Uterine fibroids are abnormal growths that consist of muscle cells and fibrous tissues that form a mass within the uterus. According to the National Institutes of Health, 70 to 80 percent of women will have fibroids by the age of 50 and between 20 to 50 percent of women of childbearing age have fibroids. The good news is that fibroids are benign (non-cancerous) uterine growths and in most cases, do not require treatment.
Fibroids and Fertility
The size and location of a fibroid determines whether it will affect your fertility. There are four types of fibroids, intramural (that grow within the uterine wall), submucosal (that grow under the lining of the uterine cavity), subserosal (that grow on the outer uterine wall) and pedunculated (that grow on a stalk either inside or outside of the uterus).
Although intramural fibroids, subserosal, and pedunculated fibroids may cause pain and discomfort, they generally do not affect fertility. However, if a fibroid is inside the uterine cavity (submucosal) or is larger than 6 cm in diameter, then it may impede conception by up to 70%. The following are ways that uterine fibroids may impact fertility:
- They can change the shape of the cervix affecting how many sperm can enter the uterus.
- They can change the shape of the uterus interfering with the movement of the sperm or embryo.
- They can block fallopian tubes.
- They can impact the size of the lining of the uterine cavity.
- They can affect the amount blood flow to the uterine cavity thereby decreasing the ability of an embryo to implant itself to the uterine wall or develop.
Most women with fibroids will not be infertile however, it is best to consult with a fertility specialist to determine if your fibroids are hampering your ability to conceive.
Fibroids and Pregnancy
Because pregnancy increases the production of estrogen there may be accelerated fibroid growth. Although most women with fibroids do not experience complications during pregnancy, 10 to 30 percent of pregnant women do have abdominal pain accompanied by light vaginal bleeding. Most studies show that fibroids do not affect the risk of premature delivery, fetal growth problems, fetal abnormalities, placental problems, or heavy bleeding after delivery. However, the need for caesarean section is more common among women who have fibroids.
Symptoms and Diagnosis
Although some fibroids occur without any symptoms, common symptoms of fibroids include heavy bleeding and pain during a woman’s menstrual cycle, pain with deep penetration during intercourse, bladder irritability, rectal pressure, constipation and painful bowel movements.
If a fibroid protrudes into the uterine cavity, it may cause an erosion of the endometrial lining and produce irregular or continuous bleeding (menomettrorhagia). If you are trying to conceive and are experiencing an irregular menstrual cycle or excessive bleeding, you should schedule an appointment with one of our doctors at the Fertility Institute so that we can help ensure your healthy delivery. We can easily identify a large fibroid by a simple bi-manual vaginal examination or transvaginal ultrasound. Furthermore, if a fibroid appears to be impinging on the endometrial cavity, we can insert a hysteroscopy (a telescope like instrument) into your uterine cavity to determine whether the fibroid is intramural and submucosal.
Treatment of Fibroid Tumors
Generally, fibroids are only treated if they are causing pelvic pain, bleeding or heavy or uncomfortable menstrual periods. Small, asymptomatic fibroids are generally monitored for growth instead of removing them. If you are starting fertility treatments such as In Vitro Fertilization (IVF), your doctor may recommend removing any large fibroids or submucosal fibroids in order to decrease the chance of implantation failure, miscarriage, pregnancy complications or premature labor. Intramural and subserosal fibroids are removed by laparoscopic resection or via an abdominal incision.