Fibroids and Fertility

What are uterine fibroids?

Fibroids are benign lumps of tissue, which grow in the muscular part of the uterus. They are very common – up to 80% of women have at least one fibroid – and increase with age. They are not cancerous or otherwise at all harmful to your health.

What are the symptoms of fibroids?

Most fibroids do not cause any symptoms at all.  If the fibroids become very large, they can cause significant period problems or pelvic discomfort but for most women, there are no symptoms.

What are the cause of Fibroids?

Nobody knows what causes fibroids. They just grow in the uterus and become more common as women get older.  They are more common in different parts of the world and are particularly common in African women.

What are the complications of fibroids?

Uterine fibroids aren’t usually dangerous, however, sometimes, very large fibroids  can cause discomfort and might lead to complications such as anemia (a drop in red blood cells). Anemia causes fatigue from heavy blood loss, and rarely, a transfusion might be needed to counteract the blood loss.

How are fibroids diagnosed?

Because fibroids often go unnoticed, since they do not always cause symptoms, you may not know you have fibroids until you see your doctor. Fibroids are usually found in a routine ultrasound scan as part of the investigation of infertility.

Can fibroids affect your fertility?

Most fibroids do not affect a woman’s fertility. They are mostly found as incidental findings during an ultrasound scan and the vast majority have no effect and do not need any treatment. The critical aspect is whether the fibroid is distorting the lining of the uterus, which most do not.

The only two situations where fibroids interfere with fertility are:

  • Where the fibroid is very large distorting the lining of the uterus
  • Where the fibroid is located inside the uterus itself (called a submucosal fibroid).

In these two situations, surgery to remove the fibroid may be needed. However, most fibroids do not need any treatment at all.

Whether fibroids affect your fertility, and therefore whether you need them removed, depends on the size of the uterus and where in the uterus, the fibroid is located. 

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.

However if the fibroid does not affect the lining of the uterus, they have much less effect on your fertility and you may not need to have anything done about them.

When should I see a doctor?

If you are struggling with your fertility, have persistent pelvic pain or pressure, heavy menstrual bleeding and painful periods, it is recommended that you see your doctor.

Pregnancy and fibroids: Complications

There are minimal to no complications from fibroids alone during pregnancy.

How to treat fibroids

If treatment is needed at all (and for most fibroids, no treatment is needed), surgery is usually the best approach. Where the woman is still trying to conceive, surgery to remove the fibroid (called a myomectomy) is normally carried out.  Where a woman’s family is complete, and the fibroids are causing severe symptoms, a hysterectomy may be considered.

Other treatments are less effective.  Uterine artery embolisation (UAE) involves injecting small pellets into the blood supply to the uterus to partially cut off the blood supply to the uterus.  This can help a fibroid to shrink without invasive surgery but is only recommended for women whose family is complete.  Some anti-hormonal agents can be used to shrink a fibroid but the effects are relatively small.

Having trouble conceiving?

If you suspect you have fibroids and have been trying to conceive for 12 months (6 months if you are over 35 years of age), you might want to consider booking an appointment with a fertility specialist.