Uterine Fibroids and Pregnancy

Uterine Fibroids and its treatment

Quick Bites

  • Uterine fibroids are common among women of reproductive age
  • Having a uterine fibroid in your uterus doesn’t mean you can’t get pregnant
  • Uterine fibroids are not cancerous

Fibroids or Uterine Fibroids are non-cancerous lumps that grow in or around the uterus (womb) [1]. They are also called leiomyomas or myomas. The lumps are made up of muscle and fibrous tissue. They vary in shape and size, for example, a uterine fibroid can be as small as a pea or as big as a melon which can distort and enlarge the uterus and may damage nearby organs.

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In this article/\

  1. Things to know about Uterine Fibroids
  2. Infertility caused by Uterine Fibroids
  3. Uterine Fibroids Diagnosis
  4. Uterine Fibroids Treatment
 

1.Things to know about Uterine Fibroids

A woman can have one or multiple fibroids. But she might not know she has them as uterine fibroids don’t usually show any symptoms. In women who do show uterine fibroids symptoms, the reason for these symptoms can be the size, location or number of fibroids.

Types of Uterine Fibroids

Uterine fibroids can grow anywhere in and around the womb. Based on their location, the fibroids can be divided into three types [2].

  1. Intramural Fibroid: It is the most commonly occurring fibroid. It develops in the muscle wall of the uterus.
  2. Submucosal Fibroid: This type of fibroid develops in the muscle layer beneath the inner lining of the uterus and grows into the uterine cavity.
  3. Subserosal Fibroid: This type of fibroid develops outside the wall of the uterus into the pelvis. These fibroids can get very large.

In some cases, submucosal fibroids or subserosal fibroids are attached to the uterus by a narrow stalk of tissue. These fibroids are called pedunculated fibroids.

Uterine Fibroids Symptoms

Even though it is not always the case, some of the women who do show uterine fibroids symptoms have the following in common:

  • Heavy menstrual periods
  • Urinating frequently
  • Lengthy periods (periods that continue for over a week)
  • Constipation
  • Abdominal pain
  • Pain in the lower back
  • Pain during sexual intercourse
  • Infertility

Uterine Fibroids Causes

It is commonly believed in the medical community that these fibroids develop from a stem cell in the smooth muscular tissue of the womb called the myometrium. A single cell divides repeatedly eventually forming a big mass. Although, It is not exactly known what causes uterine fibroids. Many kinds of research and common experiences point to the following factors:

Hormones:

It has been found that two hormones named estrogen and progesterone may be promoting the growth of the fibroids. Both of these hormones are responsible for the development of the uterine lining during each menstrual cycle in preparation for conception.

Uterine fibroids contain more estrogen and progesterone receptors as compared to normal uterine muscles which may be the reason why they get promoted by these hormones. They also seem to decrease in size after menopause due to a decrease in hormone production.

Extracellular Matrix (ECM):

Extracellular Matrix may also be one of the uterine fibroids causes. ECM is the material that makes cells stick together like cement between bricks. Increased production of ECM can play a major role in promoting the enlargement and stiffness of the fibroids.

Genetics:

Genes may also play an important factor in developing fibroids. It has been seen often that is a history of fibroids in the family of the woman having fibroids.

Complications with Uterine Fibroids

Uterine fibroids are usually benign (harmless) and they don’t cause any serious complications. However, they may cause some discomfort and lead to complications like anemia (drop in red blood cells) due to heavy blood loss. Uterine fibroids don’t often cause any problems with pregnancy. However, submucosal fibroids may cause pregnancy loss or infertility. Fibroids may also cause pregnancy complications like placental abruption, preterm delivery and fetal growth restriction.

Uterine Fibroids Prevention

There is not much scientific evidence on what causes a fibroid hence there is not much information on its prevention either. However, tending to a healthier lifestyle like eating fruits and vegetables, exercising and maintaining a normal weight may decrease the risk of having a fibroid. Additionally, it has been found that the use of hormonal contraception can help with reducing the risk of having a fibroid.

Read more: गर्भावस्था के दौरान किए जाने वाले परीक्षण और उनका महत्व

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2.Infertility caused by Uterine Fibroids

The precise impact of uterine fibroids on the infertility of a woman is still unknown. It is also unclear if infertility is one of the uterine fibroids symptoms. Uterine fibroids most commonly affect 20% to 50% women of reproductive age [3]. Fibroids don’t always create issues with infertility but sometimes their size and location may have a significant impact on it. For example, the fibroids that grow inside the uterine cavity (submucosal) or that are larger than 6 cms in diameter may affect your ability to deliver a normal child and create infertility issues [4].

