What Are Uterine Fibroids? Can Fibroids Prevent Pregnancy? Symptoms and Treatment

Short Answer

fibroids are mostly benign formations that develop from the smooth muscle and connective tissue of the uterus. Not every fibroid prevents pregnancy, and many women with fibroids can become pregnant naturally.

In terms of fertility, it is not only the size of the fibroid; Its relationship with the internal cavity of the uterus, its location, its number and whether it changes the anatomy of the uterus are important. While submucous fibroids that grow towards the uterine cavity are more important for pregnancy, the effect of submucous fibroids that grow outside the uterus on fertility is generally more limited.

Highlights

• fibroids are formations that develop in the uterus and are usually non-cancerous.
• Many fibroids cause no symptoms.
• Heavy or prolonged menstrual bleeding is one of the common symptoms.
• Location is as important as size in the effect of fibroid on fertility.
• Submucous fibroids that disrupt the uterine cavity may be more important in terms of pregnancy.
• Not every fibroid can be operated on.
• The presence of fibroid alone does not mean that it is the cause of infertility.
• The treatment decision for women planning pregnancy should be individualized to preserve fertility.

What is fibroid?

fibroids, medically known as uterine leiomyomas, are benign tumors that develop from the smooth muscle cells and connective tissue of the uterus.

They are quite common in women of reproductive age. A woman may have a single fibroid or more than one fibroid may develop in different regions.

Their size can vary from a few millimeters to sizes that can significantly increase the size of the uterus.

Some fibroids can remain unnoticed for years without causing any complaints. Some of them are:

• heavy menstrual bleeding,
• pain,
• Pressure in the pelvic area,
• frequent urination,
• fullness in the abdomen,
• Problems related to pregnancy in some cases

Can create.

One of the important points is that the majority of fibroids are benign.

What Causes fibroid?

It is not known exactly why fibroids develop in some women.

However, in their formation and growth:

• genetic characteristics,
• hormones such as estrogen and progesterone,
• Various biological factors that affect cellular growth

Can play a role.

The fact that fibroids are seen especially during the reproductive age and tend to shrink after menopause supports their relationship with hormones.

However, there is no single reason valid for everyone such as "fibroid occurs for this reason".

What are the Types of fibroids?

One of the most important features when evaluating the complaints caused by fibroids and their effects on fertility is where they are located in the uterus.

Generally speaking, submucous, intramural and subserous fibroids are mentioned.

What is Submucous fibroid?

Submucous fibroids are fibroids that grow towards the inner cavity of the uterus, that is, the endometrial cavity.

These fibroids:

• heavy menstrual bleeding,
• breakthrough bleeding,
• Deformation of the uterine cavity,
• Embryo adhesion is affected in some patients,
• difficulty achieving pregnancy

It may be related to.

It is one of the fibroid types that is given the most importance in terms of fertility.

Just because a submucous fibroid is small does not necessarily mean it is unimportant. The extent to which it affects the uterine cavity should also be evaluated.

What is Intramural fibroid?

Intramural fibroids develop within the muscular layer of the uterus.

The effects on fertility are not the same in every patient.

Evaluation in particular:

• size of fibroid,
• its proximity to the uterine cavity,
• whether the uterine cavity changes its shape,
• Whether there is more than one fibroid

It is important.

A small intramural fibroid that does not affect the uterine cavity and a large intramural fibroid that significantly deforms the cavity are not evaluated in the same way.

What is Subserous fibroid?

Subserous fibroids grow towards the outer surface of the uterus.

When they are large, they put pressure on the surrounding organs:

• fullness in the abdomen,
• pressure in the pelvic area,
• frequent urination,
• Some complaints related to the intestines

Can create.

However, since they develop away from the internal cavity of the uterus, their effects on fertility are generally considered to be more limited compared to submucous fibroids.

What are the Symptoms of fibroid?

Not every woman with fibroid experiences symptoms.

