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Fibroids and fertility

All you need to know

Uterine fibroids are the most common, non-cancerous growths found in women of reproductive age with 2 in 3 women having developed them at some point in their lives. 1

While being diagnosed with fibroids can make you feel concerned, their impact on fertility depends on different factors like their size, how many of them there are and where they are located.

This article explains the uterine fibroids and its effects on fertility, common symptoms, and available treatment options to help you make informed decisions about your fertility and pregnancy.

What are fibroids?

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in or on the womb during a woman's reproductive years. 2

They are made of muscle and fibrous tissue, and their size and quantity can vary significantly among different women. Some fibroids can be as small as a seed, while others can grow into large masses that can affect the shape and size of the womb.

Three types of fibroids

There are three types of fibroids and they are distinguished based on their location. These are:

Intramural fibroids:
These most common fibroids develop within the wall of the womb, known as the myometrium. Depending on their size, they have the potential to cause the womb to enlarge, possibly leading to pelvic pain and heavy periods.
Submucosal fibroids:
These fibroids grow just beneath the lining of the womb, called the endometrium. They grow into the inside of the womb and are more likely to cause severe symptoms, such as prolonged or heavy periods, fertility issues, or problems with embryo implantation.
Subserosal fibroids:
These fibroids grow on the outside of the womb, called the serosa. They can lead to pelvic pain and abdominal bloating.

It is possible to have different types of fibroids simultaneously, and the combination of these types can cause different symptoms. The type of treatment you need will depend on your symptoms and type of fibroid you have.

What causes fibroids?

While the exact cause of fibroids is not fully understood, it's generally believed that they are influenced by our reproductive hormones, specifically oestrogen and progesterone. 3

Fibroids often run in families, indicating a genetic predisposition. Additionally, elevated oestrogen levels, like those experienced during pregnancy or while taking hormonal birth control, can contribute to the growth of fibroids.

How are fibroids diagnosed?

Initially, your doctor will ask you questions about the symptoms you’ve been experiencing and perform a pelvic examination. In many cases, fibroids are diagnosed unintentionally during routine gynecological checkups.

But if you or your doctor suspect you may have fibroids, there are a few ways how to confirm that:

Ultrasound scan:
You may get offered either an abdominal ultrasound scan – where the ultrasound probe is moved over the outside of your tummy - or a transvaginal ultrasound scan – where a small ultrasound probe is inserted into your vagina. The doctor will be able to see the signs of fibroids.
If the fibroids are within your womb (submucosal), the doctor will likely suggest to perform a hysteroscopy. It is a procedure where a small telescope is inserted into your womb through your vagina and cervix to see the inside of the womb. The procedure takes 10-15 minutes and is usually done under local anaesthetic.
An alternative to hysteroscopy, laparoscopy is when a small incision is made in your tummy and a small telescope is inserted through your abdomen (rather than through the vagina as in hysteroscopy) to view the womb and the organs around it. This procedure is done under a general anaesthetic so you will be asleep.

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What are the symptoms of fibroids?

Fibroid symptoms can vary from person to person, depending on their size and location. 4

The most common symptoms are:

Heavy periods:
Women with fibroids can experience longer periods ( more than a week of bleeding) and may need to change pads/tampons more frequently.
Pelvic pain:
Fibroids can cause pain or pressure in the lower stomach area. This discomfort may be constant or intermittent and can range in its intensity.
Frequent urination:
Large fibroids can press on the bladder, making you feel the urge to pass urine more frequently.
fibroids located near the rectum or intestines can put pressure on these organs, leading to constipation.
Back pain:
the pressure from a fibroid can cause pain in the lower back.
Swollen stomach:
if fibroids are large or in a cluster they can make the womb bigger, leading to a swollen abdomen.
Pain during sex:
cervical fibroids (fibroids that are located near the cervix, or the opening of the womb) or within the womb can cause pain or discomfort during sexual intercourse.

Can you get pregnant with fibroids?

While fibroids can affect fertility, not all women will experience difficulties in getting pregnant. 5 How they affect fertility depends on their size, location and how many there are, but many women with fibroids conceive naturally and have successful pregnancies. 

Treatment options

If you are diagnosed with fibroids, there are lots of treatment options that vary depending on the type of fibroids, your symptoms, as well as your age and overall health.

Managing your symptoms may be enough, however in some cases surgery is the best option.  6

Your doctor will guide you in choosing the most appropriate treatment for your unique situation, but the following are the most common treatments for uterine fibroids:

First line treatment for fibroids is medication to help manage the symptoms, such as:  

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, that can help ease severe period pains.

  • Hormonal birth control, such as oral contraceptive pills, hormonal intrauterine devices (IUDs), or hormonal injections that can control heavy period bleeding and cramps. 