Many studies have found that fibroids are present in about 5% to 10% of infertile patients and may also be the sole cause of infertility in 1% to 2.4% of these patients. Although it is still not clear if uterine fibroids can be the sole reason for a woman’s infertility, there are many studies pointing to the fact that the presence of fibroids does influence their overall chances of getting pregnant. A study conducted in 1999 found that the pregnancy rate in infertile women with fibroids was 11% and without fibroids, it was 25%. The removal of the fibroids increased the pregnancy rate from 25 to 42%.

Uterine Fibroids may cause infertility in the following ways:

  • A large fibroid may affect the shape of the cervix, this change in the shape of the cervix can affect the number of sperm entering the uterus
  • Fibroids also affect the shape of the uterus which can affect the movement of the embryo and sperm
  • Fibroids can also block the fallopian tubes
  • Researchers conclude that fibroids can affect the contractibility of the myometrium (middle layer of the uterine wall) inducing a chronic inflammatory reaction which can hinder the implantation of the embryo

Effects of Uterine Fibroids in Infertility treatment

It has already been established that the presence of fibroids can influence the pregnancy rate. Apart from this, uterine fibroids may also affect infertility treatments like Assisted Reproductive Technology (ART). ART includes all the infertility treatment that handles both eggs and sperm. ART technologies can treat infertility caused by blocked fallopian tubes and abnormal gamete transfer caused by uterine fibroids, however, fibroids can also affect the proper implantation of the embryo in the uterine wall which can affect the overall outcome of an ART procedure.

Submucosal fibroids, in particular, have a significant effect on embryo implantation and pregnancy rates through ART. Furthermore, there have been studies stating that distortion of the uterine cavity by submucosal fibroids may be connected to lower pregnancy rates and miscarriage in ART treatments like IVF (In vitro Fertilization) and ICSI (Intracytoplasmic Sperm Injection) [5].

Uterine Fibroids and Pregnancy

About 2 to 12% of pregnant women have fibroids in their uterus but not all of them pose a harm to the pregnancy. However, the presence of fibroids may increase the chances of a miscarriage or preterm birth. During pregnancy, fibroids grow quickly causing intense pain. In some cases, hospitalization may also be required.

Read more:30 की उम्र के बाद गर्भावस्था के जोखिम क्या हैं ?

 

3.Uterine Fibroids Diagnosis

A woman might not know she has fibroids in her uterus until it has been diagnosed by a doctor. It usually gets diagnosed when you go to a doctor for some other condition like infertility issues, heavy period, abdominal pain etc. A doctor usually does a pelvic exam when you mention any of these symptoms. During the pelvic exam, your doctor will press on your uterus, they might sense some changes in the shape of your uterus which can be because of fibroids. They may perform the following tests to diagnose uterine fibroids.

Imaging tests for Uterine Fibroids Diagnosis

An imaging test might be the first test that your doctor may perform for diagnosing fibroids. This test can be performed right away in your doctor’s clinic. They are:

  • Ultrasound: An ultrasound uses sound waves to take pictures of the uterus. A doctor uses it to check the presence, location and size of uterine fibroids. The ultrasound may be done using the transabdominal method (where the ultrasound device is moved over your abdomen to get the images) or the transvaginal method (where the device is placed inside your vagina to get the images)

If the ultrasound does not provide proper information, they may perform other imaging tests like:

  • Magnetic Resonance Imaging (MRI): This imaging test can more effectively show the location of the fibroids and its size. It can also be used to identify different types of tumours. An MRI is mostly used in women who are approaching menopause or show signs of a large uterus.
  • Hysterosalpingography: A hysterosalpingography is a method that uses dye to highlight the fallopian tubes and uterine cavity in an X-ray image. This method is usually used when the patient is having infertility issues. It is used to check if the fallopian tubes are open or blocked as a part of an infertility test and can also show submucosal fibroids.
  • Hysterosonography: Hysterosonography or saline infusion sonogram uses a sterile solution to expand the uterine cavity which makes it easier to get the images of submucosal fibroids as well as the lining of the uterus in women who are experiencing heavy bleeding.
  • Hysteroscopy: In this method, a telescope-like device (fitted with a camera and light) is inserted through your vagina to your uterus. The uterine cavity is expanded by injecting a saline solution making it easier for the doctor to examine the uterus through a video monitor.

Other tests:

The doctor may also perform other tests like a lab test in order to rule any other cause of your symptoms. For example, if you have abnormal menstrual bleeding your doctor might perform a complete blood count (CBC) to check if you are suffering from anemia or other blood tests to rule out thyroid problems and bleeding disorders.

