Uterine fibroids are the most common benign tumor in women of reproductive age.
Uterine fibroids, also called leiomyomas or myomas, are incredibly common. Up to 70% to 80% of women will have at least one in their lifetime. Not all fibroids cause symptoms, but they can lead to heavy vaginal bleeding, pelvic pressure and painful periods, and can contribute to infertility. Up to 10% of women with infertility have fibroids, and they are the sole infertility factor identified in 3% of women who undergo an infertility evaluation.
Do all fibroids affect fertility?
The size and location of uterine fibroids are important in determining their effect on fertility. Fibroids can be located within the uterine muscle (intramural fibroids), inside the uterine cavity (submucosal fibroids), or on the outside of the uterus (subserosal fibroids).
Fibroids that distort the uterine cavity (submucosal or intramural with a submucosal component) have been shown to decrease pregnancy rates and increase miscarriage rates, and are recommended to be removed to improve fertility. Intramural fibroids also seem to negatively impact fertility. However, the decision to remove them is more nuanced and less clear-cut. Subserosal fibroids have little impact on fertility, so are not considered infertility causes and are generally left in place.
How are fibroids removed?
The optimal surgical approach to remove uterine fibroids depends on the fibroid(s) size and location. Many fibroids can be removed using minimally invasive techniques, such as laparoscopy or hysteroscopy. Larger or more complex fibroids may require a larger abdominal incision (laparotomy) in order to achieve the best result.
Because of this, surgery for fibroid(s) may be performed as an outpatient procedure with a few days of recovery, or it may require a night’s stay in the hospital, followed by a few weeks of recovery. The surgical approach is usually determined in advance and is based on both physical exam and ultrasound. Sometimes, findings discovered during surgery may cause a change in the approach.
Are there other treatments for uterine fibroids?
There are many treatment options for fibroids, including medications or other minimally invasive procedures. Uterine artery embolization is a procedure performed by specially trained radiologists. During this procedure, small coils are placed through a large blood vessel in the groin and guided into the blood vessels that feed the fibroid(s). The coils are placed within these vessels to reduce blood flow to the fibroid, causing it to shrink.
Fibroids can also be treated using high-frequency sound waves directed using a special instrument during laparoscopy. As these procedures are relatively new, there are very limited data evaluating the effect of these treatments on future pregnancies. Therefore, these other procedures are not recommended in patients desiring future fertility.
In some situations, medical treatment of uterine fibroids may be appropriate and used as a temporary treatment to optimize conditions for surgery. Medications, specifically GnRH analogues, can cause fibroids to shrink while on treatment, enabling a myomectomy to be performed using a smaller incision. In other patients with heavy bleeding from fibroids, these medications can stop all menstrual bleeding and allow blood counts to recover before a surgery, minimizing the need for blood transfusion.
Currently, surgery is the best way to treat fibroids to rapidly maximize the chance for pregnancy.
If you have any questions, please contact our San Antonio fertility center.