If you’re a Real Housewives of New York fan, you may have heard a lot about uterine fibroids after Bethenny Frankel revealed that her non-cancerous fibroids were the source of a scary health crisis. Since her diagnosis of uterine fibroids in 2013, Frankel had experienced severe pelvic cramping and uncontrollable bleeding at times, eventually leading her to lose 10% of her body’s blood and ultimately requiring surgery to rectify the situation (Read More Here). Even if you don’t watch the show, you’ve probably heard of fibroids, also known as leiomyomas or simply myomas, and may have some concerns that they may cause significant health problems, including infertility and miscarriages.
What Does Diagnosis of Uterine Myomas Mean?
The truth is that fibroids are incredibly common and often are asymptomatic. Despite a normally benign presentation, it’s still important to know the facts and understand what a diagnosis of uterine myomas really means:
1. By common, we mean MOST women will have uterine fibroids at some point in their lifetime.
Uterine fibroids are detected by ultrasound in 20-50% of all reproductive age women; by menopause: up to 80% of African American and 70% of Caucasian women will have myomas.
2. Don’t let the word “tumor” scare you.
A fibroid is a benign growth of smooth muscle. One cell starts to divide and becomes a tumor. Estrogen is concentrated in the tissue and can help the tumor then grow. Other hormones and additional endocrinology-related factors may also affect its development. Fibroids may grow or shrink during a pregnancy. They are almost always located in the uterus, but on rare occasions they may be found elsewhere, for example in the muscle walls of the intestines.
3. Annual visits to your gynecologist are important.
Fibroids are usually diagnosed during a physical exam and confirmed by a pelvic ultrasound or an MRI.
4. Location in the uterus may vary.
Fibroids can grow inside the endometrial /uterine cavity (submucosal), in the wall of the uterus itself (intramural) or off and outside the uterine muscle (serosal). Sometimes they are even on a stalk coming off the uterus (pedunculated).
5. Symptoms (or not) vary widely from woman to woman.
Often times, fibroids are silent and asymptomatic, but in some circumstances they may present a variety of symptoms, including:
- Increased abdominal girth, which can be accompanied by pressure and pain, due to the size of the myoma.
- Frequent urination, constipation or bowel tenesmus (urge to defecate) due to pressure on the bladder or bowel by a large fibroid (or fibroids).
- Very heavy menses, sometimes with the passage of clots.
- Decreased fertility and increased odds of miscarriage, as fibroids may distort the uterine cavity, inhibit implantation, affect egg pick up into the tube and/or negatively affect uterine contractility.
- For pregnant women, fibroids may affect presentation of the baby (not head first), preterm contractions, preterm labor and obstructed labor, leading to a C-section.
6. For women who want to have children, a myomectomy is a good surgical option that preserves fertility.
In this case, the fibroids are removed through an open incision on the abdomen (laparotomy) or several small incisions on the abdomen (laparoscopy) and the uterus is repaired. Myomas that are inside the endometrial cavity can be removed through the cervix with the use of hysteroscopy.
7. For women done with child bearing, a hysterectomy is often performed.
The most definitive treatment that promises no recurrence of fibroids, a hysterectomy means that the entire uterus is removed and along with it, all myomas.
8. There are alternative, non-surgical treatments as well.
Uterine Artery Embolization is a procedure where gel particles are sent into the uterine vessels that feed the fibroid. The fibroid subsequently shrinks by about a third. Although an effective treatment for some women, this is not recommended for women that are planning for future fertility.
9. The biggest adverse affect on fertility isn’t only the fibroid itself.
Adhesions or scar tissue may develop after surgery for a fibroid, which can lead to issues with getting pregnant.
10. Your doctor can help you make the best possible choice, especially when you are planning to have a child or more children.
Consider getting the opinion and guidance from a REPRODUCTIVE ENDOCRINOLOGIST/FERTILITY EXPERT, now that you know not all fibroids are created equal, and sometimes the treatment can also contribute to fertility issues. In general, your doctor will recommend surgery under the following conditions:
- The larger the myoma (> 5cm) or the more myomas.
- Cumulatively > 5cm, and the closer to the endometrial cavity or distorting the cavity, the more likely it will be recommended to remove the myomas.
- When you are considering IVF – studies suggest that in IVF, implantation rates are lower when fibroids are present. After removal of fibroids, IVF outcomes are the same in women with no myomas and those whose myomas were removed.
- Removal of myomas also seems to lower the miscarriage rates in subsequent pregnancies.
Uterine fibroids are ultimately not necessarily a health crisis, as they are common and most often benign. Even if you do require surgical treatment, outcomes are generally positive, regardless where you are on your reproductive journey.
Together We’ll Find A Way
To learn more about fibroids, please contact the West Coast Women’s Reproductive Center.