What are the signs and symptoms and fibroids and how can they affect fertility?
Fibroids are tumours in the muscle wall of the womb. They affect about 30% of women of child-bearing age and they can run in families. We don’t know exactly what causes fibroids but they can occur throughout the womb and in some cases they grow quite large. The growth of fibroids is driven by oestrogen in the body. Fibroids are not cancerous and it is extremely rare for a fibroid to ever change into a cancer.
Most fibroids do not cause any symptoms and many women will not even know that they have fibroids. Depending on the number, size and position of fibroids they can affect women in different ways. Women may notice heavy prolonged periods with occasional irregular bleeding and painful bleeding. Larger fibroids can make the lower abdomen appear bloated and if these fibroids press on the bladder or bowel may cause urinary frequency or constipation.
How are fibroids diagnosed
Fibroids are often found during a routine gynaecological or fertility assessment. Most clinicians assessing a patient will perform an ultrasound scan of the pelvis. This scan usually starts externally on the lower abdomen with a full bladder and then continues internally with a probe in the vagina once the bladder has been emptied. The ultrasound probe can detect fibroids and this is the best way to assess the size and location of the fibroids.
Fibroids that are located in the wall of the womb or close to the womb lining may affect fertility. The impact of fibroids depends on the location and size and it may be necessary to use a thin telescope (Hysteroscopy) to look inside the womb and assess this in detail in some patients. A hysteroscopy can be performed with the patient awake in most cases using local anaesthetic.
Multiple fibroids can make it difficult to reach an accurate diagnosis. If there is any uncertainty over the origin or nature of a mass in the pelvis, then an MRI scan will obtain more detail. In fertility patients fibroids will often be seen also during a Laparoscopy. A laparoscopy is a procedure performed under general anaesthetic, where a thin telescope is inserted into the abdomen to visualise the uterus, ovaries and fallopian tubes.
How are fibroids treated
There are a number of different treatment options available to patients but the choice of treatment will depend on the circumstances of the patient. There are medical treatments, some of which involve taking hormones and some involve non-hormonal treatments. There are also surgical treatments and radiological treatments. All of these treatments will tend to be used to reduce the impact of fibroids on a woman’s life.
The priorities of a fertility patient will be very different to a woman with heavy prolonged bleeding who has completed her family. The fertility patient will be rightly focussed entirely on their fertility. It is important that any fibroid treatments undertaken therefore do no harm to a woman’s overall chances to conceive. It is necessary to use both medical and surgical treatments sometimes to help patients who are struggling to conceive. If you are struggling to conceive and think you may have fibroids then it is best to discuss things with a fertility specialist.