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Uterine Fibroid

Female Infertility

Dr. Suman

Aug 02, 2021

Almost 5% to 10% of infertile women have uterine fibroid. While 70% of women by age of 45 contact uterine fibroids. Thus, making it the most common pelvic tumor. Most of the time they are asymptomatic. However, 20% to 50% of women see symptoms and may wish to pursue treatment. 

Uterine Fibroids Images

Fibroids are rare before puberty. Their risk increases during the reproductive years. The size of the fibroid decreases after menopause. 

As this is very common, let’s find out what are the chances that you may have fibroids. Plus, what are the diagnosis and treatments for it? Starting with what is uterine fibroid. 

What is a uterine fibroid?

They are non-cancerous tumors. The fibroid tumor originates from the myometrium (the uterine smooth muscle tissue).  There can be either one tumor or a cluster of many. 

Uterine fibroids are also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma. Most uterine fibroids are asymptomatic. But many do see symptoms. The next section deals with the symptoms. 

What are the signs of uterine fibroid?

Abnormal uterine bleeding which is excessive menstrual bleeding is the most common symptom of uterine fibroids. Other signs can be: –

  • Urinary frequency and urgency increase due to bladder compression
  • Pain or pressure in the pelvic region
  • Bowel dysfunction
  • Urinary retention
  • Low back pain 
  • Constipation
  • Painful intercourse
  • Menstruation is longer than usual
  • Swelling or enlargement of the abdomen

The intensity of the sign can vary. What is the reason for the growth of fibroid tumors? Let us find it out. 

What causes uterine fibroids to grow?

Here, some of the possible reasons can be: –

  • Genetics- Fibroids cause certain genetic changes which are not present in normal uterine cells.
  • Hormones- In fibroids, the uterine muscle cell contains more estrogen and progesterone receptors. This is why the size of the tumor decreases after menopause.
  • Other growth factors- Insulin-like growth factor can contribute to fibroid growth. 
  • Extracellular matrix (ECM)- It is the material that makes cells stick together. Fibroids increases it and make them fibrous. 

So, these are the cause of uterine fibroids. But do you want to know what are the chances that you will have fibroids? 

What factors can increase your chances to get uterine fibroids?

You may be at a higher risk of getting uterine fibroids based on the following: –

  • Women whose age is greater than 40 
  • Getting periods early (younger than 10 years)
  • Late age of menopause
  • Nulliparity (where the women have never given birth or carried a pregnancy)
  • African women are more at risk 
  • Obesity 
  • Family history of uterine fibroids
  • High blood pressure
  • Getting menstruation at a very young age
  • Vitamin D deficiency
  • High consumption of alcohol
  • Dietary factor, i.e., consuming too much red meat and not enough vegetables, fruit or dairy

If these are the points which increase your risk, then what factors decrease risk?

Factors that put you at a lower risk

Factors like the following put you at a decreased risk: –

  • If you have given birth
  • Late menarche that is getting period older than 16 years
  • Menopause
  • The use of oral contraception decreases the risk by 70%
  • Smoking with low BMI
  • Avoiding alcohol 

Thus, after seeing these you can figure out what is your possibility to have it. There are four types of uterine fibroid. Also, its type helps to figure out that your case would be a severe one or not. 

What are the different types of fibroids?

The types of fibroids are based on the location that they are formed. The four types are: –

  1. Subserosal– This type is formed projecting outside the uterus. This type continues to grow and increase in size. The large size of the tumor creates pressure on the surrounding organs.

Symptoms can include pelvic pain and pressure. Complications due to it will also depend on the size of the growth.

  1. Intramural– The growth is within the myometrium. It is the most common type. The fibroid tumor size in this can be mistaken for pregnancy or weight gain. 

“Bulk symptoms” like heavy bleeding and clot passing during menstruation and pelvic pain could be the symptom of this type. 

  1. Submucosal– In this the uterine fibroid is formed projecting into the uterine cavity. It is the least common. The size of the submucosal fibroid can increase and block the fallopian tube. This can cause complications in conceiving.

It can be either asymptomatic or severely symptomatic. The signs include heavy periods, and passing clots during periods. 

  1. Pedunculated– The fibroid tumor grows on a stalk resulting in the submucosal or subserosal fibroid. The tumor can either grow inside or outside the uterus. Symptoms associated with this can twist on the stalk. 

One can either have one or all of the types. Multiple fibroid tumors are common. For this to be discovered and treated timely, diagnosis has to be good. Let’s see how the doctor will go about the diagnosis. 

Diagnosis

The doctor analysis the patient based on the symptoms they say. Uterine fibroid can be asymptomatic. In that case, it is incidentally found out only during a routine pelvic examination. Another in-depth diagnosis method is imaging either through ultrasound, transvaginal ultrasonography, MRI, or CT-scan.

One of the top complications we are worried about is pregnancy. Would you be able to conceive with fibroids? What are your chances to carry a healthy pregnancy? All your doubts related to it will be cleared here. 

Uterine fibroids and pregnancy

Most of the time fibroid tumors do not affect fertility. When the tumor is small and there are no symptoms, you can conceive without any complication.

However, when the size of the tumor increases it can cause fertility issues. The type of the fibroid also matters. Like Submucosal is a rare type but can grow very large. It can an effect on women’s reproductive organs. 

In such cases, women can get pregnant with fibroids. But there has to be additional maternal and fetal observation. 

To resolve infertility first fibroids has to be treated. It will increase the chance of getting pregnant. Medication or surgery can cure it. Even then if the women face an issue, they can opt for Assisted Reproductive Techniques (ART) like IVF or intrauterine insemination, or even surrogacy. 

Why it can cause infertility?

