If you have been diagnosed with fibroids, you are not alone. 34.65% of rural women and 24% of urban women in India are likely to be affected by uterine fibroids, at some point, during their reproductive age.
In this article, Dr Prachi Benara, a leading infertility treatment specialist at Birla Fertility & IVF, provides an overview of fibroids in uterus.
What are Uterine Fibroids?
Fibroids in uterus are tumours (usually non-cancerous) that grow in varying shapes and sizes – from the size of a seed to the size of a grape. The chances of a fibroid turning cancerous are extremely rare.
Majority of uterine fibroids, usually, do not show any symptoms. In most case, they are discovered accidentally during a regular gynaecological screening or testing for another condition such as a pelvic examination or an ultrasound during pregnancy can highlight fibroids.
Uterine fibroids are categorised into three types, based on their location – Intramural fibroids: As the name suggests, intramural is the type of fibroids that grow inside the muscles of the uterus.
- Subserosal Fibroids : These fibroids appear on the outside of the uterus.
- Submucosal Fibroids : Submucosal fibroids grow under the uterine lining and inside the uterine cavity.
Uterine Fibroids Size Chart
The size of uterine fibroids may differ from one patient to another based on the severity of the condition. Refer the below table to under the classification basis on the size and measurements:
| Fibroid Size | Measurements |
| Small uterine fibroid | Less than 1-5 cms |
| Medium uterine fibroid | 5-10 cms |
| Large fibroid | 10 cms or more |
What are the Uterine Fibroids Symptoms?
As stated before, most women who have fibroids do not usually display any symptoms. However, there are some common and often painful fibroids symptoms. These include:
- Heavy bleeding and painful periods
- Bloated abdomen
- Menstrual periods lasting longer than a week
- Bleeding between periods
- Frequent urge to urinate
- Difficulty in emptying the bladder
- Painful sexual intercourse
- Lower back pain
- Pain in the legs
- Pelvic pain and pressure
Fibroids can cause or increase the effects of anaemia. If you always feel light-headed and dizzy, it could be due to frequent blood loss from uterine fibroids leading to a deficiency in iron. Untreated fibroids can also cause infertility and recurrent miscarriages. Nevertheless, it is highly unlikely that uterine fibroids remain undiagnosed during your pregnancy.
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What are the Uterine Fibroids Causes?
Uterine fibroids causes are not well-known despite advances in medical research. However, some factors that increase your chances of developing fibroids have been identified.
Majority of uterine fibroids, usually, do not show any symptoms. In most case, they are discovered accidentally during a regular gynaecological screening or testing for another condition such as a pelvic examination or an ultrasound during pregnancy can highlight fibroids.
Risk Factors for Uterine Fibroids Include :
- Genetic Factors : Gene mutations can cause the formation of uterine fibroids. This condition can also be inherited from close relatives. If members in your family have had fibroids, there is a higher chance of you being affected as well.
- Lifestyle Factors : A sedentary lifestyle that promotes obesity is also considered responsible for uterine fibroids. If you are overweight, chances are that you can develop this condition.
- Hormonal Imbalances : Hormonal imbalances can be attributed to uterine fibroids causes. An imbalance in the levels of estrogen and progesterone can trigger this condition. These hormones are also responsible for stimulating the development of the uterine lining.
- Age : Fibroids can affect women within the reproductive age group. Women who are yet to reach menopause and are above the age of 40 have a higher prevalence of fibroids.
How do I know if I have Fibroids?
As discussed above, uterine fibroids symptoms are not always clear. Some women have asymptomatic fibroids. If you do not have any obvious visible symptoms, your fibroids treatment can be delayed.
Medical experts order a variety of tests and screenings to diagnose fibroids.
Testing for Uterine Fibroids Treatment
Pelvic Exam : Doctors can identify the presence of fibroids by performing an internal examination of the pelvis. A pelvic exam is a manual analysis in which a medical doctor inserts two fingers into your vagina opening and presses your abdomen to get an idea of the shape and condition of the uterus. If you have fibroids, your uterus might seem larger or abnormally shaped.
If your doctor suspects that you may have fibroids, they may order the use of imaging techniques such as an ultrasound or MRI to get a better view of your uterus.
Ultrasound Scan : Ultrasound scan includes using high-frequency sound waves to get a clear image of the fibroids in the uterus. The size and shape of fibroids are identified using this technique.
MRI (Magnetic Resonance Imaging) : Like ultrasound, MRI uses magnetic waves to create a better image of the internal body parts. MRI is used if you have a large uterus and if you are approaching menopause.
If these methods are not helpful to diagnose your condition, other invasive methods including laparoscopy, hysterosonography, hysterosalpingography and hysteroscopy can be used.
Can Fibroids Definitely Cause Infertility?
A diagnosis of fibroids does not necessarily mean that you will face infertility due to this condition. However, fibroids can be a possible reason for sub-fertility or cause difficulty in conception.
Large-sized fibroids projected inside the uterine cavity can affect the natural process of fertilisation of an egg and sperm in the uterine cavity. Large fibroids can also hamper the implantation of the embryo leading to conception difficulties.
How do Fibroids Cause Infertility?
