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Will fibroids make me infertile?

Fibroids are common: up to 3 in 4 women may have had a fibroid by the age of 50. (1,3)

Yet, few people know much about fibroids. Doctors may talk about growths, pain, tumours, bleeding, non-cancerous, treatment, complications… What do these terms all mean?! Essentially, what are fibroids?

I hope this clarifies some questions you may have about fibroids and fertility.

What is a uterine fibroid?

The womb, or uterus, is the female reproductive organ. It’s made of muscle, fibrous tissue, ligaments and a cavity.

A fibroid is an extra growth in or around the womb. It can also be referred to as a benign tumour – benign meaning that it is non-cancerous. It is made up of some of the muscle and fibrous tissue found in the womb. 

Figure 1: Different locations of uterine fibroids – Fibroids – NHS

Who gets fibroids?

Although the exact cause of fibroids is still unclear, research has shown a link with the hormone oestrogen. As oestrogen levels are at their highest in women of reproductive age (i.e. women who have periods), fibroids are most common in 16 to 50 year-olds. (2) Being overweight also increases the level of oestrogen in the body, making fibroids more likely. Finally, the risk of developing fibroids is higher in women of Afro-Caribbean origin and women who have not had any children. 

How will I know if I have fibroids?

Many women that have fibroids will be completely unaware of them. In these cases, they may be picked up on a routine visit to the gynaecologist or tummy scan.  Unfortunately for 1 in 3 women, fibroids can cause symptoms like heavy or painful periods, tummy pain, lower back pain, increased need to pass urine, constipation or discomfort during sex. (2)

If a fibroid is suspected, your doctor will most likely perform an internal vaginal examination to feel for any masses. They may also check your blood for iron levels.

Various imaging techniques can be used to take a closer look at fibroids. These include a ‘jelly scan’, (ultrasound scan) which can be done on the tummy (abdominal ultrasound) or with a probe in the vagina (transvaginal ultrasound). Doctors may also use small telescopes for a better look inside the uterus. In a hysteroscopy, a small telescope is inserted through the vagina and cervix; alternatively, the telescopes can be inserted through small cuts made on the tummy, in a key-hole surgery known as a laparoscopy. More information can be found on the NHS website. (2)

What are the consequences of having fibroids? 

Most fibroids will not cause any long term complications. In rare cases that problems do arise, these often depend on the size and location of the fibroids. 

If fibroids are very large, they may cause problems with fertility. These growths can block various parts of the reproductive system that are needed for pregnancy to be successful. For example, submucosal fibroids can block the fallopian tube, which is needed for the egg to travel from the ovary to the womb. They can also prevent the sperm from reaching an egg for fertilisation. Finally, fibroids can stop a fertilised egg from implanting in the lining of the womb, an essential step for the growth of the future embryo. 

Fibroids can also cause problems in pregnancy such as premature labour or increase the likelihood of needing a cesarean section. Rarely, fibroids can cause miscarriage. 

What is the treatment for fibroids? 

In most cases, fibroids are small and do not cause any symptoms or complications. Yearly monitoring of the fibroids’ size and any growth may be recommended. However, fibroids often shrink after menopause and symptoms may completely resolve. If the fibroids are causing symptoms, medicines can be given to reduce heavy periods or to shrink the fibroids. If medication does not help, a specialist may suggest surgical or nonsurgical procedures. (2) 

References:

      1. CKS is only available in the UK [Internet]. NICE. Available from: https://cks.nice.org.uk/topics/fibroids/
      2. NHS Choices. Overview – Fibroids [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/fibroids/
      3. Stewart E, Cookson C, Gandolfo R, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 May 13;124(10):1501–12.

 

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