Dr. Human Fatemi
Dr. Barbara Lawrenz
Fibroids are benign (non-cancerous) tumors that can change the shape or size of the uterus (womb) and sometimes the cervix. They are also called leiomyomas or myomas that originate from the smooth muscle layer (myometrium) of the uterus.
Fibroids can vary in size, they may grow slowly or rapidly, or they may stay the same size for a long period. Some fibroids go through growth spurts, and some may shrink on their own. Fibroids don't spread to other parts of the body, except in very rare circumstances.
Fibroids can be asymptomatic, most of the time women with fibroids are unaware of having them since they are often without symptoms.
Fibroids are named according to the location where they found in the uterus.
There are many factors that uterine fibroids can contribute to reduced fertility. Fibroids could result in change, in the position of the cervix (the vaginal opening to the womb). Thus happening when submucosal fibroids are located above the cervix. This could affect the number of sperms that can travel through the cervix for fertilisation.
Apart from that, fibroids may affect the movement of sperm through the uterus, as the shape of the uterus may change because of them. Additionally, in some cases fibroids may block the movement of the embryo from the tube to the uterus for implantation if they block the fallopian tubes.
Fibroids are more common in obese women, and women who have never had children previously. Fibroids are common in 20% of women during reproductive years. however women of African descent have been known to have a higher incidence of fibroid formation, which could be up to 80%.
The exact reasons why some women develop fibroids is unknown. However, there is some indication that a combination of genetic, hormonal and environmental factors may play a role.
Some fibroids, even the large ones may be asymptomatic. However, when women do experience symptoms, the most common are the following:
Most women with fibroids have no symptoms, so they often go undetected. At times, fibroids are found during a routine gynaecological visit with a pelvic examination. A pelvic exam allows the doctor to feel the size and shape of the womb.
If the doctor thinks you may have fibroids after performing the exam, there are several tests that can confirm the diagnosis.
Fibroids usually do not require treatment because most patients with fibroids do not have symptoms. Women with fibroids should have regular checkups to determine if the fibroids are changing in size, to track worsening symptoms and if planning to get pregnant.
The type of treatment for women who have fibroid(s) depends on the age, general health, symptoms, type of fibroid. If there is a desire to conceive, pregnancy or a wish to preserve fertility.
Treatment options may vary. The management of uterine fibroids will depend upon the findings (size and location of the fibroid), the severity of the symptoms and our consultant′s recommendations. The scientific knowledge, whether asymptomatic fibroids do have a negative impact on fertility, is still very limited.
Fibroids are affected by the estrogen level in our blood. So, medical management does provide relief but does not improve fertility. Also, medication may cause certain undesirable side-effects.
Some medications used to treat fibroids and their associated side-effects are:
Gonadotropin-releasing-hormone (GnRH) analogs- hot flashes, vaginal dryness, mood changes, and osteoporosis
Birth control pills- breast tenderness, risk of thrombosis
Progestins- bloating, abnormal bleeding
Androgens- unwanted hair growth
Alternative approaches to herbal and homeopathic therapies have not been shown to improve symptoms associated with fibroids.
Usually surgery is recommended when the fibroids cause significant symptoms. But, surgery should not be considered as an option to treat infertility till a thorough evaluation of other factors that could be causing infertility is done.
If a woman plans to get pregnant in the future, the only surgical option is a myomectomy, i.e. the surgical removal of the fibroids. The size and location of the fibroids are used to determine the appropriate surgical technique in most cases.
A myomectomy (described below) can be of various types, depending on the location and size of the fibroids. All myomectomies carry the risk of scarring and adhesions, which can affect future fertility. Each also carries the risk of excessive bleeding, which may require a hysterectomy.
This approach is used to remove fibroids or tumors that are on the outer surface of the uterus and surrounding organs. The surgeon accesses these through an incision in the abdomen. This surgery usually requires a 24 to 72-hour hospital stay and 4-6 weeks of recovery.
A Laparoscopic myomectomy is a simple, minimally invasive procedure, where a laparoscope is used to remove fibroids through a small 5-10 mm incisions in the abdomen, and via the navel. Women can go home the same day or within 24 hours. Recovery time is usually two to seven days.
This procedure is the best approach for fibroids that are present inside the uterine cavity. In this procedure, a telescope-like instrument is inserted through the cervix. Then, fluid is used to fill up the uterus to expand the walls. Thus allows for better access and visualisation. Then,via a hysteroscopespecialised surgical instruments are inserted to remove submucous fibroids.
Women who choose this procedure generally, go home the same day of surgery and can get back to their routine within a few days.
This procedure is not linked to serious complications. But, there is a risk of damage or scarring to the inside cavity of the uterus, electrolyte imbalance (changes in the minerals in the blood system) and puncturing of the uterus and bleeding.
This risk of recurrence after a myomectomy is about 30% over a period of 10 years. Patients who have had multiple fibroids are more likely to experience recurrence as compared to patients with singular or isolated fibroids.
IVI Middle East Fertility Center is offering a unique, multidisciplinary approach to offer unrivaled expertise in the diagnosis and treatment of fibroids. Book an appointment with our consultants to discuss your treatment options.
To seek a consultation with an IVI expert:
Call us at +971 2 666 7049 || Email at [email protected]