Uterine Fibroids
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Uterine Fibroids

Uterine Fibroids

Fibroids are non-cancerous tumors of the uterus. Fibroids grow out of the cells that make up of the uterus. Uterine fibroids are also sometimes called leiomyoma or myoma.  Fibroids can vary in their size. They can be as small as a pea or as large as a football. Having uterine fibroids does not increase your risk of cancer. They are almost always benign, no matter how large they get.

Fibroids have different names depending on where they grow:

  • Intramural fibroids are the most common type of fibroids that develop within the muscle wall of the uterus. They can make your uterus appear bigger, and can cause heavy or painful periods and fertility problems.
  • Submucosal fibroids grow just under the inner lining of your uterus (endometrium). They can alter the lining of your uterus and reduce the fertility. Submucosal fibroids can also cause heavy or painful periods.
  • Subserosal fibroids grow on the outside of your uterus. They may bulge or extend into your pelvis, putting pressure on your bladder or bowel.
  • Cervical fibroids develop in the neck of your uterus which is the cervix

Submucosal and subserosal fibroids may grow from a stalk. They may stick out into the uterus or into the pelvic area. If a fibroid or cluster of fibroids is particularly large or is growing on the outside of the uterine wall, it can push the uterus aside or force it to grow abnormally.

The only type that considered to have an impact on reproductive function (unless they are large or numerous) is the submucosal type that pushes in to the uterine cavity. These are much less common than the other types of fibroids. Because of their location inside the uterine cavity, submucous fibroids can cause fertility problems and miscarriages. Submucosal fibroids can often be surgically resected to improve fertility.

Causes of uterine fibroids

It is not known exactly what causes uterine fibroids. But the hormones that regulate your periods, particularly oestrogen, are known to play a part. Fibroids increase in size slowly over the years but when oestrogen levels in your body rise, their rate of growth increases.
Fibroids and infertility

It’s rare for fibroids to seriously hamper your efforts to get pregnant, and much depends on what type of fibroid it is.  A very small percent less than 3% of women who seek help for infertility have fibroids without any other obvious cause for their fertility problem. Submucosal fibroids are the most likely type to affect your fertility. The reason is these fibroids can distort the uterus, and interfere with embryo implantation, whether by natural conception or IVF treatment.  This could be caused by reduced blood flow, making the lining of the uterus unfriendly to a fertilized oocyte.  If you know you have a fibroid and having problems conceiving, we suggest that you see a fertility specialist. The specialist will first find out whether there are any other possible causes of your fertility problem and treat them.

If no other cause can be found, our doctor may advise you to continue to try to conceive naturally for up to two years, unless you are over 34. In this case, you are better off seeking treatment sooner rather than later, because fertility declines with age.  Surgery to remove fibroids may improve your chances of pregnancy. Surgery is more helpful if you have submucosal fibroids than if you have intramural fibroids
How common are fibroids

Fibroids are very common in women of child-bearing age. It is more likely to have fibroids with overweight women, because your oestrogen levels increase as your body fat increases.  Although they are common, fibroids almost never cause injury to a baby.
How will I know if I have fibroids?

Approximately only a third of women with fibroids get symptoms which may include:

  • Painful periods
  • Prolonged and heavy menstrual bleeding
  • Urinating more often and could be painful which is caused by pressure on your bladder.
  • A feeling of fullness or pressure, which may cause constipation if the pressure is on your back passage.
  • Pain in your back, belly or pelvis, depending on how big and where the fibroid is.
  • Trouble with conceiving.

How fibroid are detected

  • Ultrasound: Most fibroids can be detected by transvaginal or transabdominal ultrasound which uses sound waves to get a picture of uterus to diagnose and measure fibroids.
  • Hysterosonography: Also called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of the uterine cavity and endometrium. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.
  • Hysteroscopy: a small, lighted telescope called a hysteroscope inserted through your cervix into the uterus, then our doctor injects saline into your uterus, expanding the uterine cavity and allowing the doctor to examine the walls of your uterus and the openings of your fallopian tubes.
  • Hysterosalpingography: Uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Our doctor may recommend it if infertility is a concern. In addition to revealing submucosal fibroids, it can help our doctor determine if your fallopian tubes are open.
  • Magnetic resonance imaging (MRI). This imaging test can show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.
  • Lab tests. If you’re experiencing abnormal vaginal bleeding, our doctor may order other tests to investigate potential causes. These might include a complete blood count (CBC) to determine if you have anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

Can fibroids be treated

Our doctor will be able to tell you which treatments are best for you, and discuss how each procedure may affect your fertility.  Most fibroids don’t need to be treated unless the symptoms are causing problems. Even then, in many cases, our doctor may talk to you first about ways to ease the symptoms.   If you do need treatment, there are a number of options to consider.

An operation to remove the fibroid

Myomectomy is a surgical operation usually used for small fibroids it may be carried out by keyhole surgery using a laparascope or hysteroscope. Which type of keyhole surgery is used will depend on whether the fibroid is on the outer or inner lining of the uterus. Open surgery is used for larger fibroids and involves a longer recovery time than keyhole surgery.  Myomectomy is not suitable for all women, as it depends on the size, number and location of the fibroids.  This operation is offered to women who still plan to have children, because it leaves the uterus intact. However, most women find their fibroids grow back again after about few years.

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