Uterine Fibroids: What Do They Mean for Your Fertility?
Uterine fibroids are painful growths that are estimated to affect approximately 70% of women [1. https://www.ncbi.nlm.nih.gov/pubmed/12548202]. Similar to other painful illnesses like endometriosis, the effects of uterine fibroids range from no symptoms at all to excruciating pain and can be detrimental for your fertility depending on where and how they grow.
To help better understand this condition and its impact on your reproductive health, this post will cover:
- What are uterine fibroids and how do you know if you have them?
- Who is at risk for developing these growths?
- What do they mean for fertility?
- What are long-term complications of these growths?
- How can they be treated?
What are uterine fibroids?
Uterine fibroids (aka leiomyomata) are non-cancerous growths found in the uterus and can vary considerably in their presentation:
- Size: Anywhere from microscopic to big enough that they enlarge or even distort the shape of the uterus.
- Number: Anywhere from singular instance to several growths.
- Location: Can be found directly on the inner uterine wall and growing into the uterine cavity, within the uterine wall, directly on the uterine wall, and/or attached via a stem on the outer uterine wall and growing outside the uterine cavity.
- Growth: Can grow slowly over time or can remain small for a long time and suddenly grow rapidly.
What are uterine fibroids symptoms?
If you notice any of the following symptoms, talk to your doctor about whether you might have these growths:
|The Clue:||What to Look For:|
|Your period||Longer menstruation, heavier flow|
|Cramps||More intense cramps than usual|
|Bloody vaginal discharge||Bleeding (more than spotting) outside of your period|
|Back/abdomen pain||Dull, heavy aching in the abdomen and/or lower back|
|Discomfort during sex||Intense pressure or pain|
|Urination||Urinating more or less frequently than usual|
|Bowel Movements||Constipation, painful or difficult bowel movement|
It’s important to know that approximately 50% of uterine fibroid cases are asymptomatic or have no symptoms at all [2. https://www.ncbi.nlm.nih.gov/pubmed/18375184], so it’s certainly possible to have these growths without knowing. In this case, you might incidentally find out during a pelvic or abdominal exam that these growths are present, and your doctor will likely recommend no treatment unless they become symptomatic.
Why do uterine fibroids happen?
Researchers are still trying to figure out exactly why uterine fibroids happen, but research points to two main factors:
- Hormones: High levels of estrogens and progesterone stimulate uterine fibroid growth, so they can grow during pregnancy and shrink after giving birth. Also, when these hormone levels drop after menopause, uterine fibroid growth also reduce. BUT, it’s not as simple as more hormones means more growths. In fact, low doses of hormones, like the oral contraceptive pill, can actually help reduce fibroid growth. More research about the relationship between hormones and this condition is definitely needed.
- Genetic factors: Family history of fibroid growths and genetic background increase the likelihood of these fibroids growing.
What are risk factors for uterine fibroids?
Here are the significant facts the increase the risk for uterine fibroids [3.] :
- Racial background: African women are two- to three-times more likely to suffer from uterine fibroids than Caucasian women.
- Age: Premenopausal women between the ages of 25 – 44 are more likely to experience these growths, and the risk increases with age within this group.
- Blood pressure: Hypertension (high blood pressure) increases risk.
- Family history
- Soy consumption
How are uterine fibroids detected?
Your doctor can determine whether you have these growths during a pelvic exam or via ultrasound. Your doctor may also use a hysteroscopy, or a camera that can be inserted vaginally to visualize the inside of the uterus and locate the fibroids.
How are uterine fibroids treated?
There are three main categories of treatment options for uterine fibroids:
- Pain management: If the growths are mild, your doctor may suggest using over-the-counter pain relievers like ibuprofen or acetaminophen to manage the pain. It’s important to know that if you’re trying to conceive and need to manage pain, it is recommended to avoid NSAIDs during implantation and use acetaminophen-based drugs like Tylenol instead.
- Hormone-based treatments: Treatments using hormones like the oral contraceptive pill or gonadotrophin-releasing hormone agonists can reduce uterine fibroids. However, these options would also significantly reduce your chances of becoming pregnant.
- Surgery: Depending on the severity of the fibroids, your doctor may recommend a surgical procedure call a myomectomy, or surgically removing the uterine growths. However, there is still a risk of recurrent growth, so surgery isn’t always a permanent solution. In extreme cases where the growths are very large and all other treatment options are exhausted, a hysterectomy (surgical removal of the uterus) can be performed to ultimately remove all the growths. However, this would result in permanent infertility because it’s not possible to become pregnant without a uterus. Keep in mind that this is a last-resort option that your physician would discuss with you.
If I have uterine fibroids, does that mean I’m also infertile?
Not necessarily. In fact, many women go on to become pregnancy naturally while having uterine fibroids. However, depending on how and where they are growing, they can be harmful for your fertility.
If the fibroids are submucosal, or growing on the inner wall of the uterus and into the uterine cavity, then they could disrupt implantation and embryo growth, resulting in infertility or pregnancy loss. Also, if the fibroids are large enough to distort the structure of the uterus, this can result in poor fertility outcomes regardless of whether they are growing into the uterine cavity or in the uterine wall. While it was originally thought that fibroids growing out of the uterus spared fertility, new research indicates that these fibroids are linked to reduced IVF success, so more research about this type of fibroid growths is needed [3. https://www.ncbi.nlm.nih.gov/pubmed/25482490].
The bottom line? If you’ve been diagnosed with uterine fibroids and have been struggling with infertility, it’s possible to become pregnant with or without surgical removal of these growth. Surgery doesn’t necessarily guarantee improved fertility changes [4. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012362/], but it’s definitely an option, so it’s important to consult with your doctor first to assess how likely uterine fibroids are contributing to your infertility and decide what is the best option for you.
Do uterine fibroids increase pregnancy complications?
Giving the rise in pregnancy hormones, one serious complication in early pregnancy is that the uterine fibroids grow and disrupt the progression of the pregnancy. While having uterine fibroids does not constitute a high-risk pregnancy, it can increase risk for placenta complications, needing C-section, and pre-term delivery can increase. If you’ve been diagnosed with uterine fibroids, talk to your doctor so they can monitor your pregnancy and fibroid growth.
Do uterine fibroids increase the risk of uterine cancer?
Uterine fibroids are almost always benign, aka non-cancerous, growths. In very rare cases (less than 1 in 1000), a fibroid can be cancerous. To date, uterine fibroids are not considered a significant risk factor for uterine cancer, but researchers are trying to bettter understand the relationship between both conditions.