What is Fibroid?
Fibroids, or leiomyoma, are benign tumors that grow in or on the uterus, or womb, commonly affecting the female reproductive tract, especially in the reproductive age group. Female ovarian hormones; estrogens, progesterone along with several locally produced growth factors play an essential role in the development and growth of fibroids. Fibroids do have an ethnic and hereditary predisposition and are more common in African – American women.
Types of Fibroid Fibroids can be classified and described in the following types as depicted in the diagram below:
(a) Sub-serosal fibroids – outside the uterine cavity
(b) Intra-mural fibroids – in the body of the uterus
(c) Sub-mucosal fibroids – pushing on the lining of the uterus (the endometrium)
(d) Pedunculated fibroids – hanging from the uterus on a ‘stalk’
Symptoms of Fibroid An individual may be symptomatic or asymptomatic, which depends largely on the numbers, size and location of the fibroid(s).
The most common symptoms include:
• Pain during sex
• Anemia resulting from long-term or heavy bleeding
• Heavy or painful periods
• Prolonged periods
• Bleeding between periods (spotting)
• Frequent urination
• Difficulty in emptying your bladder
• Low back pain
• Feeling “full” or a mild pressure in the pelvis
• Reproductive issues, such as miscarriage, preterm labor and infertility.
• Constipation and bloating
Diagnosis of Fibroid Fibroids may be detected during a pelvic examination. Once fibroids are suspected, a systematic diagnostic approach is initiated. This consists of the clinical examination, a transvaginal ultrasound and at times, aMagnetic Resonance Imaging (MRI) of the pelvis. These tests provide comprehensive information about uterine fibroids.
- The next step is to evaluate the uterine cavity and the fallopian tubes with saline sonohysterogram (SSHG) or hysterosalpingogram (HSG).
Fibroid and Infertility
It has been reported that fibroids affect approximately 35-77% of reproductive age-women, and that most women will have fibroids during their life time. This has necessitated a better understanding of the potential relationship that exists between fibroids and infertility. In many women, fibroids won’t hurt their tendencies of bearing children, as it may stay small, or grow in locations that don’t affect the reproductive system. However, certain fibroids pose a profound effect on the ability to conceive, remain pregnant and carry a baby to term. Base on where they grow, fibroids may stop sperm and egg from uniting for conception. They can impede the ability of an embryo to implant, as they often grow in locations or to sizes that it difficult for a pregnancy to continue. They may also affect the welfare and health of the fetus.
Effects of Fibroids on Fertility Success Effects of Fibroids on Pregnancy During pregnancy, most women will experience little or no effect from fibroids. However, 10% – 30% of women whose fibroids is larger than 5 centimeterstend to develop complications, such as pain during their second and third trimesters. Fibroids may also increase your risk for other complications during pregnancy and delivery, such as:
1. Placental obstruction
2. Fetal growth restriction
3. Breech position
4. Preterm delivery
5. Cesarean delivery
Effects of Pregnancy on Fibroids: During pregnancy, fibroids may possibly grow in size due to a rise in estrogen levels or may shrink in size.
Effects of Fibroids on Fertility: Whether fibroids affect your fertility depends on the size of the uterus and where in the uterus the fibroid is located. A lot of women who have fibroids can conceive naturally, even without treatment. This is true, especially in cases whereby the fibroids stays small, or occur in areas that don’t tamper with the lining of the uterus. The effect on your fertility is much less. However, in some scenarios, fibroids can affect your fertility. If the fibroid is located on the inside of your uterus (submucosal fibroid) distorting or obstructing the uterine cavity or blocking the fallopian tubes, they are highly likely to be affecting your fertility by interfering with implantation and most specialists would recommend their removal.
Treatment of Fibroids: Before Pregnancy The treatment of fibroids before pregnancy may ameliorate your fertility risk.
The following treatments for fibroids enhance fertility:
o Hormonal birth control pills
o Myolysis o Intrauterine device (IUD)
o Gonadotropin-releasing hormone (Gn-RH) agonists
During Pregnancy The treatment of fibroids during pregnancy is limited due to the risk to the fetus. In order to manage the symptoms of fibroids; hydration and bed rest are suggested to expectant mothers. In rare occasions, myomectomy (removal of fibroids from the outside of the uterus) may be done in the second half of pregnancy.
NOTE: Each treatment has its own risk and complication; so there is need for you to talk to your doctor about your options and ask further inquiries.