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CONDITIONS

Fibroids and Fertility*

Can You get Pregnant with Fibroids?

Introduction

Fibroids are non-cancerous growths in the uterus. They vary in size and are made up of smooth muscle cells and fibrous connective tissue. Fibroids are also called uterine meiomas or leiomyomas. Some women have a single fibroid while others have several.

Fibroids vary in size and can be as large as a grapefruit or the size of an orange seed. Some cause no symptoms, but others lead to debilitating problems. Fibroids are most common in women in their 40s and 50s1 and will occur in 40-50% of women.2

Being overweight increases the risk of developing fibroids, and they are also more common in black and afro-caribbean women.3 The development of fibroids in the body is thought to be linked to estrogen. This is why they tend to develop between age 16 and 50 when the levels of estrogen are at their highest. Fibroids tend to shrink after 50 when estrogen levels are lower.4

How Fibroids Affect Fertility

Fibroids are common during a woman’s childbearing years. Although some women conceive and give birth naturally with fibroids, others experience problems with fertility. A common issue with fibroids and fertility is a submucosal fibroid which can bulge into the uterine cavity, thereby reducing the likelihood of conception, as can very large fibroids.

Symptoms such as heavy bleeding and irregular periods as a consequence of fibroids can also lead to couples not conceiving.

Symptoms of Fibroids

  • Some women experience no symptoms from fibroids.5
  • Around 1 in 3 will have symptoms that include, lower back pain, heavy menstrual periods, abdominal pain, and constipation.6
  • Some women experience an increased frequency of urination due to fibroid pressure on the bladder, and some have pain during sex. A woman can experience all or some of these symptoms.

If a woman experiences symptoms of fibroids, it is important to get help from a doctor. If left unchecked, the symptoms can impact quality of life, particularly with pain, heavy bleeding, and needing to urinate frequently. Heavy menstrual periods will result in anemia if untreated.

Some of the symptoms of fibroids are also experienced in other diseases such as cancer. It is therefore important to get help promptly so that fibroids can be correctly diagnosed, other conditions excluded, and the correct treatment given.

Diagnosing Fibroids

A doctor will take a clinical history and pelvic examination. If they consider fibroids to be a potential cause, they will refer the patient for further tests. This is likely to be an ultrasound scan which is painless. It uses a doppler to produce high frequency sound waves, creating an image of the inside of the body. In this case, two scans are used.

One is an abdominal ultrasound scan and the other a trans-vaginal scan. If the scan is indicative of fibroids, further testing is needed. Usually, a hysteroscopy is performed. A small, tube-like telescope is inserted into the uterus via the cervix, and is used to examine the fibroids and take tissue samples. Sometimes a laparoscopy is used to diagnose fibroids. This involves inserting a small telescope and camera into the abdominal cavity through a small incision near the navel. Once a diagnosis has been made, a treatment plan can be agreed upon.

Treating Fibroids

When deciding a treatment plan for fibroids, the doctor will consider the type of fibroid and whether the woman wishes to conceive. Sometimes, no treatment is required, particularly if there are no symptoms or the woman is close to menopause.

Hormone Treatment

Hormone treatment such as a levonorgestrel intrauterine system, which is placed in the uterus to reduce bleeding, may be used. It also acts as a contraceptive, but once stopped does not affect pregnancy.

Tranexamic Acid

Tranexamic Acid is used in heavy bleeding with fibroids. They stop blood flow from small vessels in the uterus and reduce bleeding. This medication does not affect the chances of getting pregnant.

Anti-Inflammatory Drugs

Non steroidal anti-inflammatory drugs have also been used in the treatment of fibroids as they reduce the production of prostaglandin which is linked to heavy periods. The contraceptive pill has also been used to treat fibroids as it makes bleeding lighter.

Surgical Options

Surgery is another option for fibroid treatment. A myomectomy removes the fibroid from the wall of the uterus. It is suitable for women who want to conceive. It can either be done as an open surgical procedure or as a keyhole operation.

Hysterectomy is the removal of the uterus and is performed to treat fibroids. It is not suitable should a woman wish to conceive. Hysteroscopic morcellation of fibroids is a new procedure where fibroids are removed during a hysteroscopy. This is generally done as a day case. Uterine artery embolization is a procedure where a radiologist blocks blood vessels supplying fibroids, which causes them to shrink. There is a small risk that fertility will be affected in some patients having this procedure. The doctor will discuss the options available with the patient and decide on a suitable treatment plan.7

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*NOTICE: The contents of this website are for informational purposes only, and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a potential medical condition.