Based on the type and size of fibroids, they can impact your overall and reproductive health. Some complications caused due to fibroids include:
Concerns During Conception
Uterine fibroids can cause problems related to fertility based on their shape, size and location inside the uterus. If you have large fibroids, they could block the fallopian tubes and make it difficult for an egg to fuse with sperm.
Fibroids can change the shape of the cervix and affect the number of sperm entering the uterus. If there is a change in the shape of the uterus, the movement of sperm or embryo towards the uterine wall will face obstacles. Blood flow to the uterine cavity can also be affected. This can decrease the ability of an embryo to implant in the uterine wall or to develop.
Concerns During Pregnancy (after conception)
Fibroids can cause complications during pregnancy and delivery. These complications are associated with the obstruction caused in the uterine cavity due to the growth of fibroids.
Large fibroids can cause restrictions in the growth of the baby, restricting the baby to not grow to its normal size.
Preterm Delivery
Pain from fibroids causes uterine contractions leading to preterm delivery. Based on your physical condition and the doctor’s analysis, fibroids are removed to avoid early delivery.
Require Delivery Using a Cesarean Section
Fibroids can change the baby’s position in the uterus and cause problems during delivery. In such a situation, a cesarean section might be needed.
Miscarriage
The baby is connected to the mother via the placenta. The placenta can break away from the uterine wall due to blockage caused by a fibroid.
These are some of the complications that could arise due to fibroids. It is highly recommended that you consult your doctor as soon as you discover atypical symptoms. Each woman is unique and treatment must be administered accordingly.
What is Uterine Fibroids Treatment?
Your healthcare provider will evaluate several factors to determine the appropriate uterine fibroids treatment. Factors considered for fibroids treatment are:
- Your age
- The severity of fibroid symptoms
- Size, shape and number of fibroids
- Your plans for pregnancy in the future
- Your overall health
- Your personal medical history
Various treatment options exist and it is best to discuss with your doctor and decide on the way ahead.
Uterine Fibroids Treatment Options
Watchful Waiting :
If you have been diagnosed with fibroids but the symptoms are mild and do not cause much pain, your doctor may advise you to wait and watch before opting for any treatment. Mild fibroids do not cause complications with pregnancy. Their symptoms also subside on their own in due time. However, during active surveillance, your doctor will closely monitor your condition and look out for problematic symptoms.
Medicinal Treatment :
Before opting for surgical procedures, you can opt for hormonal therapy. Hormones can are injected by different methods to reduce the size of the fibroids and relieve your pain. Your healthcare provider can guide you to prepare for pregnancy using hormones.
Fibroids can grow with the help of a hormone called estrogen. Certain hormones can inhibit the production of estrogen in ovaries and slow down the growth of fibroids or even cause them to shrink in size.
Surgery to Treat Fibroids :
Surgery is often indicated as a last resort to cure fibroids. Your medical expert will recommend surgical intervention for the fibroids if your symptoms are severe and cause extreme pain and discomfort. Various surgical procedures are available that range from removal of fibroids to removal of the whole uterus.
Some of the common surgeries for uterine fibroids treatment are:
Uterine Artery Embolization : Tiny particles are inserted into your uterus to cut off the blood flow to the fibroids. This procedure is minimally invasive but may cause some discomfort for which medicines are prescribed.
Myomectomy : Myomectomy is a procedure to permanently remove large-sized or multiple fibroids in uterus. This surgery must be performed 3 months before you would like to try for pregnancy to allow for the scars to heal. It is in the best interest of the patient to plan ahead if they may want to opt for myomectomy. This procedure can be performed as keyhole surgery or hysteroscopy with minimal surgical cuts depending on the site of the fibroid.
Hysterectomy : Hysterectomy is a procedure to surgically remove the entire uterus. This procedure is prescribed only if you do not want to conceive again, since removing the uterus would result in infertility.
Fibroids treatment is based on your individual condition. You and your partner, both, should have a thorough fertility evaluation and discuss the issue with your doctor. While there are many different treatment options only surgery, often minimally invasive, can eliminate any given fibroid permanently.
Self-Care : Mild symptoms of uterine fibroids can be managed easily. A few lifestyle moderations can help you in alleviating these symptoms. Here are some measures you can take to promote self-care for fibroids.
Eat a Balanced Diet – A proper well-balanced and nutrition-based diet can improve your general health. It can help to minimise hormonal imbalances that are caused due to an unbalanced and poor diet.
Use a Hot Water Bag – You can reduce the bloating and pain associated with fibroids by using a hot water bag. By applying heat to your lower abdomen, you can improve blood circulation and be relieved from pain.
Exercise Regularly – It is beneficial to moderate exercise most days of the week. Some amount of physical activity can improve your overall health and promote blood flow.
Other techniques that can help in providing relief from pain are yoga, acupuncture and pranayama.
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Summary
The journey to becoming a parent begins with a single step. However, conditions such as fibroids can come in the way of this beginning. Uterine fibroids are common and can affect fertility in many ways. They can affect the fertilisation, implantation and cause various pregnancy complications.
Fibroids treatment is very case-specific. It is based on factors such as the symptoms of fibroids and their effect on fertility. If you are facing any of the fibroids symptoms or having trouble in conception, consult an infertility treatment specialist today.
