It’s already annoying that we as women have to deal with our monthly periods. But did you know that 20 – 80% of women will also develop uterine fibroids at some point?
This statistic of 20 – 80% seems like a large jump, but these figures reflect just how common fibroids are, yet how often they go undiagnosed. So a true percentage is hard to determine.
What is a fibroid?
A fibroid is a muscular, benign tumor that grows in the walls of the uterus. It starts out as a single cell in the uterine wall that multiplies, growing into a mass of muscle tissue.
Fibroids vary in size and quantity and can sometimes change the shape or size of the uterus or cervix.
This definition may sound scary, but the good news is that fibroids are usually non cancerous. Many women living with fibroids are asymptomatic and never experience any discomfort. So many of us may be living with fibroids, but aren’t even aware.
If this is the first time you’re learning about fibroids, then you likely have a lot more questions. So we’ll discuss fibroids in relation to conception and pregnancy, where they come from, how they impact fertility, other health concerns, and treatment options.
But can you get pregnant with a fibroid?
More good news – yes, you can get pregnant with a fibroid!
Fibroids typically don’t affect a woman’s chance of getting pregnant and many women can also have a successful pregnancy while living with fibroids. Studies show that only 10 – 30% of women with existing fibroids will experience pregnancy complications.
In fact, fibroids aren’t often detected until a pregnant woman goes in for her first several ultrasounds to monitor the fetus, proving pregnancy is definitely possible when living with fibroids.
However, about 12-25% of women undergoing treatment for infertility may struggle with a fibroid. We will further discuss how and when fibroids can impact fertility and pregnancy.
What causes fibroids?
Doctors are not sure why fibroids develop. Often, fibroids shrink or disappear as mysteriously as they appeared!
Studies show that fibroids are much less common in women after menopause, so this data suggests that the constant hormonal changes during a woman’s monthly cycle are a possible reason why fibroids appear, relying largely on the presence of estrogen and progesterone.
Many studies also show ethnicity or family history might be factors, making some women more susceptible to developing fibroids.
If fibroids also run in your family, then it’s likely you will develop them, too.
Can fibroids ever cause infertility?
The chances of getting pregnant with fibroids is no less than a woman without fibroids. Fibroids do not affect ovulation, but sometimes the size or location of a fibroid might cause infertility.
But first, it’s worth noting that there are actually three main types of fibroids…
- Intramural fibroids grow within the muscular wall of the uterus, and are the most common type. They are typically harmless.
- Submucosal fibroids bulge into the uterine cavity and develop in the middle muscle layer of the uterus (underneath the uterine lining). These are the most rare, yet are the ones that cause infertility.
- Subserosal fibroids form on the outside of the uterus. These don’t really cause any reproductive issues, but if they get big enough, they can cause other health issues if they push on organs. For example if a subserosal fibroid pushes on the bladder, it can cause frequent urination.
The impact of large fibroids
- Block fallopian tubes
One of the most common problems that large fibroids can cause is blocking the entrances to the fallopian tubes. This causes sperm to stop in their tracks before they are able to reach the egg, which of course is their final destination.
If sperm can’t get to the egg, then conception can’t happen. Or, if the sperm can reach the egg, the presence of a large fibroid might make it impossible for the fertilized embryo to return to the uterus for implantation.
- Block sperm movement
Large fibroids can also create a greater distance for sperm to swim. Instead of having a direct path to the egg, they have to swim around fibroids as if they were participating in an obstacle course! When it becomes harder for the sperm to reach the egg, the harder it becomes to get pregnant.
- Block embryo implantation
Finally, the presence of large, submucosal fibroids can also prevent an embryo from implanting. They can decrease blood flow to the uterus, preventing an embryo from sticking to the uterine wall. So even if a sperm and egg are able to successfully meet, implantation might be prevented.
Despite how common they are, fibroids are only 2 – 3% of the time the root cause for infertility. A doctor can detect or rule out the presence of fibroids through an ultrasound and/or pelvic exam.
If you are living with fibroids and are having trouble conceiving, chances are there are other issues contributing to infertility.
Many women of childbearing age worry about the effects of fibroids on their fertility, and chances are, you may not have ever heard of a fibroid before you thought about starting a family. Hence, it’s also important to discuss how fibroids can affect your overall health, too.
Can a fibroid cause health problems?
Most women with fibroids won’t experience any disruption to their health, which is another reason why so many of us don’t know what they are, or even if we are living with them.
However, if you experience any of the following symptoms on a regular basis, then you might have fibroids that need medical attention.
- Very heavy menstrual cycles
- Discomfort or feeling full in the lower abdomen
- Intense menstrual pain (to the point it interferes with your daily activities)
- Frequent urination
- Pelvic pain
- Painful intercourse
- Visible signs of bulging in the lower abdomen
While none of the above are immediately dangerous to your overall health, we often dismiss these symptoms and consider things like intense menstrual pain as ‘normal’. In fact, none of these symptoms are normal, nor should be things that women must tolerate. Addressing any of the above with a doctor can help diagnose or rule out fibroids or other female reproductive issues, like endometriosis or polycystic ovary syndrome (PCOS).
Fibroids can be effectively treated and there are a variety of ways doctors can help.
Can fibroids be removed to improve fertility or relieve pain?
If fibroids are affecting the quality of your daily life or your ability to conceive, then there are several treatment options to consider. Let’s look at some of them below.
A myomectomy is an invasive surgery to remove fibroids from the uterus. This is a proven method for improving both health complications and fertility related to fibroids. Yet, there is the risk that if any fibroid cells are left behind, they will likely grow back. Uterine wall scarring is another risk, which might make it hard for future embryos to implant.