Read more:Guide To Get Pregnant

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4.Uterine Fibroids Treatment

There are multiple ways uterine fibroids can be treated. However, there is no single best treatment for this condition. Mentioned below are some of the treatments for uterine fibroids that doctors may recommend depending on your condition.

Watchful Waiting for uterine fibroids treatment

Watchful waiting in a medical concept in which time is allowed to pass before any medical intervention or treatment. Since uterine fibroids are not cancerous and they rarely interfere with pregnancy, watchful waiting can be a good option. The fibroids usually shrink on their own after menopause when the levels of reproductive hormones decline.

Medications for treating uterine fibroids

Medications used for the treatment for uterine fibroids don’t eliminate them but they may shrink them. These medications target the hormones that regulate menstrual cycle treating symptoms such as pelvic pressure and heavy menstrual bleeding.

  • Tranexamic acid: It is a non-hormonal medication taken only on the days of heavy menstrual bleeding to ease the heavy flow.
  • Gonadotropin releasing hormone (GnRH) agonists: GnRH agonists is a medication used to block the production of estrogen and progesterone. It works by putting you in a temporary state of menopause. You stop menstruating while on this medication and the fibroid shrinks.
  • Progestin-releasing intrauterine device (IUD): A progestin-releasing IUD is not a medication that shrinks fibroids however it helps relieve heavy bleeding caused by the fibroids. It also prevents conception.
  • Other medications: Your doctor might also prescribe you some medications like oral contraceptives to control menstrual bleeding as a treatment for uterine fibroids. They may also suggest Nonsteroidal anti-inflammatory drugs (NSAIDs) for relieving pain due to fibroids. They may also suggest some vitamin or iron tablets to treat anemia and heavy bleeding. Although, all these medications won’t shrink the fibroids.

Noninvasive treatment for uterine fibroids

MRI-guided focused ultrasound surgery (FUS) is a non-invasive procedure used to treat uterine fibroids. This treatment is performed with you inside an MRI scanner. The scanner is equipped with a high-energy ultrasound transducer. The MRI scans give the doctor precise location of the fibroids as well as the location of the nearby organs like bowel and bladder that are to be avoided during the procedure.

While the locations of the fibroids and nearby organs are monitored, the ultrasound transducer shoots a beam of focused sound waves into the fibroids. The sound waves heat and destroy small areas of fibroid tissue until most or all of it is destroyed. [6]

Minimally invasive procedures for uterine fibroids treatment

There are many surgeries that can destroy the fibroids without removing them from the body. These procedures require small incisions (cuts) and are hence called minimally invasive. They are as follows:

  • Uterine Artery Embolization: This is an effective technique to shrink the fibroids and relieve the symptoms caused by it. In this technique, small particles are injected into the arteries providing blood supply to the uterus. These particles block the blood supply and the uterus shrinks and eventually dies. This technique may lead to complications if the blood supply to the ovaries or other organs is compromised.
  • Radiofrequency Ablation: This technique uses radiofrequency energy to destroy the fibroids and shrink the blood vessels that feed them. There are two approaches to this technique - laparoscopic and transcervical. During a laparoscopic radiofrequency ablation, the doctor makes two small incisions in the abdomen. The incisions are used to insert a device fixed with a camera called a laparoscope and a laparoscopic ultrasound tool. The doctor uses both the devices to locate the fibroids. Once the fibroids are located, the doctor uses a special tool to place several small needles into the fibroids. The needles heat up the fibroids destroying them almost immediately. The transcervical approach is also similar but it is performed through the cervix and also requires an ultrasound to locate the fibroids.
  • Myomectomy: Myomectomy is a surgical procedure for the removal of fibroids. Myomectomy can be performed using a laparoscope, hysteroscope or robotic instruments. If the fibroids are fewer in number a doctor might go for laparoscopic or robotic myomectomy. Both of the approaches require slim devices that can be inserted into the abdomen by making small incisions.

In a laparoscopic myomectomy, a slender device called a laparoscope is inserted through the abdomen by making a small incision. The laparoscope has a camera and light which sends video signals to a video monitor in the operating room. The surgeon locates the fibroids and removes them using other instruments inserted into the abdomen by making more incisions. In a robotic myomectomy, a doctor uses advanced surgical instruments to perform this surgery. These instruments give a 3D view of the uterus helping the doctor be more precise with locating and removing the fibroids.

Larger fibroids are removed from the smaller incisions by breaking them into small pieces.

The doctor might go for a hysteroscopic myomectomy if the fibroids are located inside the uterus. In this approach, the doctor inserts a device called a hysteroscope through the vagina. The doctor locates the fibroids using the camera in the hysteroscope and removes them.

