Gynescope Specialist Hospital

UTERINE FIBROIDS AND INFERTILITY

            

INTRODUCTION

There is a common misconception about uterine fibroids (or myomas). Many people believe that the presence of fibroids significantly reduces or abolishes a woman’s reproductive capacity. I have seen women break down as though a death sentence has been passed onto them, when they are told they have fibroids no matter how small.  We will try to clarify these issues and shine more light on fibroids.

DEFINITION

Fibroids are non cancerous growths that develop in a woman’s womb. They are benign tumours of the smooth muscle cells found in the human womb. They are the most common tumours in women of child bearing age. Fibroids vary in size, number and location. Some can be as small as a grain of rice or as big as a football.

INCIDENCE

According to a 2010 WHO report, fibroids affect between 20-25% of women. Approximately 1 out of 4 women have fibroids. They are commoner in black women than the Caucasians. This may be associated with genetic factors. Fibroids typically occur in women of reproductive age (15-49years).

CAUSES

The cause of fibroids is largely unknown. It is believed that some hormones, estrogen and progesterone aid tumour growth as fibroids rarely occur before the onset of the first menses. In other words, no woman is born with a fibroid. Fibroids start growing probably in response to hormones increasing with age up till the 5th decade.

RISK FACTORS

  • Family history:Individual family genetics may affect your chances of getting fibroids. If your grandmother, mother, or sister had fibroids, you may be more likely to have them.
  • Age; fibroids are commoner in women of reproductive age and often shrink in menopausal women.
  • Race; as stated earlier, fibroids are commoner in blacks
  • Nulliparity such as in women who delay childbearing
  • Early age of first menses
  • Obesity; some studies suggest that obesity might play a role in fibroid development
  • Lifestyle; exercise and a healthy diet may lower the risk. Eating a lot of red meat,and alcohol consumption seem to increase the risk of having fibroids

 

CLASSIFICATION

Fibroids can be classified based on their location as subserous, intramural and submucous fibroids.

  • Subserous fibroids are located on the outer layer of the womb
  • Intramural fibroids are located within the muscular layer of the womb
  • Submucous fibroids are located within the inner layer of the uterus/endometrial layer(where baby commonly resides)

CLINICAL FEATURES

A lot of women have no symptoms and the fibroids may just be incidental findings on clinical examination or fertility investigations.

Fibroids may cause symptoms based on their size and location. The commonest presenting symptoms are excessive/heavy and prolonged bleeding during menses (menorrhagia), pain, abdominal masses. Submucous fibroids are very notorious for causing heavy menses which can lead to shortage of blood. Larger fibroids may cause pressure symptoms such as frequent urination, constipation, pelvic pain or backache.

FIBROIDS AND INFERTILITY; There are conflicting reports on the effect of fibroids on infertility. The size and location are implicated to play a role in infertility and miscarriage. Big fibroids may distort the fallopian tubes while fibroids inside the womb   may interfere with the function of the womb lining and implantation of the embryo. Depending on their size and location, fibroids sometimes raise the risk of miscarriage during the first 26 weeks of pregnancy. Those in the uterine cavity may be more likely to cause miscarriage.

FIBROIDS AND PREGNANCY; Some studies have shown that fibroids may make stillbirth, preterm labour and delivery(before 9 complete months), abnormal position of the baby, and separation of the placenta from the uterine wall (abruption) more likely.  In other cases, fibroids may block the birth canal, complicating labour and delivery.

But not all studies confirm these associations. Fibroids may grow or shrink during pregnancy, but in most cases they remain the same.

A small percentage, however, can more than double in size. These fast-growing fibroids sometimes outgrow their blood supply and begin to break down, a condition called “red degeneration.”

Red degenera­tion causes severe pain and occasionally light vaginal bleeding, along with vomiting, nausea, and a low-grade fever. It usually begins at the end of the first 13 weeks or the beginning of the second – usually around 20 weeks of pregnancy – when the womb is rapidly growing in size, but it can start up later in the pregnancy too.

If the pain is severe, it can stimulate the womb to start contracting. This can cause preterm labor. In that case you may be hospitalized or put on bedrest until all signs of preterm labor are gone.

MANAGEMENT

The truth is that not all fibroids require medical intervention. As long as the fibroid poses no threat to the woman’s reproductive status and overall general health, they are best left alone.  Treatment options include

  • Medication; some hormonal drugs may be given to stop the bleeding, shrink the fibroid and improve her blood count. Unfortunately such drugs are not to be taken for long periods of time and symptoms return after stopping. Other drugs include pain relief, iron and multivitamins
  • Minimally invasive procedures; includes removing the fibroids by hysteroscopy or laparoscopy ,uterine artery embolization
  • Abdominal myomectomy(open surgery); this is the commonest method used in our environment for women who want to retain their fertility
  • Hysterectomy; removal of the uterus. This ends your ability to bear children

CONCLUSION

Uterine fibroids have remained an important health concern especially for women of reproductive age. However, with recent advances in medicine, women now have a chance to reduce the burden of fibroids and improve their fertility and wellbeing. Women need to understand that the presence of fibroids doesn’t necessarily mean you can’t get pregnant or have a healthy pregnancy

 Always seek medical advice from your doctor as to the best approach for management.