Uterine Fibroids

What Are Uterine Fibroids?

Fibroids, also called leiomyomas or myomas, are benign uterine growths in the muscle cells that, in most cases, do not require treatment.

Leiomyomas vary in size (from seed to soccer ball size), shape, and location, with some being inside the uterus, within the uterine wall, or outside the uterus. Sometimes they form in the cervix. Types of uterine fibroids are classified by where they occur. A woman may have one fibroid or several, and the leiomyomas may grow suddenly or slowly.

Uterine fibroids are muscular tumors that are noncancerous. These tumors typically do not become cancerous, but in rare cases, a uterine fibroid tumor may begin as cancerous. This is one of the reasons fibroids should be evaluated by a medical professional.

Can Fibroids Affect Fertility?

Though many women conceive naturally despite having fibroids, the tumor’s size, location, and other factors can affect conception. Submucosal fibroids (located inside the uterine cavity) or those that are larger than 2.3 inches in diameter have a higher likelihood of impeding conception. ASRM has estimated that 5%-10% of infertile women have fibroids.²

Uterine fibroids may impact fertility if they:

• Distort the cervix and uterus, negatively impacting egg movement for successful fertilization or embryo implantation in the uterus after fertilization.
• Block the fallopian tubes, which also causes similar issues of fertilization and embryo implantation.
• Create an unreceptive environment in the uterine lining, leading to a failed pregnancy.

Women who have, or suspect they have, uterine fibroids should consult with our fertility specialists to determine if the growths are hampering conception.

Can Fibroids Affect Pregnancy?

When it comes to uterine fibroids and women who are already pregnant, most doctors recommend only monitoring fibroids and not removing them, which could create a risk to the fetus.

Although most women with fibroids do not experience complications during pregnancy, up to a third of pregnant women do have abdominal pain accompanied by light vaginal bleeding. Most doctors will treat this with mild pain relievers, rest, or other minimal interventions to manage symptoms.

Depending on the severity of the fibroids, there may be additional risks. Studies show that these are rare and include fetal growth problems, fetal abnormalities, placental problems, and heavy bleeding after delivery.

Caesarean delivery (C-section) is more common among women who have fibroids. In some severe cases, they can also cause very preterm births. This is especially true if the fibroids rapidly increase in size after pregnancy begins.

Types of Fibroids

Where the uterine fibroid develops determines its type, and the type can have a bearing on the success of assisted reproductive treatments, like in vitro fertilization (IVF).

The types of fibroids women can experience include:

• Intramural fibroids: These grow within the uterine wall and are the most common type. These can grow to be large, stretching the woman’s uterus.
• Submucosal fibroids: These grow under the uterus lining and bulge out into the uterine cavity. Submucosal fibroids appear to have the greatest effect on all fertility treatment, including IVF, though they are also the most uncommon type.
• Subserosal fibroids: Growing on the outer uterine wall (the serosa), these can also become large and alter the shape of the uterus.
• Pedunculated fibroids: This is essentially a submucosal or subserosal fibroid that is attached via a stalk.

How Are Fibroids Diagnosed?

Women trying to conceive who are experiencing an irregular menstrual cycle, excessive bleeding, or other uterine fibroid symptoms should schedule an appointment with a fertility specialist for testing. The doctor can check the size and location of fibroids in a pelvic examination or transvaginal ultrasound, including a sonohysterogram that uses a saline solution to expand the uterus for better viewing during an ultrasound.

If a fibroid appears to be negatively impacting the endometrial cavity, our doctor can perform hysteroscopy, which uses a telescope-like instrument to view inside the uterine cavity. In some cases, the fibroids may be removed during this procedure.

Other diagnostic tests include a hysterosalpingogram, which is a type of X-ray evaluation, or a laparoscopy. This is a minimally invasive surgery with small incisions and a laparoscope that allows the doctor to look inside the abdominal cavity to find and evaluate fibroids.

Causes & Risk Factors

Tumors result from mutations inside the uterine wall cells that lead to unbridled growth. The mutation responsible for over 70% of fibroids is in the Mediator Complex Subunit 12 gene (MED12). Factors that increase the risk of developing fibroids include:

• Being of African ancestry
• Advanced age
• Having a family history of uterine fibroids
• The amount of time since last giving birth
• Hypertension
• Consumption of food additives and soybean milk

Symptoms of Uterine Fibroids

Many women don’t even realize they have uterine fibroids until they get an ultrasound, as they present few novel symptoms or physical signs.

When symptoms are present, they can include:

• Abnormally heavy or long menstrual cycles
• Clotting during menstruation
• Bleeding between periods and irregular periods
• Pain with deep penetration during intercourse
• Bladder irritability or overly frequent urination
• Frequent urinary tract infections
• Constipation
• Painful bowel movements
• Pelvic pressure or pain
• Lower back pain
• Leg pain
• Feeling of pressure or heaviness in the belly or rectum

Women who experience severe uterine fibroids that protrude into the uterine cavity can have additional complications. This protrusion can erode the endometrial lining and produce irregular or continuous bleeding (called abnormal uterine bleeding with intermenstrual bleeding).

How Are Uterine Fibroids Treated?

Treatment options for uterine fibroids are decided on an individual basis. We will review your options in-depth, taking into consideration your pregnancy plans, age, the specifics of the fibroids, and the extent of any symptoms. Generally, we only treat fibroids if they are causing severe symptoms or impacting a woman’s fertility status.

Fibroid Management

For asymptomatic or minor symptoms, doctors will usually only monitor fibroids for growth instead of removing them. If you are not planning on getting pregnant, hormonal birth control can help regulate symptoms. Gonadotropin-releasing hormone agonists may be given to reduce the size of fibroids.

Fertility Surgery

For women starting fertility treatments, such as IVF, our fertility specialists may recommend removing any large or submucosal fibroids to decrease the chance of embryo implantation failure or pregnancy complications. Intramural and subserosal fibroids are removed by laparoscopic resection or via an abdominal incision. Submucosal fibroids can often be removed by hysteroscopy.

To remove the fibroids, our doctors specialize in minimally invasive surgery options, including:

• Myomectomy: Removal of fibroids (myomas) that leave the uterus intact. Myomectomy can be performed hysteroscopically or as a laparotomy, using a large incision. Our surgeons can also perform a laparoscopic myomectomy, which is a minimally invasive approach that utilizes small incisions, a viewing scope and special instruments to remove or destroy the fibroid. We can also perform the laparoscopic myomectomy with a robotic surgical system.

Fertility Surgery

Treatment Risks

We discuss with women and their partners all treatment options and their specific risks before deciding with them on any procedure. Risks depend on the treatment selected. Keep in mind that any surgery carries similar risks, such as pain, bleeding, tissue damage, infection, and reactions to anesthesia. Medication risks include allergic reactions.