- Birth Control
You may be scratching your head at this one, since birth control prevents pregnancy. However in certain cases, some women may be prescribed birth control pills as a non-invasive approach to reduce the size of large fibroids. By stabilizing hormone levels, birth control pills can help manage fibroid growth. Once a doctor determines that the fibroids have shrunk to a desired size, the patient can discontinue the use of birth control and resume their attempts to conceive.
It’s important to note that birth control may not be the best option for all women, especially for those over 35 or at risk of blood clots.
- Uterine fibroid embolization
This method is minimally invasive and it almost guarantees that the fibroid(s) will not grow back.
During this procedure, the goal is to shrink the fibroid(s) by blocking off their blood supply. A thin tube called a catheter is inserted into a blood vessel in the leg or wrist. X-ray images are then used to target the blood vessels that feed the fibroids. The catheter contains tiny particles called embolic agents, and these particles stop the blood supply to the fibroid(s).
While many patients go on to have healthy pregnancies after a UFE, there are still some unanswered questions as to whether or not this procedure can negatively impact fertility or childbirth. It is possible that UFEs can weaken the uterine wall, so some doctors might recommend a myomectomy instead.
How do fibroids affect pregnancy?
We’ve talked a lot about fibroids and fertility. But what if you’re living with fibroids and become pregnant?
You will be happy to learn that the presence of fibroids doesn’t often negatively impact a pregnancy.
As previously mentioned, studies show that only 10 – 30% of women with existing fibroids will experience pregnancy complications.
The most common problem with fibroids during pregnancy is pain or discomfort as the growing fetus pushes on the fibroids, or because they outgrow their blood supply.
While the above nuisances are usually harmless, there are circumstances when fibroids may be a greater risk to the pregnancy.
- Fetal growth restriction
For example, if a large fibroid is taking up too much room inside the uterus, it can cause fetal growth restriction, which prevents the fetus from growing properly. Frequent monitoring during pregnancy is necessary to ensure the fetus is growing enough and at a healthy rate.
- Placental abruption
There is also the risk of placental abruption, which is when the placenta detaches from the uterine wall. If this happens, the fetus may not get the nutrients it needs. This complication is completely dependent on the location of the fibroid inside the uterus. But rest assured, this is not common.
- Breech position/Cesarean delivery
Sometimes, fibroids can cause the uterus to become abnormally shaped. If this happens, there is a greater chance of a baby being in breech position and needing to be delivered during a cesarean section. C-sections are extremely common and 1 in 3 women give birth this way, but a woman with fibroids is even more likely to give birth by c-section.
Research notes the chances for miscarriage is the same with or without fibroids.
However, the rise in estrogen is suspected in causing some fibroids to grow during pregnancy, and this can create some of the complications mentioned above, resulting in a worst case scenario of a miscarriage.
On the flipside, in some cases fibroids actually shrink during pregnancy. In a 2010 study, researchers found that 79 percent of fibroids that were present before a pregnancy decreased in size after delivery due to blood flow being redirected to the fetus instead of the fibroids.
The above seems overwhelming and the truth of the matter is, there are proven risks to pregnancy when there are fibroids present. However, more often than not, the presence of fibroids during pregnancy is nothing more than a nuisance and having fibroids does not guarantee a high risk pregnancy.
I know I have fibroids. What’s next if I want to start a family?
By now, it’s pretty clear that fibroids don’t typically impact your chances of getting pregnant. So there aren’t any special tips on getting pregnant with fibroids.
If you are diagnosed with fibroids and your doctor isn’t concerned, then the one tip to getting pregnant with fibroids is to not worry about them.
However, whether you have fibroids or not, all women should consider the following tips when trying to get pregnant;
- Track your cycle and ovulation window. Use a fertility monitor like Inito to track your fertility hormones in urine. This monitor measures estrogen, luteinizing hormone (LH), and follicle stimulating hormone (FSH) to track your fertile window and progesterone metabolite PdG to confirm that you actually ovulated.
- Keep your doctor informed. Are you suddenly having heavier periods? Are your cramps more painful than normal? These are some examples of changes that might indicate the presence of large fibroids or other problems. Consult your doctor right away.
- Listen to your gut. If something feels off, trust yourself and speak to your doctor.If you have fibroids but haven’t gotten pregnant after 12 months of trying to conceive, it may be time to speak to a fertility specialist. If your fibroids have grown, the above treatment options will be discussed. It’s also an opportunity to rule out any other causes for infertility.
Despite our advances in science and medicine, the reproductive system remains somewhat a mystery. So while we don’t know everything about fibroids yet, we do know that you can get pregnant with a fibroid!
Genetics and hormones are likely the biggest cause, but adopting a healthier lifestyle may also help with preventing fibroids. Prevention includes maintaining a healthy weight, eating lots of fruits and vegetables, and minimizing red meat and alcohol consumption.
- Unless the size or location of the fibroids is a problem, most women should be able to get pregnant with the presence of fibroids.
- On that note, it is uncommon for fibroids to be the root cause of infertility.
- It is important to connect with your doctor if you suspect you have fibroids.
- It is rare to have a cancerous fibroid.
- Treatment has come a long way and fibroids are not dangerous to your long-term health.
- Instances when fetuses are harmed due to fibroids are rare.
- Treatment of fibroids are treated on a case-by-case basis. Depending on the size, location, and symptoms of your fibroids, your doctor will come up with a treatment plan that suits your situation best, whether you are pregnant or not.
- Some women are more prone to fibroids than others, based on genetics and ethnicity.
- Eating a healthy diet can boost your fertility and lower the risk of complications from fibroids!