These treatments can be really effective at easing period pain and heavy bleeding, but they don’t actually get rid of the fibroid itself. 

Hormonal medicines called gonadotropin releasing hormone (GnRH) agonists are medicines used to shrink the fibroids when pain relief and hormonal birth control treatments don’t help. These medications temporarily induce a menopause-like state, which shrinks fibroids. They are typically used to reduce the size of fibroids before surgery.

The most common and definite way to treat fibroids is to surgically remove them. There are three different types of surgery and whether you plan to have a baby in the future will impact which procedure your doctor recommends.

  • Hysteroscopy: a minimally invasive procedure where a thin, lighted instrument called a hysteroscope is inserted through the vagina and cervix into the womb to remove or treat small fibroids. This procedure is an option for women who want to have children in the future. It’s often carried out under general anaesthetic, although local anaesthetic may be used, meaning you can usually go home on the same day. 

  • Myomectomy: a surgical procedure to remove fibroids from the wall of the womb and is used as an alternative to hysteroscopy. Depending on the size and position of the fibroids, a myomectomy can be done vaginally (like a hysteroscopy) or laparoscopically (small cuts are made in the stomach to access the womb). This procedure is carried out under general anaesthetic and you will need to stay in hospital for a few days afterwards and rest for a few  weeks to recover. This procedure is also suitable for women who want to have children in the future.

  • Hysterectomy: this is a surgical option in which the entire womb is removed and that ensures fibroids are definitely removed. It is only used in cases when the woman no longer wishes to have children or when other treatment options have not been effective.

Risks for pregnant women with fibroids

Many women with fibroids have healthy pregnancies, avoid miscarriage and give birth to healthy babies though there are some potential risks associated. The extent of these risks depends on the type of fibroid you have and its specific characteristics and you will be closely monitored by your medical team to ensure the best care and support needed 5.

During the first trimester (first three months):

  • Miscarriage risk: especially when fibroids are near the womb lining (called submucosal fibroids), they can interfere with the implantation of the embryo or disrupt the blood supply to the developing foetus, and lead to an increased risk of miscarriage.

  • Pain and discomfort: larger fibroids or those located in certain areas of the womb can cause pain and discomfort during early pregnancy.

  • Growth and complications: due to increased hormone levels, fibroids can continue to grow during pregnancy. Larger fibroids can cause more pain  or pressure on surrounding organs, and an increased risk of pregnancy-related complications. IYour antenatal team will help you manage this, and discuss how to prevent them growing during pregnancy. 

During the second and third trimesters:

  • Preterm birth: depending on the size and location of the fibroids, there is a risk they can contractions and contribute to premature labour, increasing the risk of preterm birth.

  • Placental abruption: in rare cases, fibroids may cause placental abruption, where the placenta detaches from the uterine wall before birth. This can lead to bleeding and endanger both the mother and the baby.

  • Anaemia: if fibroids cause heavy bleeding during pregnancy, the mother may develop anaemia and feel very tired. Anaemia can also lead to low birth weight, a greater risk of a blood transfusion during labour and iron deficiency for your baby. During childbirth:

  • Longer labour: depending on the size and location of the fibroids, they may interfere with the progress of labour, making it longer and more complicated.

  • Excessive bleeding: fibroids can increase the risk of excessive bleeding after childbirth, especially if they were causing heavy bleeding during pregnancy.

After birth (post-partum):

  • Excessive postpartum bleeding: women with fibroids, especially large or multiple fibroids, may have an increased risk of excessive bleeding after delivery. 

  • Uterine infections: following delivery, the womb is more vulnerable to infection. If fibroids were present during pregnancy or if there were complications during childbirth, the risk of infection is  slightly higher.

  • Delayed shrinking of the womb: fibroids can sometimes interfere with the normal shrinking (involution) of the womb after childbirth, leading to a prolonged recovery period and increased risk of complications.

  • Pelvic pain and discomfort: depending on their size and location, fibroids may continue to cause pelvic pain or discomfort after delivery.

Can women with fibroids have egg freezing? 

Whilst fibroids don’t directly impact the ovaries or your egg reserve, surgical treatment can delay you trying to conceive. Time is one of the most crucial factors when trying to conceive, so freezing your eggs before fibroid surgery can help preserve your fertility and increase your chance of having a successful pregnancy in the future. Some fibroids can block access to the ovaries, so it is important to check with a fertility specialist to confirm egg freezing is suitable for you.

There are many different types of fibroids which can affect fertility in many different ways. From impacting the health of the womb and fallopian tubes to impacting embryo implantation, causing miscarriage and affecting an ongoing pregnancy, it is important to be aware of fibroids, the associated symptoms and the ways to treat them. Consulting with a doctor ensures that you receive the best care and the right support tailored to your specific needs.

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