The impact of fibroids on fertility can vary depending on the size, location, and number of fibroids, as well as individual factors. In many cases, fibroids may not cause any fertility issues or complications during pregnancy.

A uterine fibroid, also known as leiomyoma or simply fibroid, is a non-cancerous (benign) tumour that develops within the muscular walls of the uterus, which is the female reproductive organ where a foetus grows during pregnancy. Uterine fibroids are quite common and can vary in size, ranging from small pea-sized nodules to large growths that can distend the uterus.

The exact cause of fibroids is not entirely understood, but they are influenced by hormonal factors, particularly oestrogen and progesterone. They tend to grow during the reproductive years when hormone levels are at their highest and often shrink after menopause when hormone levels decrease.

Many women do not even realise they have fibroids when they do not interfere with their day-to-day life. When they experience pain or discomfort during intercourse or heavy bleeding during their menstrual cycle, they see a doctor and get a scan that reveals the fibroids. Treating fibroids depends on their size, how much discomfort it is causing and if it is interfering with conception or pregnancy.

Symptoms of Fibroids

Symptoms of uterine fibroids may vary depending on their size, number, and location. Some common symptoms include:

• Heavy, prolonged, or irregular periods
• Anaemia because of heavy bleeding
• Pelvic pain
• Frequent urination
• Difficulty emptying the bladder.
• Constipation
• Backache or leg pain
• Delay in conception
• Recurrent miscarriages (in some cases)

Types of Fibroids

Uterine fibroids, also known as leiomyomas, can be classified into several types based on their location within the uterus. The main types of fibroids are:

• Intramural fibroids: These are the most common type of fibroids and develop within the muscular wall of the uterus (myometrium). They can cause the uterus to enlarge and may lead to symptoms such as pelvic pain, heavy menstrual bleeding, and pressure on nearby organs.
• Subserosal fibroids: These fibroids grow on the outer surface of the uterus, facing away from the uterine cavity. Subserosal fibroids can sometimes grow large enough to press on other organs, leading to back pain or bladder and bowel issues.
• Submucosal fibroids: Submucosal fibroids develop just beneath the inner lining of the uterus (endometrium). They protrude into the uterine cavity and can cause significant menstrual disturbances, such as heavy bleeding and even infertility in some cases.
• Pedunculated fibroids: These are fibroids that grow on a stalk-like structure called a peduncle. Depending on whether they are connected to the uterine wall (pedunculated subserosal) or inside the uterine cavity (pedunculated submucosal), they can either hang from the outside of the uterus or be partially inside and outside of the uterine cavity.

Treating Fibroids

The treatment of fibroids depends on numerous factors, including the severity of symptoms, the size and location of the fibroids, a woman’s age, and her desire to have children. Treatment options for uterine fibroids include:

• Monitoring Changes: If the fibroids are small, not causing significant symptoms, and not affecting a woman’s quality of life, the doctor may recommend watchful waiting. Regular check-ups and monitoring of the fibroids may be sufficient in these cases.
• Medications: Hormonal medications may be prescribed to help shrink the fibroids or alleviate symptoms. These medications can be useful in managing heavy bleeding and reducing the size of fibroids before surgical intervention.
• Uterine Fibroid Embolization (UFE): UFE is a minimally invasive procedure performed by interventional radiologists. It involves blocking the blood supply to the fibroids, causing them to shrink and relieve symptoms.
• Myomectomy: Myomectomy is a surgical procedure in which the fibroids are removed while leaving the uterus intact. It is an option for women who want to preserve their fertility.
• Hysterectomy: Hysterectomy involves the surgical removal of the entire uterus. It is considered the most definitive treatment for fibroids and guarantees that they will not return. However, it is only recommended for women who do not wish to have children in the future or have severe symptoms that have not responded to other treatment modalities.
• Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS): This non-invasive procedure uses focused ultrasound waves to heat and destroy the fibroids, reducing symptoms.
• Endometrial Ablation: This procedure involves destroying the lining of the uterus to reduce menstrual bleeding associated with submucosal fibroids. It is not effective for treating fibroids located outside the uterine cavity.

