Uterine fibroids: Causes, treatments, & impact on fertility
Uterine fibroids are muscular tumours also called leiomyomas or myomas that form in the muscular wall of the uterus called the myometrium. According to the figures provided by the National Institute of Health, 20-40% of women stand a chance of developing uterine fibroids by the age of 50. The good news is that most fibroids are completely harmless and do not require treatment. However, if the fibroids are the reason for heavy menstrual bleeding, pain, or a negative impact on your fertility and ability to conceive, proper treatment might be necessary.
This post will explore the various aspects of fibroids, including what causes them and when they are of concern.
What are uterine fibroids?
First and foremost, almost all typical uterine fibroids are benign, meaning they are not cancerous. The fibroids can develop in several different locations in your uterus, including on the outer surface, inner surface, or even within the muscular layer of the uterus called the myometrium.
While some fibroids are solitary, some others can grow in groups of a few smaller tumours called clusters. These fibroids‘ size can also vary a great deal ranging from a few centimetres to as big as a grapefruit in some cases. The development and growth of uterine fibroids depend on two key hormones- estrogen and progesterone.
Both these hormones are responsible for stimulating the growth of the uterine lining during the proliferative phase of your menstrual cycle. The levels of these hormones dictate how many fibroids you might have and how big they are going to get. The size and the number of uterine fibroids tend to decrease after menopause as the availability of both estrogen and progesterone declines.
Depending on the location of these tumours in the uterus, the fibroids can be classified into the following types-
- Intramural fibroids- These generally grow inside the muscular wall of the uterus
- Submucosal fibroids- These typically grow inside the uterine cavity
- Subserosal fibroids- These grow on the outside of the uterus
Out of the three types of fibroids, the submucosal fibroids are likely to hamper your fertility as they grow inside the uterus cavity, where implantation is supposed to happen.
Who gets uterine fibroids?
You can develop uterine fibroids. However, certain contributing factors can increase your chances of getting the fibroids-
- Familial history- If your mother had fibroids, you are as much as three times more likely to get them yourself.
- Weight- If you struggle with being overweight, it can also increase your chances of developing uterine fibroids. Women who are overweight have an increased amount of estrogen that can contribute significantly to developing fibroids.
- Race – It is generally observed that black women tend to develop more uterine fibroids that are larger and in number than women of any other race. Black women also tend to develop them at a younger age compared to women of other races.
- Other risk factors- If you had your first period early, you might stand a higher chance of developing uterine fibroids. A diet deficient in vitamin D can also cause the development of fibroids in young women. What you eat also affects the chances of developing fibroids. Women eating higher amounts of red meat and low amounts of fresh fruits and veggies tend to have higher incidences of such tumours.
Symptoms of uterine fibroids
Many women who have fibroids might not have any symptoms at all. However, in some cases where the symptoms are present, here is a list to look out for.
- One of the most common symptoms of uterine fibroids is heavy bleeding during your menstrual periods. In some cases, you might even experience bleeding in the middle of your menstrual cycle as well.
- As a result of a heavier flow during menstruation, some women might also experience anemia (a low amount of hemoglobin in the blood).
- Pain and cramps during and before periods are also quite common with uterine fibroids.
- Some women also report having difficulty in urinating and moving their bowels due to uterine fibroids. That said, these symptoms arise only if the location of fibroids is such that it puts pressure on the bladder or colon.
Your doctor can easily identify whether you have any fibroid is to perform a routine pelvic exam. That said, if you are experiencing the symptoms mentioned above, please talk to your doctor for a thorough checkup. Your doctor might use an ultrasound machine to locate the fibroids.
Treating Uterine myoma
One of the top reasons for developing uterine fibroids is the excess estrogen and progesterone, as these hormones are important for them to grow.
Early diagnosis is always a good thing for any disease, including uterine fibroids. So, if you have any symptoms that we mentioned above, or if you have a family history of fibroids, make sure that you have a conversation with your healthcare provider. There are multiple treatment options to treat uterine fibroids, and your doctor might help you pick a treatment that suits your needs.
Some of the treatment options that are most commonly employed include the following-
- Waiting- It might not sound like a treatment plan, but the best approach to tackle uterine fibroids in many asymptomatic cases is to wait and watch. Your doctor might not intervene medically if the fibroids are small and you have no symptoms. That said, you might need to get a few tests here and there to keep an eye on how things are progressing.
- Medication- If you have excessive bleeding or pain symptoms, your doctor might start you on hormone-targeting medicines to get the symptoms under control. In many cases, the doctors might prescribe a birth control pill to prevent the growth of the fibroids and even to check the heavy menstrual bleeding.
- Surgery- Minimal invasive surgery performed by a laparoscope might be employed to address some fibroids. One such procedure is embolization, in which the blood supply to the fibroid is cut off, causing it to starve. As it does not receive any nutrients and no hormones are available to stimulate its growth, the fibroid shrinks gradually. In some cases, it might be advisable to remove the entire uterus, so there is no chance of developing any fibroids in the future. The process by which the uterus is surgically removed is called hysterectomy. As the uterus is essential to conceive, women who have had a hysterectomy done won’t be able to have children in the future. That said, hysterectomy is not necessary in all cases of fibroids. Your doctor might get the fibroid removed by a minor surgery called a myomectomy.
Can fibroids impact fertility?
It is possible to get pregnant and carry the baby to a full term even if you have uterine fibroids. According to a recent study, only 1-2.4% of women having fertility issues had them due to uterine fibroids. However, there can be an impact of fibroids on your fertility, including the following-
- The fibroids might cause a change in the shape of your cervix. It might be difficult for the sperm to swim across the cervix to fertilize the egg in the fallopian tubes if that happens.
- Fibroids, especially if they are bigger, can change the shape of your uterus, making it inhospitable for the embryo.
- The entry to the fallopian tube might be blocked off fully or partially by fibroids making it difficult for the sperms to swim to the egg.
- Fibroids can modify how your uterus receives blood supply impacting its ability to support the fetus.
If you are trying to get pregnant and have any concerns or questions regarding uterine fibroids, talk to your doctor right away, especially if you have a family history of fibroids.
Now that you have a basic understanding of how uterine fibroids develop and their impact on fertility, you can be better prepared to deal with them. The journey to motherhood can be treacherous at times, but with the right support and help, you can get there! Remember, there is always help if you have any doubts or concerns.