Fibroids

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IVF Specialist, MD  

Uterine fibroids are very common occurrences in women. They are also known as myoma or leiomyoma. Uterine fibroids are benign tumors affecting the uterine muscle tissue. Uterine fibroids are not cancerous tumors, but they can affect fertility, nonetheless. Uterine fibroids can cause infertility, but not all of the time. The location of the fibroids usually dictates whether or not they will affect fertility.

What are the types of fibroids and their symptoms?

There are three types of uterine fibroids.
  1. Subserosal fibroids grow on the outside of the uterus. They can cause little or no symptoms unless they are severe. They give the uterus a bumpy appearance. Fibroids can grow on stalks and they are referred to as pedunculated subserosal fibroids. They can cause back pain, pelvic pain, frequent urination and cramping. If the fibroids grow large, they can affect the kidneys and other surrounding organs. Subserosal fibroids should not cause any infertility issues. However, if they grow large, they can put pressure on fallopian tubes and ovaries, inhibiting their function.
  2. Intramural fibroids are found in the muscle of the uterus. They are usually round in shape and can vary in size from microscopic to enormous. Intramural fibroids can cause the size of the uterus to enlarge. Intramural fibroids can cause excessive menstrual bleeding, cramping, pelvic and back pain, and prolonged periods. Again, intramural fibroids may not cause any recognizable symptoms and may only be discovered during a vaginal exam or during infertility treatment. Intramural fibroids can cause problems with conception. They can cause problems with implantation or miscarriage.
  3. Submucous fibroids cause the most problems with fertility. They can grow inside of the uterus. They commonly interfere with the uterine lining development and placement. This can cause miscarriage and difficulty with implantation. They can also cause painful periods and excessive bleeding. The submucous fibroid can develop a stalk and the mass can protrude from the stalk into the uterus. The stalk can allow the submucous fibroid to move further into the uterus and sometimes through the cervix and into the vagina. If the fibroid grows large, then the uterus may recognize it as a foreign body and contract to expel it. If this happens it can cause severe pain similar to labor pains.
What are the treatments for fibroids?

Fibroids are sometimes found during routine examinations but they cannot always be detected this way. They are commonly found during ultrasound or during surgery. Not all fibroids need treatment. Only if the fibroid is causing infertility by either blocking the fallopian tubes, distorting the uterine cavity, filling up the uterine cavity (as in submucous fibroids) or causing very heavy or very prolonged periods do the fibroids need treatment.

Myomectomy is a surgical procedure where fibroids are removed one at a time and the uterus is spared. This is the common treatment for women who still want to have children. This can also be done laparoscopically and hysteroscopically if it is a submucous fibroid.

Uterine Artery Embolisation is a technique where under the blood supply to the fibroid is blocked by putting a plug in the artery that is supplying blood to the fibroid. Interventional Radiologists are the specialists who do this procedure. Once the fibroid does not get any blood supply, it gradually undergoes necrosis.
Letters to Dr. Richa Katiyar

Dear Doc,

I have two subserous fibroids (2 and 1 cms in size) and submucous myoma (1 cm)too.I want to conceive. What should i do?
Thanks,
Zareen

Dear Zareen,

The two subserous fibroid are too small to be of any significance.
Small endometrial polyp- may lead to heavy periods and intermenstrual bleeding. It sometimes goes away on its own, but may need to be removed Hysteroscopically. Anyway, it will definitely need to be removed at the time of planning a pregnancy as it is a space occupying lesion in the uterine cavity and will decrease chances of a pregnancy and increase chances of a miscarriage.

Regards,
Dr. Richa Katiyar

Hi Madam,
Mailing you the Ultrasound Report of my Daughter- Dr. Rekha

Dear Sir,

I have seen all the reports that you have emailed to me.It appears that the fibroid is intramural and is mildly indenting the endometrial cavity.Such a fibroid cannot be removed Hysteroscopically but has to be removed laparoscopically.I will call you tomorrow to discuss the same.

Feel free to contact me for further queries.

Best regards,
Dr Richa Katiyar