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Fibroids (myomas or leiomyomas) are non-cancerous tumors of muscle tissue in the uterus. They may occur when a single muscle cell in the wall of the uterus multiplies and grows to form a noncancerous tumor.
They may change the shape or size of the uterus and sometimes the cervix as well (lower part of the uterus). Women often develop more than one fibroid tumor but single fibroids are possible too. The location, size, and number of fibroids determine whether fibroids cause symptoms or require treatment.
They are normally found in or around the body of the uterus. Sometimes they can be found in the cervix.
There are 3 main types of fibroids based on where they are found:
Fibroids can also be connected to the uterus by a stalk or attached to nearby ligaments or organs (bladder and bowel). They are rarely found outside the pelvic cavity.
Statistics show that approximately 5% to 10% of infertile women have fibroids. The size and location determines whether fibroids affect fertility. Some examples include fibroids that are inside the uterine cavity (submucosal) or very large fibroids (>6 cm in diameter) within the wall of the uterus (intramural).
Most women with fibroids will not be infertile. Women who have fibroids and their partners should be evaluated by a fertility specialist to find other problems with fertility before fibroids are treated. A fertility specialist can also help assess if fibroids are affecting conception.
There are a few ways of how uterine fibroids can reduce fertility:
Gonadotrophin-releasing hormone analogues (GnRHas) can reduce the levels of oestrogen in your body. They work to shrink or temporarily halt fibroid growth. GnRHas can be taken as:
One course of treatment usually lasts for about 3 to 6 months. This is due to the fact that the drugs can often cause menopause-like symptoms such as:
As soon as the treatment stops, you may start trying for a baby.
Once hormone therapy stops, fibroids often continue growing. However, they can be useful for shrinking fibroids before surgery. Hormone replacement therapy (HRT) may be administered alongside to ease the side-effects.
Myomectomy is a surgical operation to remove the fibroid. Keyhole surgery using a laparascope or hysteroscope can be carried out for small fibroids. The type of keyhole surgery used will depend on whether the fibroid is on the outer or inner lining of the uterus.
For larger fibroids, open surgery is used and it involves a longer recovery time than keyhole surgery.
Women who still plan to have children will be offered to use this treatment method because it leaves the uterus intact. With that said, about 1 in 4 women find that their fibroids grow back again after about 3 years.
This procedure is not suitable for all women as it depends on the size, number and location of the fibroids.
Endometrial resection or endometrial ablation is a non-surgical procedure. This is suitable for the treatment of submucosal fibroids (which have grown in the inner layer of the uterus). The endometrial tissue will be removed from the inner lining of the uterus where the fibroid is growing. Your endometrial tissue will grow back and then you can start trying for a baby once the treatment has been completed.
Uterine artery embolisation (UAE) is a procedure carried out by a radiologist. It is best performed using a magnetic resonance imaging (MRI) scan. This scan can show in detail where the fibroid is and the blood vessels that feed it.
A plastic plug is injected into the vessel to cut off the blood supply to the fibroid which will shrink it (often to more than half its size and it may disappear altogether). One in 10 women need a repeat treatment at one year and this number rises to 1 in 4 within five years.
If you’re planning to have children afterwards, myomectomy may be a better option for you. More research is required to ensure that UAE is suitable for women wishing to protect their fertility.
Myolysis is the procedure carried out with keyhole surgery using a laparoscope or hysteroscope. The method used will depend on whether the fibroid is inside or outside your uterus.
During this procedure, ultrasound or magnetic resonance imaging (MRI) scans are used to locate the fibroid. Needle probes or an electric current are sent into the fibroid and cauterises both the fibroid and the blood vessels around it.