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Fibroids: Facts, Fiction, and Fertility

Having fibroids does not mean you need a hysterectomy. If you want to save your uterus, you usually can.

Fibroid tumors are benign, that is noncancerous, growth in a woman’s uterus. They are very common and can cause many problems. Most of the time they’re small and cause no issues at all, but for others it may lead to increased bleeding, pain, painful intercourse, surgery, and infertility.

Fiction: Fibroid tumors only occur in African-American women. This is untrue, although they are more common in women of African heritage. Approximately 50% of women of African dissent will have a fibroid visualized on the pelvic ultrasound, with Asian Women very close behind. Approximately 30% of all Caucasian women will be found to have a fibroid tumor by the time the turn 30.

Fact: Women of African descent tend to have more and larger fibroids, more frequently require intervention, and a far more likely to have a hysterectomy.  Asian women also tend to have fibroids that require surgical intervention. No one really knows why this is true. The theories of how the fibroid tumors develop are still being developed and understood and go beyond the scope of this discussion. needless to say, there’s clearly a genetic component as race and it’s in the city are contributing factors but there also is a strong influence of family history as well.

Fiction: once you are diagnosed with fibroids you will require a hysterectomy and will never have children. This is completely untrue. As I said above fibroids can cause serious issues but most of the time they are better off left alone. If an intervention is required then the fibroids can be removed at surgery and can be treated other ways that cause them to shrink. Unfortunately, the alternatives to surgical removal typically reserved for women who no longer want to bear children. And so if a fibroid is causing a fertility issue, she will require a surgery. Surgery can be done in the traditional “laparotomy” which is an incision on the belly, or can’t they can often be removed “laparoscopicaly” which involves several small incisions on the abdomen. The laparoscopic technique, if it is appropriate for that particular woman’s situation (the fibroids are small enough), will give a much faster recovery than the larger incision and is almost always preferable.

Fact and fiction: if you’ve had surgery for fibroids then you are cured. This is usually the truth for a woman with one or two large fibroids. In a woman who has three or more, usually there are other ones too small to see or not worth removing at the time me of surgery which will grow overtime.

Fiction: once a woman reaches menopause vibrates will shrink. This is in fact usually the case but not always. When fibroids grow after menopause, the doctor usually gets concerned on this will also often lead to surgery. Why, because a fibroid can develop into cancer known as leiomyosarcoma. Until 2014, it was estimated that one in 10,000 or less fibroids would in fact be cancerous. However a doctor who underwent surgery for fibroid removal was unexpectedly found to have cancer and this spurred a reevaluation of the true incidence of leiomyosarcoma. This issue actually is a very hot topic right now with some, including the FDA who believe that it’s closer to one in 360 cases. I believe this matter has yet to be settled. Nevertheless, if a woman is past menopause and her fibroids are growing that is a very suspicious situation and surgery is advisable.

Fact: fibroids are evaluated based on their size and their location. From the fertility perspective both are extremely important.  If fibroid is located on the inside of the uterine cavity then it is called “submucous”-that is to say under the mucous membrane otherwise known as the endometrium. In this location fibroid can not only cause very heavy menstrual bleeding but also interfere with an embryo’s ability to implant and cause miscarriages. If they are located within the wall of the uterine muscle, “Intramural”, then they only are important if they are very large, greater than four or 5 cm (2 inches) and if they are located near the lining of the uterus, that is to say the endometrium. If fibroid is stuck to the outside of the uterus also known as “subserosal” or dangling off the uterus on a stock, known as “pedunculated” Then from a fertility perspective they are only important if they are large enough to distort the anatomy of the pelvis. This means that they are large enough to push the ovaries and tubes into new positions that would interfere With the tubes ability to pick up the egg from the ovary at the time of ovulation. All fibroids that are “submucous” that is to say are in the cavity of the uterus, will require surgery if the patient is struggling to conceive or has had miscarriages.  The other three varieties require the judgment of the doctor. Any surgery can cause scar tissue that can create new problems and so care and consideration is given to each case. It’s also worth noting is that fibroids can grow significantly and perhaps double their size  During pregnancy  that lead to issues during the pregnancy.  if there is a  prior history of a problem pregnancy then the doctor might be more inclined to operate but always considers the impact of the surgery itself.

If you have been diagnosed with fibroid tumors in your uterus and have not completed your childbearing then I strongly recommend that you seek out the opinion of a fertility or reproductive surgeon before a surgical procedure. A reproductive surgeon will not only exercise judgment to best maximize the patient’s ability to conceive in the future but that Dr. will also likely use techniques that will improve likelihood of pregnancy. These techniques include close attention to the prevention of scar tissue or adhesions and also positioning ovaries and tubes for any possible future fertility intervention that may be required.

Contact us for more information or call the office at 314.614.7770.

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