Uterine Fibroids

What are uterine fibroids?

Uterine fibroids (myomas or leiomyomas) are non-cancerous growths of the muscle of the uterus. They are very common, and many women of reproductive age have at least one, often without knowing it. Fibroids are described by their position: submucosal fibroids bulge into the uterine cavity, intramural fibroids lie within the muscle wall, and subserosal fibroids grow on the outer surface. Their effect on fertility depends mainly on location and size rather than number.

Symptoms and signs

• Heavy or prolonged periods, sometimes with clots
• Anaemia causing tiredness or breathlessness
• Pelvic pain or pressure, or a swollen lower abdomen
• Frequent urination or constipation from pressure on nearby organs
• Pain during intercourse
• Difficulty conceiving or repeated miscarriage, mainly with fibroids that distort the cavity

Many fibroids cause no symptoms and are found on a routine scan.

Causes and risk factors

Fibroids grow in response to estrogen and progesterone, which is why they usually shrink after menopause. Risk factors include a family history of fibroids, increasing age through the 30s and 40s, early first periods, obesity and not having had children. Fibroids can affect fertility by changing the shape of the uterine cavity, interfering with implantation, blocking the openings of the fallopian tubes or affecting blood flow to the lining.

How fibroids are diagnosed

• Transvaginal and abdominal ultrasound to map size and position
• 3D ultrasound or saline infusion sonography to see whether the cavity is distorted
• Hysteroscopy to view and treat submucosal fibroids
• MRI for large or multiple fibroids, or to plan surgery
• Haemoglobin test to check for anaemia

Treatment options

Monitoring

Small intramural or subserosal fibroids that do not distort the cavity often do not need removal before trying to conceive.

Hysteroscopic myomectomy

Submucosal fibroids are the type most clearly linked with infertility and miscarriage. They can usually be removed through the cervix using a hysteroscope, with no abdominal cuts.

Laparoscopic or open myomectomy

Larger intramural fibroids that distort the cavity or cause significant symptoms may be removed by keyhole or open surgery. Women are usually advised to wait a few months before trying to conceive, and a caesarean birth may be recommended after deep or extensive myomectomy.

Medicines

Hormonal medicines such as GnRH analogues can shrink fibroids or correct anaemia before surgery, but fibroids usually grow back once they are stopped, and these medicines prevent pregnancy while being used.

Treatments usually avoided before pregnancy

Uterine artery embolisation and ablation techniques are generally not first choices for women who plan a pregnancy, because safety data for future pregnancy are limited.

IUI and IVF

Once the cavity is normal, couples may try naturally or with IUI or IVF depending on other fertility factors, age and ovarian reserve.

Chances of pregnancy

Many women with fibroids conceive and have healthy pregnancies. Removing submucosal fibroids can improve pregnancy chances. Results depend on fibroid type, the woman's age, ovarian reserve and other fertility factors, and no treatment can guarantee pregnancy.

When to see a fertility specialist

See a specialist if you have fibroids and have been trying for 12 months (6 months if 35 or older), if you have heavy periods with difficulty conceiving, or if you have had a miscarriage and fibroids were found. Iswarya Fertility offers hysteroscopy and fertility evaluation across its 91+ centres.