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What are fibroids?
Fibroids are benign growths, made up of smooth muscle cells and fibrous connective tissue, which forms in and around your uterus. The common growths can vary significantly in size from as small as a seedling to as large as a small grapefruit. As a woman gets older, her likelihood of developing fibroids increases, with most women experiencing them in their thirties or forties. Although the growths are generally non-threatening, they can sometimes have a big impact on a woman’s fertility and her ability to conceive.
What causes fibroids?
There is no exact cause for fibroids, but as they don’t generally appear until after a woman ovulates for the first time, and then decrease in size when a woman goes through menopause, it is believed that the sex hormones, oestrogen and progesterone, can affect their growth.
Who is at risk from fibroid tumors?
Women who are close to menopause are the most likely to experience fibroids as they have had a longer time with high oestrogen levels.
There are a number of factors that may increase your risk of developing fibroids:
- First menstruation at a young age
- Being overweight
- Polycystic Ovarian Syndrome (PCOS)
- Hypertension (high blood pressure)
It is also believed that genetic factors may be involved, so fibroids can run in the family. If your mother or grandmother had fibroids, then you may develop them as well.
What are the symptoms of fibroids?
Some women can have fibroids their entire life and experience mild or no symptoms at all. Some symptoms that may be experienced include:
Heavy or long painful periods
Heavy or long menstrual bleeding, also known as menorrhagia, can be a common symptom of fibroids. This is because submucosal fibroids (fibroids within the uterine cavity) enlarge the surface area of the endometrium (uterine lining) leading to heavy bleeding. Another reason is that the fibroids contribute to disorders in hormone production. When fibroids cause issues with hormone production, it weakens the muscles in the uterus making them easier to tear and cause heavier bleeding .
Abnormal bleeding between periods
In addition to causing heavy or long painful periods, fibroids can also cause abnormal bleeding at any time during your monthly cycle, and not just during your regular menstrual period. In extreme cases of heavy periods, the loss of blood can lead to anemia (iron deficiency). But don’t worry, it is very rare that this happens and is something that your specialist can help with.
Pelvic/lower back pain
If fibroids grow large enough they can cause swelling in your lower abdomen leading to pelvic pain. Again, this only occurs in extreme cases when they grow to a large size. With larger fibroids, there is additional pressure placed on your lower back and bladder which can lead to pain in the lower back and frequent urination.
Pain during intercourse
Discomfort or pain during intercourse can be another symptom experienced as a result of having fibroids. This is a rare occurrence and usually only happens if the fibroids grow to a substantial size.
Can fibroids affect fertility?
If you are trying to conceive and have experienced one or more of the above symptoms, then it is advised that you go to see a fertility specialist who can check for fibroids. Depending on the size and location of the growths, they may have an impact on your fertility.
Once the egg and sperm meet, an embryo is created that will then travel to a woman’s uterus. If the fibroids are causing issues, it may try to implant on top of the growth or have difficulty implanting as the size of the fibroids have changed the shape your uterus. However, if the growths are not affecting the lining of the uterus, they may not have a substantial impact on your ability to conceive.
Diagnosis and treatment for fibroids
As fibroids can be symptomless, they are most often found during a routine pelvic exam and then diagnosed with an ultrasound exam.
If you are not trying for a baby and have been diagnosed with fibroids, your specialist may elect to simply monitor their growth provided they are not causing you any pain or discomfort.
If you are diagnosed when trying for a baby, your fertility specialist will assess the potential impact on your fertility and ability to conceive. If the fibroids aren’t causing any pain or discomfort, or do not appear to be in a position to impact the implantation of an embryo, then generally they don’t require treatment – just regular monitoring for size and growth. If they are deemed to be impacting your ability to conceive then your fertility specialist may elect for a small surgery called a myomectomy to remove the fibroids. Once they are removed, your fertility specialist will discuss with you the options for future conception. You may be able to conceive naturally or you may require extra assistance such as IUI (Intrauterine Insemination) or IVF (In vitro Fertilisation).
In the extremely rare circumstance that a fibroid is located in the cavity of the uterus, the removal is a bit more complicated and your options will need to be discussed in detail with your specialist.
The good news is that in the majority of cases fibroids may not affect fertility and your specialist may simply elect to monitor their size and growth.