How do fibroids affect fertility?

Surgical removal of an extremely diseased uterus, with numerous large fibroid tumors
Surgical removal of an extremely diseased uterus, with numerous large fibroid tumors
©iStockphoto.com/Thinkstock

Fibroids, also called uterine leiomyomata, are round (or semi-round), benign tumors that grow in the smooth muscle of a woman's uterus. If it sounds painful, that's because it can be.

Uterine fibroids are one of the most common causes of abnormal uterine bleeding, but the reason why some women develop fibroids is unclear.

Age is a factor. Fibroids tend to affect women over the age of 35, and as many as 20 to 40 percent of women over the age of 35 have or have had uterine fibroids. African American women seem to be at a higher risk of developing fibroids -- as many as 50 percent of black women who have yet to go through menopause are affected. Although it's less frequent for women in their 20s to have fibroids, it's still possible, and it's estimated that about 30 percent of women between the ages of 25 and 45 develop fibroids [sources: Puscheck, USAHRQ].

Family history and, as we just mentioned, ethnicity do appear play a role -- African American women are two to three times more likely to have fibroids, although the reason they are more susceptible remains unclear [source: Stöppler]. Fibroids do seem to be associated with increases in estrogen levels in the body, often rapidly growing during early pregnancy, when estrogen levels are rapidly rising, as well as in women who take oral contraception, and typically shrinking after a woman enters menopause and her estrogen levels decline.

Not all fibroids are the same, and they're classified based on where they're located: Submucosal fibroids grow inside the uterus, while subserosal fibroids grow on the outside of the uterus. Fibroids that grow inside the muscular uterine wall are called intramural fibroids [source: GUH - DVIR].

How do you know if you have fibroids? We'll talk about the symptoms of the menstrual disorder, next.

Fibroid Symptoms and Complications

Uterine fibroids are very rarely cancerous (a type of tumor called leiomyosarcoma happens in fewer than one out of every 1,000 fibroids), but that doesn't mean benign tumors can't cause problems [source: USDHHSOWH]. Only between 10 and 20 percent of women have symptoms, but those who do often experience painful periods, sometimes with heavy bleeding (known as menorrhagia) and clots, bleeding between periods, pain during intercourse, a feeling of fullness or pressure in the lower abdomen and lower back pain [source: GUH-DVIR].

While many uterine fibroids are so small they go unnoticed, some fibroids may grow as big as a grapefruit, or bigger -- those that grow into sizable tumors (several inches in diameter, compared to fibroids that never grow bigger than an apple seed) are rare, and may begin to put the squeeze on some internal organs because of the space they take up, sometimes causing pressure and more frequent and more urgent urination, as well as constipation for some women [source: USDHHSOWH].

The location of the fibroid -- or fibroids, as there could be more than one growing at a time -- may also have a negative impact on a woman's fertility. Some studies show that fibroids may increase complications during pregnancy, including increasing the risk of placental abruption (when the placenta prematurely detaches from the uterine wall) as well as increasing the risk of premature labor and delivery. Women with fibroids are also six times more likely to deliver via cesarean section (C-section) than women without [sources: USDHHSOWH, Puscheck].

Fibroids have also been implicated in conception problems such as implantation failure, as well as an increased risk of miscarriage -- in fact one study found women with fibroids may have as much as a 14 percent risk of miscarriage compared to a 7 percent risk in women without fibroids [source: Lee]. Let's talk more about how and why fibroids may affect a woman's fertility, next.

Fibroids and Fertility

While no study has yet been able to pinpoint specific evidence as to why some women with fibroids seem to have a higher than normal risk of miscarriage or trouble conceiving, multiple studies have found there may be an association between fibroids and infertility -- researchers just haven't found what that is yet.