Certain factors other than location, size, and number can be the reason for infertility. The other factors that are responsible for infertility are: –

    1. Physical factors– Impedance like the transport of sperm, egg, or embryo can affect fertility. The size of the tumor can disrupt on the passage. Thus, causing infertility.
    2. Alteration of uterine Contractions– Fibroid influences the contractility of the myometrium and induces an inflammatory reaction. It causes a problem in implantation. 
    3. Cytokine Factors– Cytokine is a substance that is released by certain cells of the immune system. They affect other cells. Glycodelin is a cytokine that is released due to fibroids. It promotes the development of new blood cells and suppresses the natural killer cells in the uterus. 
    4. Genetic– Studies have found that fibroids can reduce the concentration of certain genes in the uterine cavity. This can cause infertility in women with submucosal fibroids. 
  • Alterations in the Endo-myometrial Junctional (EMJ) Zone- There are cells in the EMJ zone that are essential for the implantation of the embryo. Fibroids cause a reduction in those cells which affects the implantation negatively. 
Other complications it can cause

Apart from fertility issues, fibroids may cause other health problems in women. 

  1. Anaemia– Heavy bleeding can result in anemia. Other related problems could be fatigue, weakness, and pale skin. This may turn life-threatening.
  2. Chronic pain– The patient can feel pain in the pelvic region, lower back, and in their legs. It can also cause severe pain during periods. Severe effect on daily life.
  3. Kidney damage– As the size of the tumor increase it will put pressure on the bladder. This can cause frequent and urgent urination or even kidney damage. 
  4. Bowel complications– Severe constipation or bloating can happen.
  5. Twisting of fibroids– This is common in the pedunculated type. The tumor can grow and attach itself to the stalk of the uterus causing severe pain.

Seeing all these complications, you would like to know the treatments available. Let’s find out what option do we have. 

Treatment

The treatment options are affected by the size, number, and location of the tumour. Other factors that are kept in mind are the patient’s age, symptoms, and desire to maintain fertility. Its cure is focused on the following four goals: –

  1. Relief of signs and symptoms,
  2. Sustained reduction of the size of fibroids, 
  3. Maintenance of fertility, and
  4. Avoidance of harm.

 For asymptomatic no treatment is required. The management should be done after waiting and regular checkups. For those with symptoms that affect daily life, medicine or surgery therapy can be the option. 

Medicine therapy
  1. Hormonal Contraceptives– The use of oral contraceptives can reduce menstrual blood loss. But hormones can cause the fibroids to grow. 
  2. Tranexamic Acid– It is an oral non-hormonal antifibrinolytic agent. It also will help to reduce menstrual blood loss. 
  3. Nonsteroidal Anti-inflammatory Drugs– These help in reducing blood loss and give pain relief. 
  4. Hormone Therapy– Gonadotropin-releasing hormone (GnRH) agonists are also an option. It will provide temporary relief from symptoms. 
  5. Other agents– Aromatase inhibitors and estrogen receptors antagonists can also be another treatment. It will block the synthesis of estrogen. It can help to reduce fibroid size and decrease menstrual bleeding. 
Surgery therapy
  1. Hysterectomy– One can go for this surgery if they do not wish to preserve fertility. After this surgery, the symptoms will go away totally. It is the least invasive form of surgery possible. 
  2. Myomectomy– It is preferred by those with submucosal fibroids. It will preserve the uterus or fertility. 
  3. Uterine artery Embolization– If you want to avoid surgery or preserve the uterus this can be an option. The benefits also include the less time required for recovery after the surgery. 
  4. Myolysis– Heat or laser is used to destroy fibroids in this method. 
Conclusion

Summing it up, a uterine fibroid is a non-cancerous pelvic tumor. It is very common for women of childbearing age. The signs are mainly heavy menstrual bleeding and pelvic pain. Some of the factors can add up to the problem. It can increase the risk factor. Fibroids do not always cause infertility. But in certain pregnancies with fibroids, one has to be careful to avoid complications. The treatment for fibroids can cause infertility. It is the decision of the patient that what treatment they chose. Also, if due to the tumor or treatment infertility is caused, we can go for ART.  

Suggestion

Most of the time uterine fibroid is asymptomatic. So, our suggestion would be to go for regular checkups with the gynecologist. It should be detected and treated timely. Also, if you are facing any fertility issues with fibroids, you can go for ART. Here, at Fertilityzilla, we provide full assistance and guidance related to ART. We provide the best IVF facility in India. For any further information contact us at- contact@fertilityzilla.com or +91-896-934-0069. 

FAQs

What causes fibroids in the muscle of the uterus?

Many factors like age, genetics, early menstruation, etc. can be the factor. 

Are there any symptoms of uterine fibroids in women?

Some may be asymptomatic. Others can face symptoms like heavy menstrual bleeding, pelvic pain or pressure, painful sex, and longer periods. 

What are the treatment options for uterine fibroid?

The treatment options for uterine fibroid include either oral contraceptive, hormone therapy or in severe cases surgery.

How are fibroids related to infertility in women?

Having a fibroid would not mean that you are infertile. You can carry a healthy pregnancy even with it. But in 10% to 20% of cases, a woman can be infertile. 

Can a uterine fibroid cause no symptoms at all?

Most women don’t have any symptoms. Many women have uterine fibroids without even realizing it. It can be accidentally discovered during a routine checkup. 

References

  1. https://www.aafp.org/afp/2017/0115/afp20170115p100.pdf
  2. https://www.msdmanuals.com/professional/gynecology-and-obstetrics
  3. https://www.webmd.com/women
  4. https://my.clevelandclinic.org/health/diseases
  5. https://www.mayoclinic.org/diseases-conditions
  6. https://www.healthline.com/health 
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859843/  
  8. https://ivf.chaitanyahospital.org/
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