The emergence of symptoms may be related to the size, number and location of the fibroid.

The most common complaints are:

• Heavy menstrual bleeding
• Prolonged menstrual bleeding
• Pain during menstrual periods
• Pressure in the groin or pelvic area
• Feeling of fullness or enlargement in the abdomen
• Frequent urination
• Waist and back pain
• Discomfort during sexual intercourse
• Weakness and fatigue due to anemia

In some women, fibroids are detected completely by chance during an ultrasound.

Do fibroids Cause A Lot of Bleeding?

Yes. Some fibroids can cause heavy and prolonged menstrual bleeding.

Bleeding complaints may be more pronounced, especially in fibroids affecting the inner cavity of the uterus.

Excessive bleeding that continues for a long time can lead to iron deficiency anemia.

In this case:

• weakness,
• get tired easily,
• shortness of breath,
• palpitations,
• dizziness

Symptoms of anemia such as: may also be observed.

If menstrual bleeding significantly affects the person's daily life, not only the size of the fibroid but also the blood loss and hemoglobin level should be evaluated.

Does fibroid Prevent Getting Pregnant?

Not every fibroid prevents pregnancy.

This distinction is important because some of the women whose fibroids are detected during ultrasound may experience anxiety such as "I have fibroids, I cannot get pregnant."

However, many women with fibroids can become pregnant naturally.

When evaluating the impact of fibroid on pregnancy, especially:

• layout,
• whether it affects the uterine cavity,
• size,
• number,
• Relationship of the tubes to the area where they open into the uterus

It is taken into account.

Therefore, only “do you have fibroids?” not the question, "Where is the fibroid and how does it affect the uterine anatomy?" The question is important.

How Can Fibroids Cause Infertility?

Some fibroids may affect fertility through different mechanisms.

Can Change the Shape of the Uterine Cavity

In order for the embryo to settle in the uterus, the uterine cavity must have a suitable anatomical structure.

Some intramural fibroids affecting the submucosa and cavity may change the shape of this area.

May Affect the Area Where the Tubes Open to the Uterus

If the fibroid is in a suitable area and large enough, it can affect the area where the fallopian tubes open to the uterus.

This may make it difficult for the sperm and egg to meet or for the fertilized egg to reach the uterus.

May Affect the Biological Environment in the Uterus

It is thought that some fibroids may affect mechanisms related to uterine contractions, local blood supply and embryo attachment.

However, these effects are not seen in every fibroid.

Therefore:

There is fibroid = there is infertility

An approach like this is not correct.

Which Fibroids Affect Getting Pregnant More?

The most important group in terms of fertility are fibroids that disrupt the inner cavity of the uterus.

Especially the effects of submucous fibroids on pregnancy and implantation may be more pronounced than other fibroid types.

The decision is more complicated in intramural fibroids. Here, not only the diameter but also the relationship of the fibroid to the cavity is important.

Since subserous fibroids do not usually affect the uterine cavity, their impact on fertility is generally lower.

Does fibroid Cause Miscarriage?

Some fibroids may affect the risk of pregnancy loss.

fibroids, especially those that change the shape of the uterine cavity, may be more important in this respect.

However, it is not correct to think that every woman with fibroid will miscarry.

When assessing the risk of miscarriage:

• woman's age,
• type of fibroid,
• size,
• number,
• Relationship with the gestational sac,
• chromosomal characteristics of the embryo,
• other pregnancy risks

They should be evaluated together.

Does fibroid Affect Embryo Adhesion?

Some fibroids that disrupt the uterine cavity may affect the anatomy of the endometrium where the embryo will settle.

Therefore especially:

• submucous fibroids,
• some intramural fibroids that deform the cavity

It may be important for implantation.

However, fibroid is not the only reason why the embryo does not adhere to in vitro fertilization treatment.

Embryo quality, age, genetic factors and other conditions related to the uterus should also be evaluated.

