Fibroids - Symptoms, Effect on fertility and pregnancy

What are fibroids?

Fibroids are benign (not cancerous) tumors which grow in tufts or groups on the uterine walls of the female reproductive system.  Medically known as leiomyoma, fibromyoma and myoma, fibroids are basically of four types - each one is termed depending on the location they are found on the uterus.

• Intramural fibroids:  These fibroids are commonly occurring ones and grow in the walls of the uterus (Most common)
• Subserosal fibroids:  These fibroids are very large and are found growing outside the wall of the uterus (Most common)
• Submucosal fibroids:  These fibroids grow under the inner lining of the uterine wall and can extend into the womb
• Cervical fibroids:  These fibroids occur in the walls of the cervix and hence the name cervical fibroids

Since fibroids are typically asymptomatic (no symptoms show up), it is hard to estimate how many women have them. Estimates range widely from 20% to 80% of all women, though in an overwhelming majority these are benign.

What are the symptoms of fibroids?

It is generally recognized that in atleast 50% of affected women, the condition is asymptomatic i.e., the women experience absolutely no symptoms because of the presence of the fibroids in their uterus.  But, in the remaining cases they do manifest themselves in the different forms.  When they occur, the typical symptoms are:

• Heavy bleeding during the menstrual cycle - This condition is also known as menorrhagia.  This incessant bleeding in the form of clots causes a lot of fatigue, anaemia and also inconvenience.
• Pressure and pain in the pelvic region - Continuous pain in the pelvic region during the cycle, which at times becomes unbearable.
• Anaemia - Caused of the heavy and long bleeding during monthly cycles
• Pain during intercourse
• Constipation and hemorrhoids
• Frequent urination and incontinence

What causes fibroids?

The causes of fibroids are not clear.  Fibroids are a common condition prevalent in women aged between 35 and 50.  There are chances that they might take seed after puberty due to the excess levels or imbalance of hormones that are produced in the body.  Their onset gets frequent as women get older, but they usually shrink after menopause.  Obesity and genetics may also be connected to fibrouds.

Interestingly, fibroids increase in size during pregnancy, because of the higher secretion of the hormone estrogen.

How do fibroids affect women?

Fibroids typically go undetected until a smear test is conducted or an ultrasound scan is taken.  In most of the cases, it is found that they do not affect the normal functioning of the persons though some suffer from the symptoms above.

How do fibroids affect fertility?

Most commonly occurring fibroids (Intramural and Subserosal) do not significantly affect fertility but fibroids in the womb or in the cervix can affect fertility.

How do fibroids affect pregnancy?

In certain cases fibroids may cause miscarriages. Depending on the location of the fibroids the complications during pregnancy may differ, though in most cases there are no adverse effects.

Common problems are:

• Increased risk of a preterm delivery
• Women might experience a prolonged labor or the labor does not progress at all
• The baby is in a breech position which makes normal vaginal delivery very difficult.
• In a few cases, the placenta might break away from the uterus wall which leads to insufficient supply of oxygen to the fetus.

Due to all of these, the chances of a C-section are also increased.

Can fibroids be cured or prevented?

If the fibroids do not cause any inconvenience or symptoms, no treatment is called for.  Mild symptoms may be mitigated through medication.

But if it manifests itself in severe symptoms that cause a lot of trouble, then one can go in for either surgical or non-surgical methods depending on the advice of their gynecologist.  The main ways in which one could get treated are:

• Myomectomy - the fibroids are removed surgically and the uterus is left in place
• Hysterectomy - the entire uterus is removed surgically
• Uterine artery embolisation - In this procedure, the fibroids are shrunk by arresting the supply of blood to them.
• Myolysis – the fibroids are destroyed by either freezing them or using electric current, by inserting a needle into them.
• Endometrial Ablation – this is a minor surgery where the endometrium lining of the uterus is removed to arrest the excessive bleeding.  Once this is performed, the woman cannot conceive.