With over 70% of women worldwide being affected by uterine fibroids, they are the most common tumor in women of reproductive age. In this comprehensive guide, we’ll cover everything you need to know about fibroids — what they are, how they affect fertility, the various types, and potential treatment options.
How do uterine fibroids affect female fertility?
Uterine fibroids (leiomyomas) are noncancerous growths that develop in or around the uterus, often during a woman’s childbearing years. Fibroids may grow quite large and often vary in size and number. Some women might have a single fibroid, while others might have multiple fibroids of varying sizes.
While many women with fibroids have no symptoms, others may experience heavy menstrual bleeding, prolonged periods, pelvic pressure or pain, frequent urination, and constipation. The symptoms largely depend on the size, location, and number of fibroids.
Fibroids can impact female fertility and pregnancy in several ways, but it’s important to note that many women with fibroids can still conceive and carry a pregnancy to term. However, fibroids can sometimes cause complications. Here’s how:
- Distortion of the Cervix or Uterus: Fibroids can change the shape or size of the cervix, affecting the number and movement of sperm entering the uterus.
- Blockage of the Fallopian Tubes: If fibroids develop so that they block the fallopian tubes, they can make fertilization and implantation difficult or even impossible.
- Impact on the Blood Supply to the Embryo: Fibroids in the uterine wall can impact the uterus’s ability to contract, influencing blood flow to the embryo, which can hinder growth and development.
- Influence on the Uterine Lining: Submucosal fibroids, which develop just underneath the inner lining of the uterus, can disrupt the uterine lining and affect the embryo’s implantation.
In the research paper “Optimal approaches to fibroid management,” published by RMA doctors Scott Morin, MD, and William Schlaff, MD, it states that while many hypotheses have been proposed to explain how fibroids may affect fertility, “fibroids alone are often not the only identifiable cause of infertility.” A recent analysis found that when you exclude all other causes of infertility, fibroids are found in only 1-2% of patients.
It’s important to discuss any concerns about fibroids and fertility with a Reproductive Endocrinologist (fertility doctor), as there are many effective treatments and strategies to manage fibroids in women seeking to become pregnant.
Can uterine fibroids cause female infertility?
While many women with uterine fibroids can conceive naturally and have a healthy pregnancy, fibroids can cause female infertility in some cases.
The types of fibroid that would affect a woman’s fertility may:
- Block the fallopian tubes
- Alter the shape and size of a woman’s uterus
- Interfere with the transportation of sperm, eggs, and embryos
- Hinder embryo implantation
Can you get pregnant with uterine fibroids?
Many women with uterine fibroids can still conceive and have normal pregnancies. Depending on the number of fibroids and their size and location, they may increase the risk of miscarriage, preterm delivery, and specific complications during pregnancy and labor.
What are the various types of uterine fibroids?
The various types of fibroids are:
- Intramural fibroids are the most common type and develop within the uterus wall. Intramural fibroids can grow large, causing the uterus to expand.
- Subserosal fibroids grow on the serosa (outer wall of the uterus). They can increase in size to the point where they begin to push on the bladder or rectum, causing urinary or constipation issues.
- Submucosal fibroids are the least common type and grow beneath the uterine lining (endometrium). Submucosal fibroids can distort the uterine cavity, which can sometimes cause problems with fertility and pregnancy.
- Pedunculated fibroids grow on a stalk into the uterine cavity or outside the uterus. They can sometimes twist, leading to severe pain.
- Cervical fibroids grow in the cervical tissue. They are rare compared to other types.
Uterine polyps vs. fibroids
Uterine polyps and fibroids can develop in or on the uterus, but they are distinct in several ways.
Uterine polyps are overgrowths of cells in the lining of the uterus (the endometrium). These growths are usually small, about one-tenth of an inch, similar to a sesame seed, to about one and a half inches, equivalent to a golf ball.
Uterine polyps attach to the uterine wall by a thin stalk or base. They can cause irregular menstrual bleeding, bleeding between menstrual periods, heavy menstrual bleeding, and even infertility in some cases.
Uterine fibroids are tumors that grow within the muscle tissue of the uterus. They can range in size from tiny and nearly undetectable to large masses that can distort the shape and size of the uterus.