Fibroids and Cancer

Uterine fibroids, also known as leiomyomas, are almost always benign, meaning they are non-cancerous growths. Most fibroids do not turn into cancer (malignant tumours). They are considered a benign condition.

However, in extremely rare cases (less than 1% of all fibroids), a type of cancer called leiomyosarcoma can develop within a fibroid. Leiomyosarcoma is a malignant tumour that arises from the smooth muscle cells of the uterus. It is crucial to emphasise that leiomyosarcoma is exceptionally uncommon, and most fibroids are benign and pose no cancer risk.

While the risk of fibroids turning cancerous is exceptionally low, it is essential to be aware of potential warning signs and seek medical attention if you experience:

• Rapid and significant growth of a fibroid
• Severe pain or pressure in the pelvic area
• Unexplained weight loss
• Abnormal bleeding, especially after menopause
• New-onset heavy or irregular bleeding

Fibroids and their impact on fertility

The impact of fibroids on fertility can vary depending on the size, location, and number of fibroids, as well as individual factors. In many cases, fibroids may not cause any fertility issues or complications during pregnancy. However, in some instances, they can influence a woman’s ability to conceive or carry a pregnancy to term. Here are some ways fibroids can impact fertility.

• Distorted Uterine Cavity: Submucosal fibroids, which grow inside the uterine cavity, can alter the shape of the uterus, and interfere with the implantation of a fertilised egg, reducing the chances of conception.
• Fallopian Tube Blockage: Large fibroids located near the fallopian tubes can block or obstruct the tubes, preventing the sperm from reaching the egg.
• Implantation Issues: Even if fertilization occurs, the presence of fibroids can hinder the implantation of the embryo into the uterine lining, leading to difficulties in getting pregnant.

Many women with fibroids can conceive and have successful pregnancies. However, if you are having trouble conceiving or have concerns about fibroids and their potential impact on your fertility or pregnancy, it is essential to consult with your doctor. They can assess your individual situation, provide guidance, and recommend appropriate treatment options if necessary. In some cases, addressing fibroids before attempting pregnancy may be recommended to optimise the chances of a successful conception and healthy pregnancy.

How to prevent fibroids?

The exact cause of uterine fibroids is not fully understood, and therefore, there is no definitive way to prevent their development. However, certain lifestyle choices and factors may play a role in reducing the risk of fibroids or minimizing their growth. Here are some considerations that may help:

• Maintain a Healthy Weight: Obesity is associated with an increased risk of developing fibroids. Maintaining a healthy weight through a balanced diet and regular exercise may help reduce the risk.
• Eat a Nutritious Diet: A diet rich in fruits, vegetables, and whole grains has been linked to a lower risk of fibroids. On the other hand, excessive red meat and ham consumption may be associated with a higher risk.
• Control Blood Pressure: High blood pressure has been associated with an increased risk of fibroids. Monitoring and managing blood pressure levels may be beneficial.
• Pregnancy and Breastfeeding: Some studies suggest that having multiple pregnancies and breastfeeding may be associated with a lower risk of fibroids.
• Limit Alcohol Consumption: Excessive alcohol consumption has been linked to an increased risk of fibroids in some studies. Limiting alcohol intake may be beneficial.

While these factors may have some influence on fibroid development, it is essential to remember that fibroids can still occur despite taking preventive measures. Additionally, some risk factors for fibroids, such as age, family history, and ethnicity, are beyond an individual’s control.

Regular gynaecological check-ups are essential for early detection and monitoring of fibroids, especially if you are experiencing any symptoms or belong to a higher-risk group. If you have concerns about fibroids or other gynaecological issues, it is best to consult with an expert for personalised advice and appropriate management.

Reviewed By:

DR.DEVI C

CONSULTANT – OBSTETRICS & GYNAECOLOGY

MBBS, MD OG, DNB (OG)