Fibroids and Infertility – Causes and Treatments
Fibroid tumors also referred to as fibroids, uterine leiomyomata, or uterine myomas, are benign growths of smooth muscle tissue in the uterus. They are extremely common, affecting one in five (20 percent) of Caucasian women and up to one in three African-American women. In a minority of cases, however, fibroids may interfere with the appropriate implantation and early growth of a pregnancy, resulting in decreased fertility or miscarriage.
In many women fibroids occur randomly, but sometimes they appear to run in families. Fibroids that affect reproduction are most common in older reproductive-age women (35-45), simply because older women’s bodies have had more time to create the large fibroids that can affect fertility.
A fibroid arises from the abnormal growth of a single smooth muscle cell in the wall of the uterus. For reasons largely unknown, the cell receives the wrong growth signals and continues to divide and multiply long after it should have stopped. Over time, the single cell grows into a small ball and may become quite large.
Common Symptoms of Fibroids
Usually fibroids cause no symptoms, and they are often found during a woman’s yearly gynecological exam. The most common symptom of fibroids is heavy, prolonged, and/or painful menstrual periods. However, prolonged or heavy menses with or without pain can indicate a number of possible problems, not just fibroids. Other less common symptoms of fibroids include a feeling of abdominal pressure, abdominal distension (a woman might notice her pants growing tighter despite no weight gain), recurrent miscarriage, infertility, uterine pain even when a woman is no premenstrual or menstrual, increased urgency or frequency of urination, and loss of bladder control. Once again, most women with fibroids have no significant symptoms.
Location of Fibroids
There are three general locations for fibroids in the uterus. The fibroids can lie within the cavity of the uterus, inside the wall of the uterus, or on the external surface of the uterus. If you have been diagnosed with fibroids but you have no symptoms, this usually indicates that the fibroid(s) is deep within the wall of your uterus or at the external surface of the uterus. The location of the fibroid appears to be the most important factor in whether or not it causes any symptoms or has an adverse effect on reproduction. Fibroids within the wall or at the external surface of the uterus usually will not significantly affect the lining of the uterus (the endometrium), where the pregnancy grows and the tissue is shed during menstrual periods.
The fibroids that grow either in the uterine cavity or inside the wall of the uterus, and become large enough to deform or distort the uterine cavity and the endometrium, appear to have the highest risk for causing menstrual disturbances, miscarriage, and perhaps also decreased fertility. The endometrium and uterine cavity may not work normally, leading to bleeding problems, difficulty in implantation, and sometimes miscarriage.
Treatment for Fibroids
The heavy bleeding and severe cramping that are the most common symptoms of fibroid are usually responsive to medications such as birth-control pills and nonsteroidal anti-inflammatory agents (for example, ibuprofen or naproxen sodium). An ultrasound, or an ultrasound technique called sonohysterography or hydrosonography are usually suggested to ascertain the size and location of fibroids within the uterus. Unless your symptoms are untreatable or refractory to medical treatment, our fibroids are very large, or you have a history of adverse reproductive outcomes-such as recurrent miscarriage or infertility-you would probably not need surgery to remove fibroids.
When fibroids cause problems and conservative treatment measures are not effective, then surgery is often suggested. In order to retain your fertility, you will need to make sure that you receive a myomectomy, not a hysterectomy. In a myomectomy the fibroids are removed but the uterus is left in place. The myomectomy is usually done through an incision in your abdomen, but sometimes can be performed through laparoscopic surgery, using a small cameral inserted through the naval, or hysteroscopic surgery, with a small camera place through the vagina and into the uterus.
The American Society for Reproductive Medicine has an excellent video on the causes of fibroids.