Fibroids and Pregnancy
A fibroid or leiomyoma is a benign tumour of the uterus. They are very common, with around 30% of women having a fibroid in their uterus by the age of forty. Clearly the vast majority of women are unaffected by the presence of these fibroids, but some woman suffer badly from them. The sort of problems that a woman might suffer from depends upon the size and position of the fibroids. The size can vary from less then a centimetre through to 15cm or more across (the size of a small melon). The position of the fibroid within the uterus is also important.
Diagnosing the Presence of Fibroids
If your clinical history is suggestive of fibroids, your doctor will examine you and may find the uterus is enlarged. An ultrasound of the pelvis will confirm the size and position of fibroids.
To get a definitive picture of the size and position of any fibroids in the uterus, which is very useful pre-operatively, the doctor may arrange an MRI scan.
Fibroids in Infertility and Pregnancy
The impact of fibroids on fertility depends upon the size and position of the fibroids in the uterus. Clearly a one centimetre fibroid polyp located in the middle of the uterine cavity will have a negative impact on the chances of a conception. It is difficult though to be so definitive about intramural fibroids, but in general it is felt that a fibroid greater than 5 cm in diameter is likely to be significant, probably by altering the blood flow to the endometrium where implantation might occur.
Subserosal and pedunculated fibroids have less of an impact, unless they are very large or a positioned in such a way as to affect the uptake of the egg into the fallopian tubes, or maybe crush the fallopian tubes altogether.
Other Problems associated with Fibroids
The most common symptom women complain of with fibroids is heavy periods, associated with clotting, flooding and pain. Sometimes the bulk of the fibroids cause general discomfort and bloatedness, or there may be pressure symptoms with the fibroids pressing on the bladder, leading to incontinence or discomfort.
Cancerous Change in Fibroids
Cancerous or malignant change in fibroids is extremely rare. Probably around 1 in 1000, and therefore the risks of removing them would far out way the benefits from reduced risk of cancer.
Clearly not all fibroids need treatment, and the treatment depends entirely upon the woman’s symptoms and choice.
Diet and Alternative Fibroids Treatments
There are many suggestions for ‘natural’ ways to treat fibroids, through dietary changes or alternative therapies. Unfortunately there is little evidence that these are of any benefit.
However after the menopause fibroids will naturally regress in size as they are oestrogen dependant.
Medical Fibroids Treatment
Fibroids can be shrunk through taking various drugs, particularly a group called Gonadotrophic Releasing Hormone Antagonists (GnRH). These are useful in the short term, pre-surgery for example, but not in the long term as they render a woman temporarily menopausal. As soon as they are stopped, the fibroid expands again.
In some cases a plastic device called a Mirena IUS, can be inserted into the uterus. This slowly releases a hormone that reduces the bleeding from heavy periods, and may shrink the fibroid a little. It also acts like a coil for contraception and is therefore no use in fertility patients.
Uterine Artery Embolisation (UAE)
It is possible to block off the blood supply to a fibroid and it will shrink over time. The result of this is variable between patients, with many getting very satisfactory results, whilst others find little benefit. It is possible to conceive after UAE, but it is not usually recommended as a treatment for fertility problems.
Transcervical Resection of Fibroids (TCRF)
For submucosal fibroids and fibroid polyps it is often possible to remove them by passing a telescope through the cervix and using a cauterising wire to cut the fibroid away.
It is possible to remove most fibroids through surgery through the abdomen. This can be done through laparoscopic instruments (key-hole surgery); by mini-laparotomy (a cut in the bikini-line of about 5cm); or through a laparotomy (a more traditional surgical approach). Which is the most appropriate depends entirely upon the size and position of the fibroids, and the preference of your surgeon.
This is obviously a last resort, but appropriate for those that wish to definitively resolve the problems they have been suffering from.
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IVF Chelsea offers fertility treatment closely associated with the Chelsea & Westminster Hospital. We offer personalised care for the management of infertility with a philosophy of providing individualised care for each couple. We are ideally suited to couples in and around Chelsea, Westminster, Brompton,Hammersmith, Kensington, Mayfair, Lambeth, Battersea, Wandsworth, Weybridge and Fulham, but also see couples throughout the UK. Please contact us to see how we can help you today.