Fibroids are categorized based on their location: intramural (within the uterine wall), subserosal (on the outer wall of the uterus), submucosal (beneath the uterine lining), or pedunculated (attached to the uterus by a stalk-like structure).
Fibroids can lead to symptoms such as heavy and prolonged periods, pelvic pressure or pain, frequent urination, constipation, and complications during pregnancy and labor.
While both uterine polyps and fibroids can cause similar symptoms, they differ in their location, composition, and the way they grow. Polyps are generally soft pieces of tissue, while fibroids are harder and denser masses.
Can uterine fibroids be cancerous?
It is exceedingly rare for fibroids to be cancerous. The condition, known as leiomyosarcoma, is not thought to arise from pre-existing fibroids.
Can uterine fibroids cause other issues like digestive problems or gastritis?
Uterine fibroids can cause pressure on the bowel, leading to constipation and bloating. However, they’re unlikely to cause gastritis, which is stomach lining inflammation. Neither of these symptoms would affect your fertility in any way.
Can uterine fibroids cause back pain?
Yes, uterine fibroids can cause back pain. If the fibroids grow large and press on specific nerves or the spine, they can result in discomfort or pain in the lower back.
Can uterine fibroids cause weight gain?
While uterine fibroids themselves don’t directly cause weight gain, the presence of large fibroids can sometimes lead to a noticeable increase in the size of the abdomen. It can often be mistaken for weight gain or bloating, especially if the fibroids grow large.
Additionally, some women with fibroids may experience heavy menstrual bleeding, which can lead to anemia. In response to the fatigue and lower energy levels associated with anemia, some people may decrease their physical activity level, which could contribute to weight gain over time.
Lastly, some hormonal therapies used to manage symptoms of fibroids can potentially lead to weight gain as a side effect.
However, it’s important to note that these scenarios don’t apply to everyone with fibroids. Many women with fibroids don’t experience these issues.
Being overweight in general (having a BMI over 30) can potentially affect your fertility, but the weight gain associated with fibroids is insufficient to be a problem.
Do uterine fibroids go away on their own?
Fibroids may not need treatment if they’re not causing symptoms, and some fibroids may even shrink or disappear on their own, especially after menopause. Fibroids often rely on the body’s production of estrogen and progesterone to grow, and hormone levels decrease with age. Specifically, during menopause, fibroids often reduce in size and may even disappear.
If you want to conceive, you’ll want to speak with a fertility doctor or OB/GYN about your uterine fibroids immediately.
Can uterine fibroids burst?
Fibroids are typically solid, benign growths, and the concept of a fibroid “bursting” or “rupturing” isn’t something that generally happens. However, fibroids can undergo a process known as degeneration, which can cause severe pain and discomfort.
Degeneration happens when a fibroid outgrows its blood supply. Parts of the fibroid can die off without sufficient blood, leading to degeneration which can cause severe pain, fever, or an increase in the size of the fibroid or uterus.
Fibroid Degeneration and Fertility:
While painful and uncomfortable, fibroid degeneration does not directly affect a woman’s fertility. The presence of fibroids- especially submucosal fibroids that grow into the uterine cavity – can affect fertility by changing the shape of the uterus, blocking the fallopian tubes, or interfering with the implantation of an embryo.
What are the causes of uterine fibroids?
It is unknown what causes uterine fibroids, but research suggests that factors such as reproductive hormonal changes over a long period of time (estrogen and progesterone), starting periods early in life (<10 years old), genetic alterations, increased body mass index (BMI), and changes in the extracellular matrix (a substance that makes cells stick together) of the muscle layer of the uterus (myometrium) are risk factors for developing fibroids.
It is important to know that hormonal contraception (oral, injectable progestins, or intrauterine devices) is not associated with fibroid growth. In addition, fertility-enhancing strategies such as ovulation induction and in vitro fertilization do not stimulate the growth of fibroids either.
What are the symptoms of uterine fibroids?
Uterine fibroid symptoms don’t present themselves for all women. Those who experience symptoms may include heavy menstrual bleeding, prolonged periods, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, and constipation.
