Alison C., now in her 30s, was informed by a doctor that she noticed an abnormality during a routine GYN check-up when Alison was 23 years old. Although the doctor mentioned that Alison might consider surgery when she was ready to have children, it wasn’t until a few years later that Alison realized something was wrong when she noticed an increase in bathroom frequency.
“Being a teacher who learned to keep forever,” she said, “I knew something was going on when the time between trips was shortened and more frequent.” Follow-up ultrasound revealed a large fibroid near the bladder and protruding it. When she had surgery to remove them, she was surprised when doctors told her she had more fibroids: A total of five were removed, including a fist-sized fibroid atop her uterus that the doctor said would have caused infertility. It has not been removed.
As Allison experienced, fibroids are actually the most common non-cancerous tumor in women and are estimated to be the only cause of infertility in the 2%-3% of those with the condition. For people who are able to get pregnant with fibroids, the risk of miscarriage and pregnancy loss is also higher.
What are fibroids exactly?
Fibroids are benign tumors in the muscular layer of the uterus. Symptoms of fibroids can vary based on exactly where they are located in a person’s body and how large they are. For example, fibroids inside the uterus can lead to heavy menstrual bleeding, and large fibroids can worsen menstrual cramps or put pressure on other organs in the body, especially the bladder or intestines, causing pain or discomfort.
Fibroids can also cause symptoms and health conditions, such as:
- Increased frequency of urination
- bleeding between periods
- Reproductive issues
- Pain during sexual intercourse
Fibroids are very common in women, and the complications can be severe. As many as 7 in 10 white women and up to 8 in 10 black women may develop fibroids, explained Dr. Rashmi Kodisiya, a fertility specialist and member of the Women’s Health Advisory Board. “Fibroids are very common, and they occur in more than half of women depending on their racial and ethnic background,” she said. The majority of these conditions do not cause symptoms and therefore may remain undiagnosed. And in the case of people with symptoms, it often takes years before an explanation is revealed.
The relationship between fibroids and fertility
Although fibroids may cause infertility in some women, a person with fibroids may not make intercourse. This could be because their fibroids are asymptomatic, or if they were using hormonal birth control before they were ready to conceive, it could be controlling their symptoms and the growth of the fibroids. Only when they stop taking hormonal contraceptives may symptoms of fibroids appear.
From a fertility perspective, Kudesia said fibroids can interfere in many different ways. Fibroids can cause infertility — prevent pregnancy or successful implantation — or lead to early miscarriage. For example, fibroids that grow in the uterus can prevent a pregnancy from implanting successfully. Or fibroids that grow near the junction between the uterus and fallopian tubes can block the tube, preventing a fertilized egg from entering the uterus.
Fibroids may affect fertility in another way, too. In addition to creating a problem as a result of their physical location, there are also some cellular changes that come with having fibroids that may affect how implantation in the uterus occurs. Fibroids may reduce fertility by causing increased uterine contractions when an egg tries to implant, altering blood flow and causing inflammation.
How are fibroids treated?
The good news is that fibroids are highly treatable once they are identified. Kodiscia said most doctors will recommend surgically removing fibroids causing symptoms if they’re in the uterus and if they’re large enough to cause problems during pregnancy (usually larger than a pool ball in diameter). Doctors can perform a surgery called a myomectomy, which removes fibroids from the uterus but keeps the uterus itself intact. For other people, a hysterectomy — which removes the entire uterus, and sometimes the ovaries as well — would be the best option.
Depending on the size and location of the fibroids, there are several ways to shrink, destroy, or remove them, as well as reduce or stop bleeding. Options include embolization to shrink fibroids and endometrial ablation to reduce or stop heavy bleeding, medical treatments such as gonadotropin-releasing hormone (GnRH) agonists with or without hormonal therapy, GnRH antagonists with hormonal therapy, or hormonal contraceptives such as the IUD, or acid Tranexamic.
If you have fibroids, you should discuss the best course of treatment for your condition with your doctor.
How are fibroids diagnosed?
Diagnosing fibroids can be difficult, but Kudesia encourages anyone who suspects they have fibroids to talk to their HCP about ordering a basic ultrasound. And if you experience symptoms such as severe cramping, heavy bleeding, a change in urination habits, or if you have a family history of it, you should also tell your doctor. This is especially important if you are trying to conceive because the presence of fibroids can pose a risk to you and the fetus if you are pregnant.
Kudesia encourages anyone experiencing troubling symptoms to talk to their healthcare provider about the possibility of fibroids.
“If you’re worried you might have fibroids, you should definitely seek care,” she said. “It’s an easy diagnosis.”
* The last name is not used for privacy.
This resource was created with support from Myovant Sciences GmbH.
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