- Overview (jump to link): Uterine fibroids are abnormal growths of muscle cells and fibrous tissues that form a mass within the uterus, affecting about 70% of women of reproductive age.
- How fibroids can affect infertility: They can prevent the sperm and egg from meeting for fertilization, or afterward by disrupting embryo implantation in the uterus. They can also cause some complications during pregnancy.
- Fibroids & pregnancy: Although most women with fibroids do not experience complications during pregnancy, some women experience mild pain or bleeding during pregnancy.
- Causes: Fibroids are caused by genetic mutations in the uterine wall cells that result in unbridled growth, which is most often not cancerous and generally does not require treatment.
- Types: There are four types of fibroid growths, some of which can impact fertility treatment success.
- Symptoms: Fibroid symptoms are most often not present, but can include pressure in the pelvic area, some pain and abnormally heavy menstrual bleeding or bleeding between periods.
- Diagnosis: Fibroids are discovered through physical exam, imaging and minimally invasive procedures.
- Fibroid treatments: Uterine fibroids can require monitoring by our physicians, who may recommend treatments such as medications or surgery to reduce any risks of infertility or to address severe symptoms.
What are uterine fibroids, also called leiomyomas?
Fibroids, also called leiomyomas or myomas, are benign uterine growths in the muscle cells that in most cases do not require treatment. According to the American Society for Reproductive Medicine (ASRM), they are the most common tumor in the reproductive tract and affect about 70% of women of childbearing age.
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 (see below) are classified by where they occur. A woman may have one fibroid or several. The leiomyomas may grow suddenly or slowly.
Uterine fibroids are muscular tumors that are noncancerous. These tumors do not become cancerous. In rare cases, a uterine fibroid tumor may begin as cancerous, which is one reason that fibroids should be evaluated.
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Do fibroids affect infertility?
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 says 5%-10% of infertile women have fibroids.
Uterine fibroids may impact fertility because they can:
- 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.
Do 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. This is due to risks 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.
Causes and risk factors of fibroids
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.
- Consumption of food additives and soybean milk.
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)Following are the four types of fibroids.
Intramural fibroidsThese grow within the uterine wall and are the most common type. These can grow to be large, stretching the woman’s uterus.
Submucosal fibroidsThese 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 fibroidsGrowing on the outer uterine wall (the serosa), these can also become large and alter the shape of the uterus.
Pedunculated fibroidsThis is essentially a submucosal or subserosal fibroid that is attached via a stalk.
Uterine fibroid symptoms
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.
- 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).
Women trying to conceive who are experiencing an irregular menstrual cycle, excessive bleeding or other uterine fibroid symptoms (above) 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, and 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.
FINO offers both minimally invasive and robotic laparoscopy as a diagnostic and treatment options for fibroids.
Uterine fibroid treatment
Treatment options are decided on an individual basis. We will review these options with each person, taking into consideration pregnancy plans, age and the specifics of the fibroids and the extent of any symptoms. Generally, we only treat fibroids if they are causing severe symptoms, especially heavy or long menstrual periods, or impacting a woman’s fertility status.
FINO works with patients to determine the best course of treatment together, making a whole-body decision based on finances, emotion, biology and even spirituality.
For asymptomatic or minor symptoms, doctors will usually only monitor fibroids for growth instead of removing them. If the woman is 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.
Fibroid fertility surgery
For women starting fertility treatments, such as IVF, our fertility specialists may recommend removing any large or submucosal fibroids in order to decrease the chance of embryo implantation failure or later pregnancy complications. Intramural and subserosal fibroids are removed by laparoscopic resection or via an abdominal incision. Submucosal fibroids can many times be removed by hystersocopy.
Our doctors specialize in minimally invasive surgery options.
Surgery is the most common treatment for women experiencing severe symptoms. The woman’s plans for future pregnancy may dictate the surgical option she chooses:
This is the removal of fibroids (myomas) that leaves the uterus intact, thus making a future pregnancy possible. 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 similar to the laparoscopy for diagnosis 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.
This is surgical removal of the uterus and is only recommended for women who do not wish to have children in the future and are experiencing severe symptoms. A benefit of hysterectomy is that it is the only treatment that ensures the uterine fibroids do not form again.
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.