Some research indicates submucosal fibroids -- those are the type that grow in the uterus -- may twist or misshape the uterus, causing conception and pregnancy complications. Other theories suggest that the location of the fibroid(s) may play a role in early miscarriage, and that fibroids growing in the uterus or within the uterine wall may impact blood flow to the placenta and cause an irritable uterus.

Treatment options vary depending upon the age of the patient, the severity of the symptoms and the size of the tumor(s), as well as whether or not the woman wants to try to have children. For many women, over-the-counter pain relievers may be the only thing needed to minimize symptoms. For others, hormone therapy may be the right choice to stop fibroid growth.

Surgical interventions are typically needed for fibroids that cause moderate to severe symptoms. Women with severe symptoms and/or chronic fibroids who have already had children or who aren't interested in having children often undergo a hysterectomy, which removes the uterus and is 100 percent effective in treating fibroids and their symptoms. These women also may consider a procedure called endometrial ablation, which destroys the uterine lining via heat, laser, freezing or microwaves, or uterine fibroid embolization (UFE) or uterine artery embolization (UAE), which block blood flow to the fibroids, causing them to shrink.

Treating fibroids in women who hope to have children some day and wish to preserve their fertility is a little different, and the treatment methods used in such cases are minimally invasive and aimed at preserving the uterus as much as possible.

Currently, a procedure called myomectomy, a minimally invasive surgical removal of fibroids, is used to treat women who still wish to have children. Recent findings show that women who choose to have fibroids removed via a myomectomy risk having new fibroids develop (which happens to about one-third of women who undergo the procedure), but you can't argue with the success rate: It's estimated that as many as 40 to 60 percent of women who have undergone a myomectomy to remove fibroids have gone on to become pregnant post-treatment [source: WebMD, GUH-DVIR].

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Sources

  • Brody, Jane E. "PERSONAL HEALTH; Options for Dealing With Uterine Fibroids." The New York Times. 2009. (June 22, 2012) http://query.nytimes.com/gst/fullpage.html?res=9503EED71E3BF930A25753C1A96F9C8B63
  • Cleveland Clinic. "Center for Menstrual Disorders, Fibroids and Hysteroscopic Services." 2009. (June 22, 2012) http://my.clevelandclinic.org/Documents/OB_GYN/fibroid_brochure.pdf
  • Georgetown University Hospital. Division of Vascular and Interventional Radiology. "What are Fibroids?" (June 22, 2012) http://www.fibroidoptions.com/backgrnd.htm
  • Lee, Hee Joong; Norwitz, Errol R.; and Julia Shaw. "Contemporary Management of Fibroids in Pregnancy." Reviews in Obstetrics & Gynecology. Vol. 3, no. 1. Pages 20-27. 2010. (June 22, 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876319/
  • Puscheck, Elizabeth E. "Infertility." 2012. (June 22, 2012) http://emedicine.medscape.com/article/274143-overview#showall
  • Stöppler, Melissa Conrad. "Uterine Fibroids (Benign Tumors Of the Uterus)." MedicineNet.com. 2010. (June 22, 2012) http://www.medicinenet.com/uterine_fibroids/article.htm
  • U.S. Department of Health & Human Services - Agency for Healthcare Research and Quality. "Management of Uterine Fibroids - Summary: Evidence Report/Technology Assessment: Number 34." 2001. (June 22, 2012) http://www.ahrq.gov/clinic/epcsums/utersumm.htm
  • U.S. Department of Health & Human Services - Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Uterine Fibroids." 2005. (June 22, 2012) http://www.nichd.nih.gov/publications/pubs/upload/uterine_fibroids_2005_rev.pdf
  • U.S. Department of Health & Human Services Office on Women's Health. "Uterine fibroids fact sheet." 2008. (June 22, 2012) http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.cfm
  • U.S. National Library of Medicine. "Uterine fibroids." 2011. (June 22, 2012) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001912/
  • WebMD. "Uterine Fibroids." 2010. (June 22, 2012) http://women.webmd.com/uterine-fibroids/uterine-fibroids