Have Fibroids? Freaked Out About Your Fertility? Don’t Worry!

It can be very stressful to hear you have a fibroid. I see a lot of patients who have fibroids and while some of these fibroids can impact fertility, not all of them do. If you have received a fibroid diagnosis and are feeling a bit freaked out, take a deep breath. In this blog we’ll discuss what fibroids are, as well as whether it’s better to treat them or leave them be.

Fibroids are benign (non-cancerous) growths of muscle in the uterus. These muscle cells grow into a ball which can be seen on ultrasounds.  They are extremely common. In fact, approximately 50-70% of women will get a fibroid in their uterus during their lives and most do NOT need any treatment or intervention. Very, very rarely - less than 1 in a 1,000 - they can be cancerous.

Who is at risk for fibroids?  Women who have a family history, African American women, women who are obese, or women who eat a lot of beef can be at higher risk for fibroids. That pretty much covers everyone, right? Like I said, they are extremely common. If you don’t have them, the chances are that several women you know do.

There are three main types of fibroids – those that occur on the outside of the uterus, those that occur within the uterine muscle layer, and those that occur within the cavity of the uterus. Often fibroids are small, but can get very large.

Large fibroids can be the source of several uncomfortable problems. They can often put pressure on the bladder or bowels, causing issues with going to the bathroom and even a back-up of urine in your kidneys. Intercourse can be painful sometimes for those large fibroids. Women with large fibroids can look like they are a few months pregnant if the fibroids grow so large they reach the belly button. When fibroids cause bloating or put pressure on the organs, it is best to have them removed.

Fibroids that grow in the muscle layer, if large enough, can distort the shape of the uterine cavity. It is unclear if this can cause infertility issues.

Even if there are small fibroids within the inside of the uterus, they can present a potential problem. Small fibroids in the wrong area can block your fallopian tubes, preventing the egg from reaching the uterus. They also can cause inflammation and prevent an embryo from implanting into the uterus and attaching to the uterine wall. Often women experience very heavy, painful periods and can bleed so much they become anemic. If you have a fibroid in the inside cavity of the uterus and you are trying to get pregnant, you should talk with your doctor about having it removed.

I am often asked if there is medicine to treat fibroids. There are some medicines that can help shrink the fibroids, but as soon as those medications are stopped, they typically grow back. Some doctors like to use these medications for a few months before surgery to make the procedure easier and safer.

Medication will not make fibroids go away; surgery is the only way to remove fibroids. For small fibroids inside the cavity of the uterus, they can be removed with a hysteroscopy or a camera in the uterus through the vagina. Larger fibroids can be removed with a larger incision or with a laparoscopy (camera in the belly button). This larger surgery can result in larger amounts of blood loss or scar tissue around the fallopian tubes.

Typically, after fibroids are removed though the uterus via hysteroscopy, you can start trying for a baby right away and have a vaginal delivery. If larger fibroids are removed either with a laparoscopy or larger incision, you may need to wait a few months to try to get pregnant. A cesarean section for delivery will likely be necessary due to the weakening of the muscles after surgery.

If a doctor sees a fibroid, how do they know if it is inside the cavity?  A special ultrasound called a saline infusion ultrasound can be done to determine if the fibroids are within the cavity of the uterus, where the baby will need to develop. This is done shortly after a menstrual period. The doctor will insert some saline into the uterus while doing an ultrasound. This opens up the cavity to see where the fibroids are located.

Again, most fibroids do not need to be removed and do not cause problems. It really depends on how big they are and where they are located. Your doctor should be able to help determine what, if anything, needs to be done. Before you freak, remember there are a lot of medical professionals out there who can guide you and lessen the symptoms and effects of fibroids.







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