Fibroids: Do they affect fertility?
When do these non-cancerous tumors affect reproductive ability and how are they treated? What women need to know and why there is no reason to panic.
Many women, upon hearing the word “fibroid” from their gynecologist, panic and imagine the worst. However, there is no reason to worry. Fibroids are quite common, and their diagnosis is often made incidentally during a gynecological exam. They are non-cancerous tumors that develop in the wall of the uterus, a very common condition, since it is estimated that 2 out of 10 women of reproductive age will develop fibroids.
“The size of fibroids can vary significantly, ranging from a few millimeters to many centimeters, with large masses pressing against nearby abdominal organs. In fact, they can range from a single fibroid to dozens of different sizes,” explains Sotirios Trompoukis, obstetrician–gynecologist surgeon.
It is also important for women to know that over time, fibroids may grow, shrink, or even disappear. Fibroids are sensitive to estrogen produced by the ovaries. They tend to grow when estrogen levels rise, such as during pregnancy, and shrink when levels drop, such as during menopause.
About two-thirds of women with fibroids do not experience symptoms. However, some women may suffer without knowing the cause. These women may experience painful periods, abdominal or pelvic pain, constipation, urinary problems, and pain during sexual intercourse.
The signs that fibroids may cause include heavy menstrual bleeding (menorrhagia) and painful periods. In fact, excessive blood loss can lead to anemia.
Other symptoms of fibroids include bloating, abdominal swelling, and back pain. They can also cause frequent urination or constipation. A fibroid, usually a large one, may create pressure effects — either on the bladder, causing frequent urination, or on the colon, causing constipation. When fibroids are located low near the vagina or cervix, they may cause pain during sexual intercourse.
The exact cause of fibroids remains unclear, but evidence suggests a combination of genetic, hormonal, and environmental factors. It is estimated that women with a family history of fibroids are twice as likely to develop them compared to those without. Other risk factors include age (more likely after 40), obesity, hypertension, low vitamin D levels, and not having children.
The primary diagnostic method is ultrasound, usually transvaginal. In cases of very large fibroids, abdominal ultrasound is also helpful.
Regarding the impact of fibroids on fertility — a concern for younger women — fibroids are found in 10% of infertile women. Certain types of fibroids reduce reproductive ability and affect a woman’s chances of conceiving. Sometimes, they are associated with recurrent miscarriages.
Submucosal fibroids, in particular — because of their growth into the uterine cavity — reduce fertility by up to 70%. These fibroids distort the uterus and interfere with normal embryo implantation.
What about fibroids during pregnancy? They are likely to increase in size but usually do not cause complications, although cases of miscarriage or preterm labor have been reported. In addition, very large fibroids may obstruct natural childbirth, making cesarean delivery necessary. It should be noted that fibroid treatment is avoided during pregnancy.
Fibroid removal
Surgical treatment is recommended for women with submucosal fibroids who struggle to conceive, either naturally or through in vitro fertilization (IVF). Studies show that after fibroid removal, infertility issues are resolved. However, the gynecologist will determine whether surgical removal is necessary. In the past, doctors performed abdominal myomectomy (open laparotomy), where the surgeon removed the fibroids through an abdominal incision. This procedure required a 72-hour hospital stay, and the woman returned to her activities within four to six weeks.
Today, specialized and experienced gynecologists prefer laparoscopic removal. The doctor inserts a laparoscope (camera) into the abdomen through a small incision near the navel. Then, surgical instruments are inserted through small 5–10 mm incisions to remove the fibroids. The woman can usually be discharged within 24 hours and fully resumes her activities within two to seven days.
Sotirios Trompoukis
Obstetrician – Gynecologist
www.sotiristrompoukis.gr
(Source: Dimokratianews)