Can In Vitro Fertilization Be Performed If I Have fibroid?

Yes. In vitro fertilization treatment can be performed in women with fibroid.

Not every fibroid needs to be removed before in vitro fertilization treatment.

Before treatment, the following questions are especially evaluated:

• Does fibroid disrupt the uterine cavity?
• Is it located in the submucosa?
• A large intramural fibroid?
• Have you had a failed embryo transfer before?
• Does it cause any significant complaints such as bleeding or pain?
• Can the surgery itself create an additional risk for pregnancy?

Treatment is more on the agenda, especially in fibroids that disrupt the cavity.

fibroids that grow towards the outer surface of the uterus and do not affect the uterine cavity may not need to be operated on routinely, just because they are present.

Does fibroid Cause Problems During Pregnancy?

A significant portion of women with fibroids can have a healthy pregnancy.

However, some fibroids develop during pregnancy:

• pain,
• change in the baby's position in the womb,
• Increased risks associated with premature birth,
• Some problems related to the placenta,
• affecting the mode of birth

It may be associated with situations such as.

The risk varies depending on the number, size and location of the fibroid.

Especially large fibroids in the lower part of the uterus can affect the birth canal in some patients.

Does fibroid Grow During Pregnancy?

Since fibroids are tissues sensitive to hormones, their size may change during pregnancy.

However, not every fibroid grows during pregnancy.

Some may grow, some remain similar in size, and some fibroids may change in size at different periods of pregnancy.

For this reason, follow-up during pregnancy is individualized in women with fibroids before pregnancy.

How is fibroid Diagnosed?

fibroids are sometimes noticed during a routine gynecological examination.

One of the most commonly used methods in diagnosis is ultrasonography.

With ultrasound:

• location of fibroid,
• size,
• number,
• Relationship with the uterine cavity

Can be evaluated.

Some patients may require more detailed examination.

For this purpose:

• saline infusion sonography,
• hysteroscopy,
• magnetic resonance imaging (MRI)

Methods such as can be used.

Correct determination of whether the fibroid affects the inner cavity of the uterus is important in the treatment decision, especially in women planning pregnancy.

Are fibroid and Polyp the Same Thing?

No.

fibroid and endometrial polyp develop from different tissues.

fibroid originates from the muscle and connective tissue of the uterus.

Endometrial polyp develops from the endometrium layer that lines the uterus.

Both can cause abnormal bleeding and in some cases may be important for pregnancy.

However, diagnosis and treatment methods may differ from each other.

Are fibroid and Adenomyosis the Same Thing?

No.

fibroid is a limited benign formation that develops from the muscle tissue of the uterus.

Adenomyosis is a different disease characterized by the presence of endometrium-like tissue within the muscle layer of the uterus.

In both cases:

• heavy menstruation,
• painful menstruation,
• growth in the uterus

Since similar complaints such as may be observed, differential evaluation with ultrasound or MRI may be required in some patients.

Should Every fibroid Be Treated?

No.

Many fibroids that do not cause any complaints, do not affect the uterine cavity, and do not cause clinical problems can only be monitored.

When making a treatment decision:

• symptoms,
• location of fibroid,
• size,
• number,
• patient's age,
• Whether there is anemia,
• pregnancy plan

They are evaluated together.

For this reason, it is not correct to decide on fibroid treatment based on centimeters alone.

How Many Centimeters of fibroid is Operated?

There is no single numerical answer to this question that is valid for everyone.

For example, a smaller submucous fibroid that significantly affects the uterine cavity may be more important to pregnancy than a larger fibroid on the outer surface of the uterus.

When making a surgical decision, more than centimeters are considered:

• Where is fibroid?
• Does it disrupt the uterine cavity?
• Does it cause bleeding?
• Does it cause pain or pressure?
• Does it change rapidly?
• Is there a pregnancy plan?
• Will infertility treatment be applied?

