Uterine fibroids are noncancerous growths in the uterus muscle and can be a significant cause of female infertility. They can block fallopian tubes, prevent embryo implantation, and cause pregnancy complications such as miscarriage and preterm birth. Symptoms include heavy menstrual bleeding, pelvic pain, and frequent urination. Diagnosis is made through pelvic exams and imaging tests. Treatments include medication to manage symptoms and various surgical options to remove the fibroids, improving the chances of pregnancy.
Uterine fibroids, also called myomas or leiomyomas, are benign growths of the smooth muscle tissue of the uterus. They can range widely in size, from tiny, undetectable nodules to large masses that distort the uterus. Some women have a single fibroid, others have several. The exact cause is not clearly understood, but the natural cycle of hormones like estrogen and progesterone appears to play a role in stimulating fibroid growth.
The types of uterine fibroids are classified by their location in relation to the uterus wall:
- Subserosal Fibroids: These grow on the outside of the uterus. They may press on nearby organs and cause pelvic pain or pressure.
- Intramural Fibroids: Grow within the uterine wall, can expand and make the uterus larger than normal and can lead to heavy menstrual bleeding, pelvic pain, and fertility issues.
- Submucosal Fibroids: Develop just under the uterus’s lining. These are most directly linked to infertility and miscarriage, as they can distort the uterus cavity and interfere with embryo implantation.
- Pedunculated Fibroids: These are Fibroids that grow on a stalk and can cause pain and pressure, especially if they twist.
Possible causes and risk factors of uterine fibroids
While the exact cause of uterine fibroids is not fully understood, research suggests several contributing factors:
- Hormones: Estrogen supports the growth of the uterine lining each cycle and is believed to encourage fibroid growth.
- Genetics: Fibroids tend to occur more frequently in women with a family history of the condition.
- Obesity: Women with obesity have a two- to three-fold higher risk, likely due to increased estrogen levels in the body.
Symptoms and Detection
Many women with fibroids do not experience symptoms, and fibroids may be discovered only during a gynecologic exam or imaging such as ultrasounds. When symptoms do occur, they can include:
- Heavy or prolonged menstrual bleeding
- Pelvic pressure or abdominal discomfort
- Pelvic pain or discomfort
- Frequent urination or a feeling of pressure on the bladder
- Irregular bleeding between periods
- In some cases, fibroids can lead to anaemia from chronic heavy bleeding
How Fibroids Affect Fertility
Fibroids can impair fertility in a few ways:
- Structural interference: Especially submucosal fibroids can distort the uterine cavity or block the fallopian tubes, making it harder for sperm to reach an egg or an embryo to implant.
- Impaired implantation: Fibroids within the uterus may disrupt the endometrial lining where the embryo implants.
- Pregnancy complications: Fibroids can increase risks such as miscarriage, preterm birth, or abnormal fetal positioning.
As a result, fibroids are one of the notable gynaecological causes of infertility, though not all women with fibroids will experience trouble conceiving or maintaining a pregnancy.
Diagnosis
To diagnose fibroids, clinicians use:
- Pelvic examination
- Abdominal or transvaginal ultrasound
- Hysteroscopy, where a small camera is inserted into the uterus
- MRI or other imaging in select cases
These tests help determine the number, size, and exact location of fibroids, which in turn guide treatment decisions.
Treatment Options
Treatment depends on symptoms, fibroid size and location, and whether the woman wants to preserve fertility:
- Medications can help manage symptoms like heavy bleeding, but do not eliminate fibroids.
- Surgical options:
- Myomectomy: Surgical removal of fibroids while preserving the uterus. Often chosen for women who wish to have children.
- Hysterectomy: Removal of the uterus, which is typically recommended when fertility is no longer desired, or when symptoms are severe.
Minimally invasive procedures, such as laparoscopic (keyhole) surgery, are often preferred, when possible, to reduce recovery time.
Importance of Early Detection and Follow-Up
Routine gynaecology check-ups are important, especially for women planning pregnancy or experiencing symptoms. Regular monitoring through ultrasound imaging can catch fibroids early and allow for timely intervention that may improve fertility outcomes.
Conclusion
Uterine fibroids are common benign growths that can affect fertility and pregnancy, depending on their size and location. While fibroids don’t often cause symptoms, those that distort the uterine cavity, interfere with fallopian tubes, or cause heavy bleeding may contribute to infertility. Early detection, careful assessment, and appropriate treatment, especially for women wishing to conceive, are crucial parts of managing the impact of fibroids on reproductive health.
Bangkok Hospital has this interesting read on how uterine fibroids can be a major cause of infertility.
