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Reproductive diseases like polycystic ovarian syndrome (PCOS), interstitial cystitis, and endometriosis can make family planning more challenging. Another lesser-known condition many women face is uterine fibroids, which can not only cause pain and discomfort but can also lead to potential fertility complications.
Between 20-70 percent of women will develop fibroids during their reproductive years, and they're almost always harmless, but that doesn't mean you should ignore them. For patients with fibroids looking to expand their family, it’s essential to understand the potential risks that may arise before, during, and after pregnancy.
Here’s what you should know about uterine fibroids and how they can affect female fertility.
What are uterine fibroids?
Fibroids, also known as leiomyoma or myoma, are muscular tumors that form within the walls of the uterus. Fibroids are typically considered benign (non-cancerous) and can develop as a singular tumor or multiple in the uterus. Fibroids vary from being as small as a pea to as big as an orange.
While most fibroids can grow in the walls of the uterus, they can develop in other areas, like the uterine cavity and the outside of the uterus. Depending on where the fibroids grow, they can cause discomfort, pain, and bleeding.
Types of uterine fibroids
There are four known types of fibroids:
- Intramural: the most common form of fibroids that grow inside the uterus.
- Subserosal: these fibroids grow outside the uterus and can cause significant pain due to their size.
- Submucosal: fibroids that grow underneath the uterus’s lining and can pack themselves inside the uterus, leading to heavy bleeding and other complications.
- Pedunculated fibroids: fibroids that form in stalks inside or outside the uterus
Cause of uterine fibroids
The cause of uterine fibroids is currently unknown, though research suggests that risk factors such as genetics and prolonged exposure to hormones like estrogen and progesterone can influence the development of the health condition. In addition, certain medications, menopause, or pregnancy can increase or decrease hormone levels, playing a role in whether or not fibroids develop in the uterus. There is uncertainty around why these tumors grow or shrink in size due to these factors.
Risk factors for uterine fibroids
Women in the reproductive stage of their lives are more likely to develop fibroids. Black or African American women are disproportionately affected by reproductive health conditions and are commonly diagnosed at a younger age than other races and ethnicities. In addition, this demographic may face more severe symptoms from uterine fibroids, like anemia and internal bleeding. Some research suggests that low vitamin D levels may be associated with the development of fibroids amongst Black or African American women.
Additional risk factors for fibroids include:
- Obesity or overweight
- High intake of red meat
- High blood pressure
- Family history of fibroids
Symptoms of uterine fibroids
Many women who experience fibroids may be asymptomatic (not showing symptoms). However, other women may have mild to severe symptoms that interfere with their daily activities.
Some common fibroid symptoms are:
- Bleeding between periods
- Pelvic pain or discomfort
- Lower back pain
- Abdominal discomfort
- Pregnancy complications
- Painful intercourse
- Bladder problems (difficulty passing urine or frequent urination)
- Heavy or extended periods
- Bowel symptoms (complicated bowel movements or constipation)
- Infertility
Getting pregnant with uterine fibroids
Uterine fibroids are primarily diagnosed based on the symptoms a patient is experiencing. A gynecologist may follow up with ultrasonography, a diagnostic medical imaging test, to find any uterine fibroids. Once a diagnosis is given, the patient will receive a treatment plan to manage the condition.
Certain types of fibroids and treatment methods may cause infertility in women. For example, submucosal fibroids are known to increase the risk of infertility or pregnancy complications. In addition, when fibroids grow outside the uterus, it can cause difficulties for the embryo to enter the uterus lining.
Fortunately, in most cases, women with fibroids can become pregnant without any issues. Ultimately, the size, location, and the number of fibroids will determine pregnancy outcomes. For some patients with fibroids, their doctor may recommend a premature delivery or a cesarean section (C-section) to reduce complications during delivery.
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It’s always important to speak with a gynecologic surgeon to ensure a safe and healthy pregnancy with uterine fibroids.
Treatment and surgery for fibroids
A standard fibroid treatment to help with fertility is a myomectomy. Myomectomy is a surgical operation that removes uterine fibroids. The surgery aims to reduce symptoms associated with fibroids and rebuild the uterus. As a result, many patients report improved fibroid symptoms like pelvic pain and heavy bleeding during menstruation.
Myomectomy is the recommended uterine fibroids treatment for patients who are planning to have children but don’t want their uterus completely removed. While this is a safer option for patients who wish to become pregnant, it is essential to note that potential risks may occur after receiving a myomectomy.
Possible complications from a myomectomy include:
- Infection
- Blood clots
- Hemorrhage
- Pregnancy or childbirth complications
- Potential re-growth of fibroids
- Scar tissue around the uterus
Fortunately, the possibility of complications after receiving a myomectomy is low. In fact, in a study of 2,050 patients who received a laparoscopic myomectomy (surgery through the abdomen), only 225 (or 11.1%) experienced complications.
The Bottom Line
Uterine fibroids are noncancerous tumors that often go undetected by patients with reproductive health conditions. Women who experience symptoms associated with this condition may endure heavy menstruation, pain, and bladder problems. Thankfully, uterine fibroids are readily diagnosed based on symptoms and ultrasonography, and with a myomectomy or other recommendations from their healthcare providers, women can have healthy pregnancies while managing uterine fibroids.
Taneia Surles is an Alabama-based freelance health and wellness writer and the founder of Content By Taneia, LLC. She holds a Master's degree in Public Health with a Health Behavior concentration and specializes in health and wellness, productivity, education, entrepreneurship, and true crime content.