Therefore, there is no general rule such as "3 cm is operated on, 2 cm is not".

How is fibroid Treated?

There is no single standard method in the treatment of fibroid.

Treatment options in general:

• following,
• drug therapy,
• surgical treatment,
• Interventional methods in selected patients

.

The goal of treatment is not always to completely eliminate the fibroid.

The aim is to control bleeding in some patients, to reduce pressure and pain in some patients, and to preserve the uterine anatomy as much as possible in women who want pregnancy.

Drug Treatment in fibroids

Drug treatments especially related to fibroid:

• heavy menstrual bleeding,
• pain,
• bleeding that contributes to anemia

It can be used to control complaints such as.

Some hormonal treatments can temporarily reduce the size of fibroids during certain periods.

However, most medications do not permanently eliminate fibroid.

Therefore, the purpose and duration of treatment should be determined according to the characteristics of the patient.

What is fibroid Surgery?

Surgical removal of fibroids while preserving the uterus is called myomectomy.

It is one of the important treatment options that can be considered especially in women who want to have children in the future.

Myomectomy:

• hysteroscopic,
• laparoscopic,
• open surgery

It can be accomplished by methods.

Which method will be used is determined by the location, size, number and distribution of fibroids in the uterus.

What is Hysteroscopic fibroid Surgery?

Suitable submucous fibroids extending into the uterine cavity can be removed by hysteroscopic method.

During hysteroscopy, the uterine cavity is reached through the vagina and cervix. No incision is made in the abdomen.

This method specifically:

• distorting the uterine cavity,
• causing intense bleeding,
• may be important for pregnancy

It can be evaluated in suitable submucous fibroids.

What is Laparoscopic fibroid Surgery?

In laparoscopic myomectomy, the uterus is accessed through small incisions made in the abdomen with a camera and surgical instruments, and appropriate fibroids are removed.

In suitable patients, it may have advantages such as smaller surgical incisions and faster recovery.

However, not every fibroid is suitable for laparoscopic surgery.

Other surgical methods may be required for fibroids that are very large, numerous, or technically located in different locations.

Can You Get Pregnant After fibroid Surgery?

Yes. Pregnancy may be possible after myomectomy.

One of the main features of myomectomy is the preservation of the uterus.

However, the surgery:

• Depth in the uterine wall,
• The number and size of fibroids removed,
• whether the uterine cavity is opened or not,
• Post-operative recovery,
• whether adhesion develops

It may affect future pregnancy planning.

For this reason, when pregnancy can be attempted after the surgery and how to plan the delivery method in the future should be evaluated by the physician according to the characteristics of the surgery.

When Can You Get Pregnant After fibroid Surgery?

This period is not the same for every patient.

The extent of surgery performed on the uterus and how deep the uterine muscle is cut may affect recovery time.

For this reason, it is not correct to apply a single "wait 3 months" or "wait 6 months" recommendation given on the internet to all patients.

The appropriate time for pregnancy should be determined individually by evaluating the surgery report and the healing status of the uterus.

What is Uterine Artery Embolization?

Uterine artery embolization aims to reduce the blood flow of the vessels feeding fibroids. As a result, shrinkage of fibroids can be achieved.

It may be considered as an alternative to surgery in some patients.

However, fertility and pregnancy outcomes should also be taken into consideration when choosing treatment for women who want to have children in the future.

For this reason, in a patient planning to become pregnant, the choice between myomectomy, embolization or other methods should not be made solely based on the size of the fibroid.

Do fibroids Recur?

Yes, new fibroids may develop.

In myomectomy surgery, existing fibroids are removed, but this procedure does not completely prevent the uterus from forming new fibroids in the future.

Especially:

• at a young age,
• having many fibroids,
• those who are prone to fibroid development

New fibroids may appear in women in later years.

For this reason, follow-up continues after surgery in necessary patients.

Does fibroid Turn into Cancer?