  • Endometrial Ablation: Endometrial ablation is a surgical procedure used to destroy the lining of the uterus [7]. This treatment uses special instruments that are inserted into the uterus through the vagina (no incision required) and the fibroids are destroyed using heat/ microwave energy/ electric current or hot water. This treatment is used to stop or reduce abnormal bleeding. The doctor can remove any fibroids inside the uterus during this treatment, however, the fibroids outside the uterus cannot be removed.

Surgical procedures for uterine fibroids treatment

These are the traditional surgical treatment for uterine fibroids that are used to remove uterine fibroids. These are major surgeries that require larger incisions as compared to a minimally invasive procedure. Also, the recovery period from these surgeries is longer than the other treatments mentioned above. The surgical procedures are:

  • Abdominal Myomectomy: Abdominal myomectomy is also known as open myomectomy. This surgery is performed when you have multiple, large or very deep fibroids. In this procedure, an incision is made in the lower abdomen (also called the bikini cut) and the fibroids are removed from the wall of the uterus. The uterine muscle is then stitched back together [8].
  • Hysterectomy: Hysterectomy is a surgical procedure for removing the uterus. There are many reasons for performing this procedure, permanent removal of fibroids is one of them. In this procedure, the uterus itself is removed from the body leaving no chance for the fibroids to regrow. You cannot become pregnant after a hysterectomy.

Natural remedies to prevent uterine fibroids

There are some natural treatments that may help with reducing the symptoms of uterine fibroids. They are:

  • Weight loss: Researches show that obesity may be linked to a higher risk of having uterine fibroids. It is because fat cells produce more levels of estrogen. Hence losing weight may shrink the fibroids or help prevent them.
  • Food Intake: Your daily diet may also have an effect on the uterine fibroids. It has been found that eating some food may increase your chances of having a fibroid. For example, eating red meat and drinking can make you more susceptible to uterine fibroids. Also, eating sugary foods and excess refined carbohydrates can worsen the fibroids.

In order to prevent or shrink a fibroid, one should avoid eating food like corn syrup, potato chips, baked goods like cakes, cookies, doughnuts, white rice, pasta, flour, packed cereals, soda and other sugary drinks.

One should eat healthy food like dried fruit, quinoa, raw or cooked vegetables and fruits, brown rice, fresh and dried herbs, whole grain bread, lentils and beans, etc to prevent or shrink the fibroids.

  • Vitamins and Supplements: There are some vitamins that may help shrink the fibroids. Researches show that you may be at the risk of having a fibroid if you have low levels of vitamin A and vitamin D. Some vitamins like vitamin B-1, vitamin E, vitamin B-6, magnesium, omega-3 fatty acids can also reduce the symptoms of uterine fibroids like menstrual pain, cramping and bloating.
  • Blood Pressure: Researches also suggest that there might be a link between high blood pressure and uterine fibroids. You can limit eating foods with added salt and sodium and exercise to keep your blood pressure in check.
  • Other natural remedies: Drinking green tea may help with reducing the number and size of the fibroids. A bioflavonoid in green tea called EGCG has the ability to reduce inflammation and remove toxins from the body. Chasteberry (Nurgundi in Hindi) can help balance hormonal levels and help reduce heavy menstrual bleeding and painful periods.

Last updated on:: 24 Aug 2020

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Article references/\

  1. Mayoclinic.org. “Uterine fibroids”. Mayoclinic.org, 10 December 2019.

  2. Nhs.uk. “Fibroids”. Nhs.uk, 17 December 2018.

  3. P. Purohit and K. Vigneswaran. “Fibroids and Infertility”. Curr Obstet Gynecol Rep. 2016; 5: 81–88, PMID: 27217980.

  4. Xiaoxiao Catherine Guo, B.S. and James H. Segars. “The Impact and Management of Fibroids for Fertility: an evidence-based approach”. Obstet Gynecol Clin North Am. 2012 Dec; 39(4): 521–533, PMID: 23182558.

  5. Marek Lisiecki, Maciej Paszkowsk, et al. “Fertility impairment associated with uterine fibroids – a review of literature”. Prz Menopauzalny. 2017 Dec; 16(4): 137–140, PMID: 29483857.

  6. Ferenc A. Jolesz. “MRI-Guided Focused Ultrasound Surgery”. Annu Rev Med. 2009; 60: 417–430, PMID: 19630579.

  7. Reproductivefacts.org. “Endometrial Ablation”. Reproductivefacts.org, 01 July 2020.

  8. Ucsfhealth.org. “Myomectomy”. Ucsfhealth.org, 31 October 2019.

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