Fibroids have the potential to impact fertility, but not everyone with fibroids will experience fertility struggles or require surgical intervention. Difference in fibroid’s size or location can result in different experiences for patients.
What are fibroids?
Fibroids are benign tumors that most commonly grow in the wall of the uterus. About 70% of women are found to have fibroids by the age of 50. However, the exact incidence is unknown.
“Fibroids affect women of all ages, but fibroids grow under the influence of hormones, namely estrogen,” said Yale New Haven Health minimally invasive gynecologic surgeon Angela Qu, DO, assistant professor of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. “So, when women are in their reproductive ages, the fibroids have the potential to grow and become more symptomatic.”
Fibroid symptoms
Dr. Qu says fibroid symptoms fall into two big categories: bleeding related symptoms and pain related symptoms. Bleeding symptoms can include:
- Heavy menstrual bleeding
- Prolonged menstrual bleeding
- Irregular menstrual bleeding
Pain related symptoms include dysmenorrhea, which is painful menstrual cramps and bulk symptoms, which refer to symptoms caused by the large size of the fibroid. This can include:
- Pelvic pain, pressure or discomfort
- Lower back pain
- Vaginal pain
- Frequent urination
- Change in bowel habits
Impacts of fibroids
Left untreated, bleeding symptoms can lead to profound anemia, requiring IV iron or blood transfusion. Anemia can impact energy levels and cardiovascular health. Chronic pain can also impact a patient’s daily function, leading to missed work and struggles with mental health.
For those trying to conceive, potential fertility or pregnancy complications are largely dependent on the size and location of the fibroid.
“Many women get pregnant and give birth with fibroids in place without complications. In patients with small size and fewer number of fibroids who is trying to get pregnant and does not have obvious risk factors for infertility, we generally encourage them to start trying and see what happens,” said Dr. Qu. “For people who already have fertility challenges, that is when intervention for fibroids might be helpful. It really is case-by-case basis and oftentimes we manage those patients with our fertility colleagues and come up with a coordinated plan based on risks and benefits.”
There had been many pregnancy and delivery complications thought to be related to fibroids, such as miscarriage, preterm labor, malposition of the fetus, fetal growth restriction, and delivery complications such as postpartum hemorrhage and fibroid near the cervix leading to obstruction of vaginal delivery. However, based on current studies, preterm labor is the only complication where association with fibroids has been shown. Other complications would be highly dependent on the size and location of the fibroids.
Treatment options for fibroids
There are many options for fibroid treatment, and some may impact future fertility, while others may not. Less invasive options include the use of medications, such as pain management with NSAIDs, menstrual regulation and suppression with hormonal contraceptives and GnRH class medications, which works by suppressing ovarian function.
There are also interventional treatments, such fibroid embolization and radiofrequency ablation, which causes fibroid cells to die, resulting in symptom relief. These generally have a faster recovery course compared to fibroid removal surgery and hysterectomy.
In terms of surgical interventions, myomectomy is the surgical removal of fibroids, and it leaves behind the uterus. However, it requires one or more incisions on the uterus, which can result in more pain during recovery as well as increased risk of bleeding and longer surgical time compared to hysterectomy. Leaving the uterus also means opportunity for fibroids to grow back.
A hysterectomy is the removal of the uterus and fibroids, which is also the most definitive treatment for fibroids as it would eliminate the symptoms as well as the risk of recurrence.
Dr. Qu says understanding a patient’s desire and plan for future pregnancy is an important part of determining what treatment option is best for them.
“A common misconception is that hysterectomy is the only treatment,” said Dr. Qu. “But there are often other options. For patients who suffer from significant fibroid symptoms but are worried about removing the uterus, I do try to reassure them as long as they feel ready, there is nothing wrong with taking out the uterus because it is one of those organs that once you’re done with pregnancy, we can remove it without negative impact on quality of life.”