The majority of fibroids are benign.

It is not an expected natural process for a typical fibroid to turn into cancer over time.

However, not every mass detected in the uterus should automatically be considered a fibroid. Additional evaluation may be required, especially in masses with unusual imaging features or clinically suspicious masses.

Therefore, the idea that "fibroid is cancer" and the idea that "every mass in the uterus is absolutely harmless" are not true.

Do fibroids Shrink After Menopause?

Since fibroids are sensitive to hormones, most fibroids may tend to shrink after menopause.

For this reason, follow-up may be an appropriate option for some women who are approaching menopause and have mild complaints.

But new onset after menopause:

• bleeding,
• pain,
• feeling of growth in the uterus or abdomen

Symptoms such as should be evaluated separately.

When Should You Consult a Doctor If You Have fibroid?

In the following cases, it would be appropriate to consult a gynecologist and obstetrician:

• Very heavy menstrual bleeding
• Long lasting periods
• Anemia
• Persistent or recurring pelvic pain
• Noticeable growth or pressure in the abdomen
• Frequent urination
• Difficulty achieving pregnancy
• Recurrent pregnancy loss
• fibroid known before pregnancy planning
• Significant change in fibroid size or symptoms

If there is sudden onset of very severe pain or uncontrollable heavy bleeding, more rapid medical evaluation may be required.

Common Mistakes

“If you have fibroids, you cannot get pregnant.”

Wrong. Many women with fibroids can achieve pregnancy naturally.

“Every fibroid must be operated on.”

Wrong. Many fibroids that do not cause complaints and are not clinically important can be monitored.

“It only matters how many centimeters the fibroid is.”

Wrong. Especially its relationship and placement with the uterine cavity is extremely important.

“fibroid is cancer.”

Wrong. The majority of fibroids are benign.

“In vitro fertilization cannot be done if there is a fibroid.”

Wrong. In vitro fertilization can be performed in women with fibroid. Whether intervention is required before treatment is determined according to the characteristics of the fibroid.

“A woman who has fibroid surgery cannot get pregnant again.”

Wrong. Myomectomy is a surgery that aims to remove fibroids while preserving the uterus, after which pregnancy may be possible.

Assoc. Prof. Dr. Nurettin Türktekin's Evaluation

In fibroid evaluation, only "how many centimeters is the fibroid?" It is not enough to focus on the question. Especially in women who want to have children, the relationship of the fibroid to the uterine cavity, its location, its number and the patient's pregnancy plan should be evaluated together.

The effect on fertility of a fibroid growing into the uterine cavity and a fibroid located on the outer surface of the uterus is not the same.

For this reason, it is not right to accept every fibroid as the cause of infertility or to see every fibroid as unimportant in terms of pregnancy.

Similarly, not every fibroid requires surgery. It should not be forgotten that unnecessary surgical procedures may also have effects on the uterus.

The aim of the treatment is not only to eliminate the fibroid seen on imaging; Our aim is to create a personalized approach that protects the uterus and fertility as much as possible while reducing the patient's complaints.

Conclusion

fibroids are common formations that develop in the uterus and the majority of them are benign. Many fibroids do not cause any symptoms and do not require treatment.

When determining the impact of fibroids on pregnancy and fertility, looking only at their size is not enough.

Especially:

• The location of the fibroid in the uterus,
• whether it changes the uterine cavity,
• size and number,
• Complaints it creates,
• patient's age,
• pregnancy plan

They should be evaluated together.

While submucous fibroids that grow towards the uterine cavity may be more important in terms of fertility, the effect of submucous fibroids that grow towards the outer surface of the uterus is generally more limited.

For this reason, detection of fibroid does not automatically mean that surgery is required or the chance of pregnancy is eliminated.

Especially for women who want to have children, the main goal is to create a personalized plan that preserves the uterus and future fertility as much as possible while treating the fibroid when necessary.