Understanding Fibroids: Causes, Symptoms, and Fertility Impact
Understanding Fibroids: Causes, Symptoms, and Fertility Impact
Uterine fibroids (also called myomas or leiomyomas) are non-cancerous growths that develop in or on the uterus. They are extremely common — affecting up to 80% of women by age 50 — yet many women don't know they have them.
What Causes Fibroids?
The exact cause remains unclear, but several factors contribute:
Hormones: Oestrogen and progesterone stimulate fibroid growth. They tend to shrink after menopause when hormone levels drop.
Genetics: If your mother or sister had fibroids, your risk is higher.
Ethnicity: Women of African descent are 2-3 times more likely to develop fibroids and tend to develop them at a younger age.
Other factors: Obesity, vitamin D deficiency, and a diet high in red meat may increase risk.
Types of Fibroids
- Subserosal: Grow on the outer wall of the uterus
- Intramural: Grow within the muscular wall
- Submucosal: Grow into the uterine cavity — these have the greatest impact on fertility
- Pedunculated: Attached by a stalk
Common Symptoms
Many fibroids are asymptomatic, but when symptoms occur they may include:
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Frequent urination
- Constipation
- Pain during intercourse
- Abdominal bloating
How Fibroids Affect Fertility
Not all fibroids cause fertility problems, but they can impact conception in several ways:
- Distorting the uterine cavity: Submucosal fibroids can prevent embryo implantation
- Blocking fallopian tubes: Large fibroids near the tubes can create physical blockage
- Altering blood flow: Fibroids can reduce blood supply to the uterine lining
- Changing uterine shape: Making it harder for a fertilised egg to implant
- Pregnancy complications: Including miscarriage, preterm birth, and abnormal fetal positioning
Diagnosis
Fibroids are typically diagnosed through:
- Pelvic ultrasound (transvaginal is most accurate)
- MRI for detailed mapping
- Hysteroscopy to view inside the uterus
- Saline infusion sonography
Treatment Options
Medical management: Hormonal treatments to shrink fibroids or control symptoms.
Myomectomy: Surgical removal of fibroids while preserving the uterus — the preferred option for women wanting to conceive.
Hysteroscopic resection: For submucosal fibroids, removed through the cervix with no incisions.
Laparoscopic surgery: Minimally invasive removal for subserosal and some intramural fibroids.
Fibroids and IVF
For women undergoing IVF, your specialist will assess whether fibroids need treatment before proceeding. Submucosal fibroids are typically removed first, as they can reduce IVF success rates by up to 70%.
The Way Forward
If you've been diagnosed with fibroids and are trying to conceive, don't panic. Many women with fibroids conceive naturally or with assistance. The key is getting a thorough assessment to determine if and how your fibroids are affecting your fertility.