How does a fertility doctor diagnose uterine fibroids as a cause of female infertility?
To detect and diagnose uterine fibroids, a fertility doctor (reproductive endocrinologist) may use pelvic exams, ultrasounds, hysteroscopy, hysterosalpingography, or an MRI. These procedures may be performed to determine the fibroids’ size, number, and location. Your OB/GYN may also perform some tests before referring you to a fertility specialist.
Will fertility treatments work if I have uterine fibroids?
Most fertility treatments are available to women with fibroids. If the fibroids do not impair the uterine cavity, then treatments like in vitro fertilization (IVF), intrauterine insemination (IUI), or ovulation induction (OI) are options that are often very successful.
If the fibroids are affecting your fertility, surgical and/or medical interventions may need to be performed before fertility treatment to remove or reduce the size of the fibroids.
Treatment Options for Uterine Fibroids
If fibroids are affecting your fertility, they may require surgery before moving on to fertility treatment. In this case, a myomectomy procedure may be performed to remove the uterine fibroids without causing harm to the uterus.
A myomectomy can be performed safely in different ways, depending on the size, location, and number of fibroids. The least invasive myomectomy is through a hysteroscope (a camera placed in the uterus to visualize the endometrial cavity) which would be able to remove submucosal fibroids without the need for any incisions. It can also be performed through a laparoscope (camera used to visualize the abdominal cavity) in selected cases of larger fibroids requiring small incisions on the belly button and abdominal wall. Finally, a myomectomy can be done through a laparotomy, a surgical incision on the abdominal wall (similar to a C-section most of the time), in cases of multiple and large fibroids not amenable to the other less invasive procedures.
A word of caution regarding other styles of interventions to reduce the size and symptoms of fibroids using high-intensity ultrasound, uterine artery embolization, or endometrial ablation. While these avoid surgery, they are not necessarily safe to maintain the integrity of the uterus for future fertility purposes; therefore, they are not recommended for women with fibroids desiring fertility.
Are there medications for uterine fibroids?
Yes, medications such as Gonadotropin-releasing hormone (GnRH) agonists and antagonists, Progestin-releasing intrauterine devices (IUD), and Tranexamic acid can help manage symptoms of uterine fibroids. Some of these medications may prevent you from becoming pregnant, so you must speak with a fertility specialist before starting any treatment plan if you’re looking to start building a family.
Medical treatment is a temporary strategy to manage fibroids and their symptoms. Most medications stop the ovaries from ovulating; therefore, they interfere with fertility. Others can only be used for a short amount of time. As soon as the medications stop, the fibroids return to their original sizes. Medications that may reduce the size of fibroids can be helpful in a pre-surgery strategy to facilitate their removal during surgery or to help reduce the amount of blood loss before and during surgery.
Recent research published in March 2023 by Dr. Hortensia Ferrero, a researcher at the IVI Foundation, found that vitamin D analogues (Doxercalciferol) as a therapeutic option for uterine fibroids reduced the growth of fibroids by 42%. The research paper won the prestigious President’s Presenter’s Award at the SRI scientific committee.
What are some lifestyle changes you can make to help manage the symptoms of uterine fibroids?
Lifestyle changes may reduce some of the symptoms caused by fibroids. Maintaining a healthy weight, regular exercise, and eating a healthy diet rich in lean protein may relieve symptoms. If you’re trying to conceive, simply managing your symptoms may not be enough.
Can uterine fibroids affect my sex life?
Struggling to conceive can be stressful enough. Fibroids may complicate the process even further by making sex less comfortable (even painful at times).
Part of your treatment plan at Reproductive Medicine Associates will include emotional support services to help navigate all aspects of trying to conceive, both physically and mentally. We work with licensed local mental health professionals nationwide to ensure that your needs are met during this difficult time.
A Word from RMA Network
At Reproductive Medicine Associates (RMA), we understand that fertility can be a complex and emotional experience, and we’re here to support you every step of the way. Our team of fertility doctors provides compassionate care and personalized treatment options to help guide your fertility journey and achieve your dream of having a child.
Don’t hesitate to contact us for more information or to schedule a consultation.