and medications to stop the pain.

If you have been menstruating excessively, have severe abdominal pain or are finding it difficult to conceive due to fibroids, you may be a candidate for myomectomy.

What is the surgery like?

There are three types of myomectomy performed for fibroids. The type used depends on the size, number and location of the fibroids.

What is the recovery time like?

This depends on the type of surgery undertaken.

Are there any complications?

All surgeries have some complications.

Is there any reason I wouldn't be able to have a myomectomy?

There are a few contraindications to women having myomectomies. Firstly, myomectomies are generally avoided if you are pregnant. Some surgeons may be able to perform the procedure but this varies by a case-to-case basis. Any kind of active infection may prevent the surgery, especially pelvic or urinary tract infections. Most doctors will also want to rule out the chance of having uterine or cervical cancer before performing the procedure.

Will the surgery remove fibroids permanently?

The procedures will remove most of the fibroids, with laparotomy being the most effective at removing the entire tumor. There is a significant recurrence of fibroids following surgery. Studies have varying opinions on the rate of recurrence, and this varies person-to-person and depending on the type of removal used.

Keep in mind that fibroids are common in women of reproductive age, and though you may get fibroids again, they may not cause you any symptoms.

If you're still unsure about the surgery types, their risks and methods, have a look at the summary table below.

  Hysteroscopy Laparoscopy Laparotomy
Method Insertion of a tool through vagina into uterus Small cuts in stomach Large cut in stomach
Fibroid size Small Small-medium Large
Fibroid location Inner wall of uterus Outer wall of uterus Deep inside uterus wall
Fibroid number 1-3 1-2 Numerous
Contraindications Pelvic infection, uterine cancer, pregnancy
Hospital stay Outpatient Outpatient 1-4 days
Recovery time 1-2 weeks 1-2 weeks 4-6 weeks
Rate of fibroid recurrence 20% 33% 15%

I'm infertile because of uterine fibroids, what now?

A surgical procedure known as a myomectomy is recommended for infertile women. This involves removal of the fibroid through a small incision in the abdomen. Myomectomies can both promote fertility and also increase the chance of a successful pregnancy outcome. Some surgical risks exist, such as fever, bleeding infection and organ injury, but these are generally minor. Some clinical trials are in place for newer procedures such as uterine artery embolization, which involves cutting off the blood supply to the fibroid causing it to die. This procedure can however affect infertility so is not a worthwhile option for all women.

How can I prevent them?

There has been no proven method to prevent the development of fibroids. However, some studies have shown that women who exercise regularly are less likely to have fibroids. If you have concerns about your risk of fibroids, especially if you lead a sedentary lifestyle, try exercising more often.

Should I be worried about them affecting my chances of getting pregnant?

The bottom line is, no. Fibroids usually have little impact on the normal day-to-day function of your uterus, even in pregnancy. If you are finding it difficult to get pregnant and are having symptoms of fibroids (heavy periods, abdominal pain or the presence of risk factors as mentioned above), see your doctor.

References:
1. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Iverson RE Jr, Chelmow D, Strohbehn K, Waldman L, Evantash EG Obstet Gynecol. 1996;88(3):415.
2. Second look after laparoscopic myomectomy. Dubuisson JB1, Fauconnier A, Chapron C, Kreiker G, Norgaard C. Hum Reprod. 1998 Aug;13(8):2102-6.
3. Explained compared with unexplained fever in postoperative myomectomy and hysterectomy patients. Rybak EA, Polotsky AJ, Woreta T, Hailpern SM, Bristow RE Obstet Gynecol. 2008;111(5):1137.
4. Laparoscopic versus open myomectomy - a meta-analysis of randomized controlled trials. Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, Chen FD, Gu HZ Eur J Obstet Gynecol Reprod Biol. 2009;145(1):14.
Do you know if you have fibroids? Got a question or want to leave a comment? Please leave one below.

New Join the Discussion!

  1. SParkle Dec 02, 2016
    I have had these fibroids for some time now and have been trying to get pregnant for 4 years and nothing is happening. I've tried the natural method, but still no hope. I have given up now. I hate to go out because everywhere I look, I see happy mothers and it's destroying me inside and out. Sometimes, I just want to end my life because there is no point of living. Age is not on my side now. I'm stressed and confused.
    1. Christina (OC Team): I'm so sorry you're feeling this way. It would be best to talk your feelings through with an experienced counselor. Wishing you all the best! - (Dec 03, 2016)
    Reply
  2. Esther Dec 06, 2016
    @SParkle so sorry you are feeling this way. But don't loose hope. Have you gone to see a doctor to discuss this issue? I am sure there will be a solution. Wishing you all the best. And baby dust soon. With God, all things are possible.
    Reply
  3. Soyna Dec 26, 2016
    Just wondering if you get the depo shot, will it stop the growth and cut blood supply for the fibroid?
    1. Katie: Hi, I had to have 3.6mg of Zoladex for 6 weeks. This was 2 weeks before I had fibroids removed to stem blood flow. - (Dec 27, 2016)
    Reply
  4. Gloase Jan 13, 2017
    In March 2016, I went to see my gynecologist and he asked me to do a pelvic scan. The scan showed a submucosa myoma that might be calcified. My gynecologist said the size was nothing to be worried about and would not affect my TTC, but I should start making plans on conceiving early in my marriage. In Dec, I noticed heavy white milky CM and AF came 4 days early. On CD2, I passed out. What I think might have been the fibroid, is small and hard like a bone. I wish I could post pic of it. This is just to encourage someone out there to be hopeful. I wasn't on any treatment for the myoma, but God cleansed it out naturally.
    Reply
  5. Erica Jan 28, 2017
    I had an open myomectomy in May, 2016, and I started TTC this month. Hopefully, I've become more fertile. Fingers crossed!
    Reply

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